Expanding Medicaid in Michigan

Henry Ford Hospital’s Chief Nursing Officer, Gwen Gnam, lent her voice and her more than 34-years of nursing experience to an important topic facing our state: The expansion of Medicaid in Michigan.

Gwen took part in the Michigan Health & Hospital Association’s campaign to expand Medicaid, sharing her story as a registered nurse in this video:

The decision of how federal money will be spent impacts our patients and our hospital.

The Expand Medicaid coalition – made up of Michigan hospitals, mental health care providers, physicians, community-based health centers, health plans, human service organizations and others – urges the state Legislature to join with Gov. Rick Snyder to expand Medicaid as states are authorized to do under the federal Affordable Care Act (ACA). Continue reading

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Leading the Way: The Future of Health Care

For the 2012 Henry Ford Hospital Grand Ball, we wanted to make a high-impact video that expresses the passion that we have for our great hospital’s past and its future.

Enter our creative partners from DBA. They donated their time and talent to create a video modeled after the popular TED talk format to serve as that vehicle.

Actors being far too expensive, we found someone else to read the lines. And read the lines…and read the lines. (How do actors do this every day?)

I hope the above video from the 2012 Grand Ball inspires, motivates and excites you about the future of health care at Henry Ford Hospital.

Change is coming, we are ready, we are Henry Ford Hospital.

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Relationships in Medicine

“Anything happen in your day? Anything new happening at work?”

After an extended deliberate process by leadership of Beaumont Health System and our own, Henry Ford Health System, leadership of both organizations announced a plan Wednesday to begin exclusive negotiations to create a new organization merging our operations into a new organization, to serve as a new model of health care delivery.

From left: Beaumont CEO Gene Michalski; HFHS CEO Nancy Schlichting; Beaumont CMO Dr. Ananias Diokno; Me; HFHS Board of Trustees Chair Sandy Pierce; and Beaumont Board of Trustees Chair Steve Howard at Wednesday’s press conference.

The Boards for Henry Ford and Beaumont approved a letter of intent to develop this new organization, and to enter a period of negotiations and due diligence to determine how best to bring the systems together. The goal is to create a definitive agreement for approval in the first half of 2013.

So when we go home and our spouse asks what happened at work today, we can say something more than, “Nothing, really.”

Here are comments I shared at the press conference announcing this event…

Medicine and health care create strong relationships.

Through those relationships, Henry Ford has had a long history of collaborating with Beaumont on patient care, education and research.

Many Beaumont physicians and my colleagues, including me, cared for patients together, patients who received their health care in both systems, systems with histories of clinical strength and deeply shared values.

Combining these two national leaders in clinical excellence and patient safety will transform our focus from not only healing the sick but to keeping people and our communities healthy.

The prospect of what we can do together for patients is exciting, especially opportunities to improve population health through quality, safety, integration and premier clinical programs.

This partnership can provide:

  • A comprehensive service offering to our patients with ample coverage throughout the full spectrum of medical specialties,  as well as
  • Greater access to care with broad selection of clinical sites close to home wherever you live in Southeastern Michigan.

With the installation to the EPIC electronic medical record throughout Henry Ford, both Beaumont and Henry Ford will have a common integrated medical record across all clinical sites.

  • With a common electronic medical record, patients will always be treated by a clinician who knows their history, no matter which site they visit, because their patient records will be at the clinician’s fingertips.
  • This common electronic record enhances patient safety, reduces duplication of test and services, and increase patient satisfaction.

Today’s announcement follows months of study and deliberation by both organizations on how to continue their nationally recognized industry leadership in the face of the changing health care environment. Continue reading

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The Affordable Care Act & Henry Ford

What does the U.S. Supreme Court’s ruling on the Affordable Care Act mean to Henry Ford Hospital and Henry Ford Health System, and our patients?

The law has been in effect for two years and Henry Ford has been meeting the necessary steps to comply with the provisions of the law affecting us and our patients.

Doc in the “DIV.” The end of this post includes links to my local news interviews about ACA.

The ruling on Thusday supported the constitutionality of the ACA.

Some of the most controversial aspects of the law are scheduled to be implemented in 2014. Two of these components, mandated insurance and extension of Medicaid, were major subjects of the Court’s ruling.

Mandated insurance was supported as part of the tax provision, that is, failure to adhere to obtaining or providing insurance will be subject to tax penalties.

Without the insurance mandate, the insurance exchanges or pools would likely have fewer healthier enrollees, meaning insurance rates for policies purchased through the exchange would need to be much higher to support costs.

Expansion of Medicaid was left to states wtihout Federal threat of withholding all Medicaid dollars for not extending.

The ruling has brought some “certainty” to the constituionality of the law. This is a certainty that must be looked at through the lens of continued political polarization, the fall elections, threats of repeal of the law in the 2013 Congress, business and personal reaction, and implementation at the state and delivery system level.

But, importantly, this ruling allows Henry Ford to continue to make positive reforms to the country’s health care system, through our efforts to integrate care, reduce costs, increase access and make advances in medical technology, treatment and hospital care.

The ACA means the possibility of extending Medicaid to the nearly 500,000 uninsured people in Michigan, as well as extending additional benefits to lower income familes through insurance exchanges.

The implementation in 2014 also strikes denial of insurance to those patients with pre-exisiting illness. Families will continue to cover their adult children on family policies up to the age of 26.

By expanded coverage for uninsured and low-income patients, the act may help to provide economic relief to Henry Ford’s growing burden of uncompensated care.  In the past eight years uncompensated care at Henry Ford has doubled, from $111 million in 2003 to $210 million in 2011. Continue reading

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Planning a “Good” Death

Dr. Ken Murray, a retired clinical assistant professor of family medicine at the University of California, wrote a thought-provoking article earlier this year in the Wall Street Journal entitled, “Why Doctors Die Differently.”

The essential point of the paper was captured in the sub-headline, noting that doctors’ experiences throughout their careers teach the limits of treatment and reinforces the importance of the need to plan for the end.

In essence, physicians – and I would add other clinical care providers to that list – know all-too-well that medicine cannot fix all, especially at the end of life.

Murray quotes nursing professor Karen Kehl, who in the article called “Moving Toward Peace:  An Analysis of the Concept of a Good Death,” noted features of a graceful death, such as:

  • Being comfortable
  • Being in control
  • Having a sense of closure
  • Making the most of relationships, and
  • Having family involved in their care.

Unfortunately, in today’s world, many patients experience a death without these attributes. Physicians have seen this so frequently that it influences how they think about the end if their lives too.

Why the disconnect? 

To avoid what may be considered undo influence, physicians try not to impose their own views on the situation.

Providing hard clinical data to enable a patient to make a decision is generally believed to be the extent of the information a physician or care provider should offer.

When asked directly what they would do for themselves, physicians often deflect the question to ensure patients are not overly influenced by their answer:

“It is what you would want to do, not what I would do.” 

This is adherence to the medical ethical principle of autonomy, making sure that patients or their decision-makers make decisions for themselves and without coercion.

But perhaps we have lost something by the answer we provide.  Continue reading

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The Power of Habit

How’s that New Year’s resolution going so far? Still carrying those extra 10, 15 or 20 pounds?

Certainly, if we resolve to do something and put all of our effort behind it, we should be able to do it, right? This type of “free will” is a great part of our traditional view of how we change or conduct our lives and business.

Unfortunately, it is not as simple as that.

I recently read an opinion piece by David Brooks in the New York Times that highlighted a book written by Charles Duhigg called “The Power of Habit.” In the book, Duhigg, who’s also a reporter at the Times, explores research about how our habits determine our actions.

As much as we think free will overcomes all, much of our actions and behaviors are driven by unconscious habits. Duhigg notes that researchers at Duke University calculated that 40% of our actions are governed by habit, not by conscious decisions.

So much for free will!

According to Brooks’ article, researchers have also come to know the structure of habits. Cue, routine, reward is how habits become ingrained.

Duhigg highlights several examples of how people have learned to replace bad habits with good ones, or create new habits.

From the routine use of toothpaste to football coaches creating practice drills to Starbucks baristas, creation of habits will dictate how one responds to a situation even more quickly and routinely.

Changing your neural network not merely based on forming routine or common triggers. These are instead fortified by emotions and strong desires, like the commitment to a higher purpose or gaining admiration.

What does this have to do with Henry Ford Hospital? 

We are going through a world class service training exercise called by the mnemonic, AIDET (Acknowledge, Introduce, Duration, Explanation, Thanks).

The habit that we wish to create is a common greeting and dialogue that forms the basis of our service culture.

I have heard from many that say they already do this in their patient interactions. Me too, except sometimes I do A, I and E, or I, D and T, but not the habit of routinely doing all the elements. I have a hunch you are no different. Continue reading

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It’s the Little Things (and the Routine Things) That Count

Every day I hear a patient care story at Henry Ford Hospital that absolutely inspires me and fills me with pride. 

Henry Ford Hospital teams work to bring water into the hospital during the August 2003 power outage.

These are often heroic efforts of clinical expertise and team work, with many of our people working against all odds to perform care that saves a patient from what appears to be an impossible situation. These “miracles on the Boulevard” seem almost routine.

Times of crisis also seem to bring out the best in Henry Ford. 

I noticed this years ago when we lost electricity on Campus on two occasions. 

You could not have had a group of people working together more incredibly to overcome not only the obstacles of minimum electrical power, but the even greater challenges of inadequate water so needed for thirst and cleanliness.

I sit back in awe of our people at these times.

Where do we falter?

What is remarkable is that when we fail, it is in the little things or the routine things that we need to perform on a daily basis. The concentrated efforts and energy during a crisis do not always translate as well to our daily tasks.

Not that it is easy to have these bursts of focus at all times. 

As a physician once told me, you can sprint for periods, but you can’t run a marathon by sprinting. It takes a different approach and mindset.

Much of health care is a marathon. Repetitive, frequent, routine, if you will. 

No fan fare in our employee newsletter and no flurry of congratulatory emails on a remarkable effort.

Our true business challenge is to relentlessly focus on day-to-day patient care and to do it as well as it can be done.  It is the most important element to ensure our success as a hospital.

Yet these daily acts – the ones that we must do – count just as much as all of our photo-op moments.  Continue reading

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Driving Innovation (and an Electric Car) in Detroit

When I last met up with Frank Venegas, we were at the Detroit Institute of Arts talking about Frida Kahlo and her ties to Frank’s family, as well as Henry Ford Hospital.

Henry Ford Hospital also has something else in common with Frank and his company, Ideal Group:  a focus on innovation in Detroit.

One of Ideal Group’s customers, General Motors, is responsible for creating one of the bigger innovations to recently come out of Detroit – the Chevy Volt, a plug-in, range-extended electric vehicle with an on-board gasoline generator.

Not only did Frank show support for GM’s innovation by buying two Chevy Volts, he’s also been documenting his driving experience on his blog, “Frank’s V in the D.”

Frank’s even been handing the key fob (no keys needed for the Volt) to business colleagues in Detroit, giving them the chance to test-drive this game-changing product.

I recently had the opportunity to get behind the wheel of Frank’s Volt. (And, yes, it does comfortably seat someone taller than 6 ft.)

I thought that one of the best ways to really test the car’s electric charge and gas mileage – and continue the conversation about innovation – was to drive to a few Henry Ford sites in and around Detroit, where innovation is changing how we care for our patients.

Continue reading

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Care Rounds

As you may have read this week in a Detroit News article, my leadership team and I have recently incorporated care rounding with patients at Henry Ford Hospital into our weekly activities.

You might ask, “What’s new about a physician and an administrative team rounding on patients in a hospital?”

My response? “Quite a bit.”

At Henry Ford Hospital, care rounds concentrate specifically on the general care and services a patient receives.

Although not fully divorced from clinical issues, these rounds bring out issues related to environment, food, communication, ease of use, and general comfort. Quite simply, it is the service aspect of our profession and business.

At the hospital, all of us go about our activities with a specific purpose. As a physician caring for patients, my concentration and intention is primarily on the diagnosis and treatment of the patient. Patients’ needs are generally first viewed from the perspective of their clinical care.

Much is discovered when the lens is focused intently.

I was struck by the application of purposeful activities when studying LEAN-inspired management methods, where so called “waste rounds” had managers stepping out of their usual role (which includes waste reduction in processes) to concentrate fully on eliminating unnecessary steps or use of supplies.

On care rounds, after asking if I can come into the room and talk, I introduce myself and acknowledge the patient formally before asking one simple question: “How has your care been at the hospital?”

Continue reading

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Day 3: The Complete Top 10 Health Care Issues in 2011 List

Here are the final three items on my list of the top things I expect to see in health care over the next year. 

I will stop at 10.

Which are on your mind? (Please post your comments, or your top 10 list below.)

 Top 10 List, Day 3:

1. Fight Over Health Care Reform
2. Transparency. Moving Toward Reporting Performance & Outcomes in Health Care
3. Organized Physician Practices (Can You Say Accountable Care Organizations?)
4. Health Care Amenities
5. Recruitment, Retention and Engagement
6. Declining Revenues
7. Reduction in Cost per Unit Service

8. Looking for Solutions Outside of Our Industry
. Health care has been slow to adopt business practice changes that other industries have used to be internationally competitive. 

Industrial re-engineering, relentless process improvement and management transformation will increasingly be used in hospitals beyond the usual inventory and production functions.

Benchmarking of performance will become more focused on best in class, not best in industry. (Think of the service expectations set by an excellent hotel versus a traditional hospital).

Continue reading

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