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  • Hospital Impact - Collaborative spirituality's role in healthcare
    life s beauty and the abundant relationships that gave me strength My girlfriend who was at my side became my wife of more 29 years At our wedding my father quipped You already have taken the vow of sickness and health Before modern anti nausea drugs I experienced times when I only had the strength to lie in bed in between bouts of vomiting The realization that I was doing all that I could helped me get over millennia of Jewish guilt More The connection of collaborative spirituality to healthcare The connection to healthcare is that in times of rapid change like we re experiencing now the meaning of events may be unclear in the present Transformation can be a nonlinear unpredictable messy experience requiring faith that we are co creating a better environment for patients and their families to maintain their health and obtain the services they need Perhaps that is the reason my mentor Lee Kaiser said in Collaborative Gnosticism The solution to the healthcare crisis is not economic social or political but spiritual based on abundance collaboration and sharing Collaborative spirituality can inspire others and give them hope During my fellowship at Memorial Sloan Kettering Cancer Center in New York City my mentors inspired me to cure occasionally and provide comfort and hope always In retrospect the SPIKES protocol for conveying upsetting news based on analysis of the setting perception invitation knowledge empathy and strategy represents a mindfulness exercise to remind us that patients and their families need more than a check off the box approach for sharing operative findings and the results of a pathology report Collaborative spirituality reminds us that out of setbacks and confusion epiphanies can arise It reminds me to remain curious and apologize to myself when I hear myself judging others It is the universe s way of keeping me humble a constant reminder from my departed mentor Cornelius Sedgewick a Massachusetts Lahey Clinic surgeon When you think you know everything about an operation or a patient s disease that s the time to retire before you hurt someone We re all here to learn and the lessons come in various forms when we re mindful enough to appreciate them Each of the Blind Men of Indostan came to a different conclusion as he touched a different part of the elephant s body As Mel Zuckerman wrote in The Power of Possibilities Things such as love purpose connection and meaning cannot be measured but they are the very foundations of a resilient and motivated life The more you strengthen your spiritual self the more your journey of wellness can thrive Ken is a general surgeon MBA and CEO of HealthcareCollaboration com who works with organizations to engage disgruntled doctors to improve clinical and financial performance Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes

    Original URL path: http://www.hospitalimpact.org/index.php/2014/05/30/http_links_fmlinks_net_ctt_kn_29ams_otax (2016-02-10)
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  • Hospital Impact - Stuck in a rut? Change your perspective
    oneself in the speaker s frame of reference using summary questions such as Do I understand you to say Empathy is not sympathy It brings people together and helps them make sense of issues beyond their control I wrote in Journey to Excellence that sense making leads people to go beyond narrow silos to focus on processes that they need to perform well to achieve desired outcomes One technique to be flexible is to start from a position of inquiry rather than advocacy to demonstrate curiosity rather than stubborn adherence to one point of view Another way is to depersonalize our differences using the Hegelian dialectic of thesis antithesis synthesis to celebrate the improved solution that results when we allow others to point out and help us correct weaknesses in our approach In this decade of healthcare transformation conflict is inevitable I hope that insights from authors like Dubus help us become more aware of our assumptions and more willing to reflect and reframe I welcome your insights Please share with our readers ways that reframing perspective has allowed you to add value to your workplace Ken is a general surgeon MBA and CEO of HealthcareCollaboration com who works with organizations to engage disgruntled doctors to improve clinical and financial performance Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates unit to improve outcomes through innovation 4 ways hospitals can foster family centered

    Original URL path: http://www.hospitalimpact.org/index.php/2014/05/01/stuck_in_a_rut_change_your_perspective (2016-02-10)
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  • Hospital Impact - Collaborative premedication for healthcare leaders
    acetaminophen More The next day went well More than 25 members of the medical staff showed up listened respectfully to the data I presented and engaged in active discussion in small groups and at large over the following questions What resonated with you What did you find unsettling Upon what past events that involved working together might we build Where do we go from here What are your top three recommendations to improve the practice environment and improve care for our community in the next three to six months We had a shared vision of the hospital s strengths challenges opportunities and threats and a clearer idea of next steps I reassured them that they had a can do spirit and vibrant culture The reason I am an unabashed cheerleader for independent community hospitals who want to shape their future is I believe nobody faces a tougher challenge than a CEO who aspires to lead confidently into uncertainty As the CEO with whom I was working confessed her uncertainty I recalled the words of a community hospital CEO in Connecticut that I worked with 15 years ago If you don t feel the tension in your belly you re not living and leading change Ken is a general surgeon MBA and CEO of HealthcareCollaboration com who works with organizations to engage disgruntled doctors to improve clinical and financial performance Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline

    Original URL path: http://www.hospitalimpact.org/index.php/2014/04/16/collaborative_pre_medication (2016-02-10)
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  • Hospital Impact - The path to physician reinvention
    just need to be trained The path toward physician reinvention includes Tune into trends outside your field Gary Yates M D looked to nuclear power and commercial aviation as models to develop a high reliability safety culture at Sentara Healthcare in southeastern Virginia Find unmet needs and solve the problems Charles Rinker M D a rural surgeon found a way to learn sentinel node biopsy and train other rural surgeons so patients did not need to travel long distances for breast care Find your niche by asking What do I do really well what benefits do I provide that people will pay me to deliver and what gets me so excited that I lose track of time Expect any new idea to be perceived as an antigen which triggers an antibody response As Machiavelli noted more than 500 years ago There is nothing more difficult to take in hand more perilous to conduct or more uncertain in its success than to take the lead in the introduction of a new order of things Another general surgeon commented Think of your current career as a springboard to your next one not as a prison to escape from Any healthcare professional who wants to pursue reinvention can begin the journey Ken is a general surgeon MBA and CEO of HealthcareCollaboration com who works with organizations to engage disgruntled doctors to improve clinical and financial performance Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse

    Original URL path: http://www.hospitalimpact.org/index.php/2014/03/12/path_physician_reinvention (2016-02-10)
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  • Hospital Impact - Physician engagement can cut waste
    CFOs so the front lines can understand the system implications of their daily decision making and CFOs can become more strategic rather than reactive in their thinking In a hospital in Idaho a CFO rounds on the floors She engages clinical colleagues with open ended questions such as What wastes your time and Please tell me about times when you felt patient care was compromised because you did not have adequately functioning equipment and supplies Collaboration as described in the above examples gives me hope What gives you hope that despite the messiness of being in the middle of healthcare transformation we will arrive at a leaner more aligned focused patient centered healthcare delivery system 1 Kelley R Where can 700 billion in waste be cut annually from the US healthcare system Thomson Reuters Waste White Paper 2009 2 Brook R H The role of physicians in controlling medical costs and reducing waste JAMA 2011 3 Cohn K H and Allyn T R Cultural transformation from the ground up Being part of something larger than yourself Ignite Your Business Transform Your World Orlando Celebrity Press 2010 4 Cohn K H Better Communication for Better Care Mastering Physician Administrator Collaboration Chicago Health Administration Press 2005 5 Nance J Bartholomew K M Charting the Course Bozeman Second River Healthcare Press 2012 Ken is a practicing general surgeon MBA and CEO of HealthcareCollaboration com who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White

    Original URL path: http://www.hospitalimpact.org/index.php/2014/02/12/physician_engagement_healthcare_waste (2016-02-10)
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  • Hospital Impact
    switch from volume to value October 21st 2013 by Kenneth H Cohn Autumn in New England seems like a fitting metaphor for healthcare reform in that it requires us to let go of the past and prepare for an uncertain future Recently I spoke to the Physician CEO Healthcare Roundtable on Healthcare What s Next To deal with my uncertainty I used Prof Michael Porter s Framework 1 which states that healthcare organizations must meet seven different conditions to move from a volume based to a more value based healthcare system Read more Leave a comment Flipping the switch to value based healthcare September 3rd 2013 by Kenneth H Cohn We face a serious dilemma recounted a community hospital CEO who participated in my seminar Practical Strategies for Engaging Physicians If we stop doing fee for service now it will cost us millions of dollars On the other hand if we wait the trap door may close behind us We need to be ready to flip the switch All the other CEOs in the room nodded their heads The fundamental challenge in the transformation of U S healthcare from volume to more value based metrics is readiness in an uncertain environment As I ve noted complex adaptive systems involve a collection of people acting interdependently such that one group s response changes the context for everyone else 1 Read more Leave a comment Show your work to learn the real patient story August 6th 2013 by Jeffrey Cohn Many of us probably recall from high school the exhortation from our math science teacher to show your work on test problems I remember being irritated about that thinking if I could come up with the correct answer what was the necessity for showing how I got there Looking back I believe that this was in my best interest In the linear world of high school math and science there truly is a best way to get to the correct answer and showing the work allowed the teacher to determine whether I d learned that pathway accurately Moving into college I m reminded of my first Introduction to Philosophy exam When I told my roommate I only filled up 2 3 of a blue book he said I d get no better than a C And he was right I was again disappointed but my professor considered my thinking process just as important as my conclusion He was trying to help me think in a more expansive way than I was used to The challenge for me was converting my rapid tangential non linear thinking process into writing Showing my work felt redundant if I actually did think broadly the way my professor was training me to think why did I have to convert that to words The solace was that my roommate s words were a valid interpretation of the professor s perspective It takes a lot of writing to document an expansive thinking process on a complex topic Read more

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=cohn&page=1&disp=posts&paged=3 (2016-02-10)
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  • Hospital Impact - What does Hobby Lobby ruling mean for healthcare, separation of church and state?
    Court decision is contrary to a majority opinion according to a Kaiser Foundation Many felt that employers should be required to cover birth control regardless of whether it violates the owners religious beliefs Obviously advocates for religious freedom laud the decision while members of the Obama administration vow to pass legislation to work around the exemption so that employees may receive healthcare coverage for comprehensive preventive health services What fundamental healthcare issues does this important case bring out Most industrialized healthcare systems do not pit employer against employee with respect to personal religious values and beliefs The United States has a unique employer based healthcare system with tax exemptions and defined benefit contribution plans for its employees Thus employer chooses insurance coverage and federal and state governments regulate it This is an unusual approach as it creates the opportunity for employers to make faith value based decisions that may conflict with the faith values of its employees Most healthcare systems emphasize preventive healthcare services and not the care of acute medical and surgical emergencies Most prospective or capitated healthcare systems incentivize healthcare organizations and practitioners to keep people well and not to provide non value added diagnostic or therapeutic services Thus preventive healthcare is considered the foundation for good care and few industrialized nations deny its citizens access to care that has both the potential to reduce the cost of care for payers employers and can add quality of life to those who contribute to the economic well being of their nation The United States mandates the obligatory provision of stabilization for acute emergency medical conditions under EMTALA but does not require the provision of preventive care that could save payers billions per year and add years of quality to life Most industrialized nations provide universal healthcare coverage for basic and preventive healthcare services The United States is one of three industrialized nations that does not offer some form of universal healthcare coverage for fundamental and preventive healthcare services the other two are Mexico and Turkey This is self defeating as it leads to cost shifting to everyone who can afford to pay which artificially drives up the cost of care and reduces access to care for whom it is most needed Most industrialized healthcare systems incentivize practitioners to prevent disease and not merely to diagnose and treat it Most industrialized nations incentivize practitioners based upon a capitated covered lives month form of payment and thus there is significant economic incentive to not perform nonvalue added diagnostic and therapeutic treatments Fee for service incentivizes the search for conditions that are amenable to some form of reimbursed treatment Burwell v Hobby Lobby pits employers with sincere religious beliefs against employees who require preventive birth control healthcare services and this is both unnecessary and inappropriate as an individual s religious values should be both personal and private This case highlights the necessity to provide fundamental preventive and palliative services to all citizens so that neither employers nor employees are placed in a

    Original URL path: http://www.hospitalimpact.org/index.php/2014/07/02/what_does_supreme_court_hobby_lobby_ruli (2016-02-10)
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  • Hospital Impact - Population health is the next big thing
    in which healthcare practitioners are charged with improving the health experience and per capita cost of a defined population Where the incentives are to not hospitalize not operate not send to the emergency department and not order diagnostic or therapeutic modalities that will not likely benefit the patient Unfortunately doing this in a discounted fee for service or bundled payment world does not work as all of the financial incentives are misaligned We must accomplish it in some form of capitation with incentives and this cannot be done within the established business models used to diagnose and treat acute medical and surgical conditions Organizations that are set up to do capitation profitably include disease management networks such as OptumHealth or Healthways Inc or integrated self insured providers such as Kaiser Permanente and Geisinger Health System that have their own captive insurance systems to manage actuarial risk for defined populations Moving to population health will require a significant and transformational change to our healthcare system including Conversion of free standing hospitals and physician offices to integrated healthcare networks connected by a seamless health information exchange and personal electronic healthcare records Separation of diagnostic solution shop therapeutic value added process and chronic disease management facilitated network business models so that they can operate effectively and efficiently Conversion of payment methodology to capitation with incentives and complete integration of healthcare delivery and payment financing mechanisms Regulatory guidelines that permit reimbursement and payment only for services that have a beneficial impact on the health or well being of patients Significant incentives to patients beneficiaries employees to align their financial and healthcare interests by following evidence based guidelines and recommendations Delegating healthcare conditions managed through standardized evidence rule based approaches to nonphysicians with physician oversight Emphasizing self management and behavioral change for patients to both prevent and treat chronic diseases by mitigating causative factors e g smoking overeating under exercising etc Decentralizing healthcare so that the majority of diagnostic and therapeutic monitoring can be done within an individual s home Converting transactional healthcare services e g prescription renewal healthcare screening etc of healthy individuals to 24 7 low cost virtual cloud based services The engagement of key stakeholders e g payers large employers CMS in the creation of quality safety service and cost effectiveness incentives for physicians healthcare executives and other key healthcare providers The challenge for our healthcare system is that most organizations hold on to the traditional fee for service system due to the persistence of dysfunctional incentives This will ultimately be self defeating as the race for international high quality low cost services through both international and domestic medical tourism is on and late entrants will find themselves with little if any remaining market share Population health is the new national healthcare imperative and every organization must create a strategic plan to redesign and innovate its existing resources so that it can dedicate itself to the health and well being of the populations it serves Jonathan H Burroughs MD MBA FACHE FACPE

    Original URL path: http://www.hospitalimpact.org/index.php/2014/06/05/population_health_is_the_next_big_thing (2016-02-10)
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