Saturday, March 31, 2007

The doctor as STAR

Yesterday was “doctor’s day” at CGH, and members of the medical staff stopped in the cafeteria for a free pancake breakfast – and a chance to socialize with their medical colleagues. In today’s fast-paced, high-tech world, a pancake breakfast is a low-tech opportunity for doctors simply to say “hi” and take a moment to catch up with one another.

Physicians have faster access to information, such as the Digital Passport,[1] but they may actually see one another less frequently than in the past. With hospitalist services available to patients, many physicians spend more time in their offices and less time at CGH. With more outpatient care, the hospital is not the sole focus of physicians’ busy lives. So CGH’s “famous pancake breakfasts” are an opportunity for doctors stay in touch on a personal level, not just professionally.

Yesterday, the doctors’ pancake breakfast added a new dimension, thanks to Dr. Andrew Merritt, the Marcellus family physician who is serving as CGH’s interim Chief Medical Officer, or CMO. Dr. Merritt has started a “physician STAR award” to recognize doctors with star qualities – that is Sensitivity, Thoughtfulness, Appreciation, and Respect (STAR).[2]

I was pleased to join Dr. Merritt yesterday in presenting CGH’s first STAR award to Dr. Joseph Barry of Preventive Medicine Associates, PLLC in Camillus, NY. Dr. Barry, who also serves as medical director of CGH’s skilled nursing facility (sixth floor), “on a routine basis sets aside time to play chess with multiple residents on 6 West,” in the words of one nomination form.

Dr. Barry’s “genuine humor and lighthearted challenge to residents has created a splash of excitement,” on the sixth floor, and his “thoughtfulness extends to the rest of the residents who…come to watch the ‘the chess match’…” During the match, Dr. Barry talks with the residents “on a casual, loving level,” and he is “always generous to provide pizza as a prize if he loses…”

Another nominator called Dr. Barry “a man of the people, always approachable,” and “someone who totally immerses himself in an medical problems from the patient’s perspective.”

The STAR award comes with a certificate for the physician, dinner for two at a local restaurant, and a special visit (next week) with treats for the doctor’s office staff – all courtesy of the Auxiliary to Community General Hospital.

Medicine may be more fast-paced than ever. Physicians may communicate less in person and more over the internet. But the STAR award reassures us that physicians, as busy as they may be, continue to make a difference on the human level.

Thank you, Dr. Barry.

[1] The Digital Passport is CGH’s name for several electronic information initiatives that started in 2005 and will continue to roll-out over the next two years. They are SCM Clinical Manager, Computerized Physician Order Entry (CPOE), and the Surgery Information System (SiS).

[2] Anyone can nominate a CGH physician for a STAR award. On any CGH computer, go to CGHNet and move the cursor to “Point Here” to find the drop-down menu. On the menu find “Forms” and click on “Physician STAR Award.” This brings you to the STAR nominating form. After completing the form, return it to Trudy Orr or Joan Russell in the Medical Affairs Office.

Saturday, March 24, 2007

What the CEO said...

I wrote my first family letter on October 20, 2002 (my third week as CEO), and with a few exceptions I’ve been writing my thoughts every Saturday since, e-mailing these letters to departments and posting them on the CGH website. They remain on the website for about six weeks, and anyone can write to me by return mail from the website.

I’ve recently become aware of a hospital CEO who puts these humble letters to shame. He’s Paul Levy, the President & CEO of Beth Israel Deaconess Medical Center in Boston, and he writes a blog.[1]

If nothing else, Mr. Levy’s blog is impressive by its sheer scale. The blog contains about 55,000 words. This letter, for example, is 590 words in length. If I write four such letters a month, it will take me almost 24 months to equal the length of Mr. Levy’s blog – and he’s been writing only since last August! How does he find the time to do it?

But his blog is more than mere words. Mr. Levy discusses everything from his hospital’s infection rates (“We saved one person's life. Can we keep it going?” February 16, 2007) to questions about expensive new technology (“daVinci Uncoded…” February 20, 2007). He’s written about the SEIU union organizing campaign at Beth Israel Deaconess (“Union Issues,” August 25, 2006) and even about his own income (“Do I get paid too much?,” January 28, 2007).

According to the Boston Globe:

There are some things that Boston hospital executives generally believe are best kept quiet. Gripes about competitors are one. The rates of hospital-acquired infections among patients are another, at least at this point.

Then came Paul Levy's blog.

In August, Levy…began writing an Internet blog called ‘Running a Hospital,’ about the inner workings of an academic medical center. Since then, he's broken a few unwritten rules.[2]

Last week another Boston hospital was in the news, again because of something its CEO wrote. Dr. Paul Slavin, CEO of Massachusetts General Hospital (and a competitor of Bet Israel Deaconess), wrote a memo about that hospital’s recent unannounced survey by the Joint Commission.[3] He didn’t post his memo on the web, but when it came to the attention of a newspaper, it was news because Dr. Slavin talked about deficiencies in Mass General’s hand washing (one of my favorite subjects), medical records documentation, pain management, and medication reconciliation.

That memo prompted the Globe to editorialize. “But how does this renowned institution [Mass General] compare with other hospitals?” [4] The paper continued: “Paul Levy, president of Beth Israel-Deaconess, courted controversy on his blog ‘Running a Hospital’ last December when he listed the rate of infections for a common procedure at his hospital. He challenged others, including MGH, to do the same. They haven't done so yet.”[5]

Meanwhile, a blog by the Wall Street Journal (yes, another blog) asked the following question: “What’s your take on Levy’s blog? Self-indulgence? Or a welcome experiment in accountability in health care?”[6] The responses from readers have been generally positive. Some readers pointed out that Mr. Levy’s blog seeks a public relations advantage, others gave Mr. Levy credit for being “transparent” about hospital quality measures, and others said “time will tell.”

In past letters, I’ve written about the many changes affecting doctors and hospitals, about the financial pressures from state and federal budgets, and about the relentless movement toward public reporting of hospital outcomes.

It’s time to add CEO memo writing and blogging to our record of “these changing times.”

[1] Paul Levy’s blog address is: Blogs are an on-line diary or journal in which an individual provides daily commentary on a particular subjects, such as news events or a job or a hobby. The word “blog” is a blend of the words “web log.”
[2] “Blog tests hospital leaders' patience,” Boston Globe, February 23, 2007.
[3] CGH is expecting its own unannounced survey by the Joint Commission any time this year. It could be as early as next month – or next week.

[4] “Improvement time at MGH,” Boston Globe, March 20, 2007.
[5] Ibid.
[6] “Paul Levy, Online CEO,” Wall Street Journal Health Blog, March 16, 2007. The blog entry is available at:

Saturday, March 17, 2007

Trust but verify

On March 13, 2007 at an early morning Board of Directors committee meeting, the Directors (that is, my bosses) excused me from the room to meet in confidence with Deb Kurtz, Director of Corporate Compliance.

Deb had just completed her semi-annual report to the Board Corporate Compliance Committee where she documented and discussed activities used to monitor and investigate CGH business practices. “Corporate compliance” means that CGH follows ethical and legal business practices. In other words, we do not issue fraudulent bills, and we do not engage in illegal practices with vendors or doctors.

In her report Deb briefed the Board about calls she gets on the “corporate compliance hotline.”[1] Such calls may come from many sources, but they are typically from employees asking if it is appropriate to accept a gift from a patient or wondering if a vendor might be using unfair influence with CGH. Each call has to be taken seriously because any one of them could be a warning that something is not as it should be. Corporate compliance is something the Board wants to know about, up to and including any potential unethical behavior involving senior management.

I should note at this point that CGH has a well-developed policy about such things (called the corporate compliance policy) that sets forth the do’s and don’ts of business practices for everyone who works here, whether our job is to negotiate contracts with doctors, order materials from suppliers, or work directly with patients. [2]

So why do I leave the room when Deb speaks to the Board? To assure she and they are able to speak freely about anything, including any potential matters affecting the management of the hospital. This is another safeguard against bad business practices.

Sometimes I hear from people that it must be great to be president because “you get to do whatever you want.” Well, that’s not true. I have responsibilities to the organization, the same as anyone does, and the Board, with its oversight function, has a responsibility to assure that I do my job – and in this case, to assure that I do not misuse the job in illegal or unethical ways.

Ronald Reagan had a catch phase, used repeatedly during the final days of the Cold War – “trust, but verify.” The US was willing to subject itself to verification that it had, in fact, dismantled the proper number of nuclear warheads as specified by treaty – and the Soviet Union must be willing to subject itself to the same verification. It is not enough to trust that people do what they are supposed to do – you have to verify it.

A recent article in the Wall Street Journal featured, of all things, an interview with two convicted felons.[3] The two individuals served time in prison because they defrauded the investors of their companies. Both have since been released, and both talked to the newspaper columnist about fraud. Interestingly, their message was similar to Mr. Reagan’s. They said, “Do not trust – verify." Verify what? asked the Journal’s columnist. "Everything,” the ex-convicts said. “Criminals are scared of skeptics and cynics….We are petrified when you verify our representations.”

“Criminals” is a strong word, and none of us expects a criminal to be working among us – but how do we prevent fraud except by being prudent and having in place systems that document and check? If 99% of us are trustworthy, we still need controls in place to assure that the other 1% do not harm patients or misuse hospital resources. Each of us reduces the risk of unethical or illegal behavior when we understand, cooperate with, and help enforce the corporate compliance policies.

So the Board may trust Tom Quinn when he represents that CGH is operating according to ethical principles, is complying with laws, and has in place systems to identify errors or wrongdoing and to fix them. But they also want to hear directly from Deb Kurtz – so they verify it too.

[1] CGH’s corporate compliance hotline number is 492-5965. It may be used anonymously by anyone to report a potential violation of the law.

[2] The corporate compliance policy is available in two locations on CGH computers. In Outlook, find “Public Folders” and click on “All Public Folders,” then open “Corporate Compliance.” In CGHNet, find “Manuals” in the dropdown menu, click on “Other Manuals,” and open “Corporate Compliance.” The Healthcare Fraud and Abuse Prevention, Corporate Compliance Program Handbook is available in both locations. The handbook is 32 pages long, plus two Appendices. There is also a copy of the Handbook in each department.

[3] H. Greenberg, “My Lunch With 2 Fraudsters: Food for Thought for Investors,” Wall Street Journal, March 3, 2007