jenuesse health

What's the secret of building resiliency, the ability to withstand unexpected challenges, into your organization?  Lots of leaders I know take this attitude: "When the crunch comes, we'll deal with it. I'll explain that we have a burning platform, and the team will respond." Well, yes, they will, but to the extent that you succeed in handling the crisis?  If so, will the team respond in a way that creates the potential for future success, or will the effort just get you through the crisis? A recent story [subscription required] in the UK Health Service Journal shows what happens when an administrative fiat is issued to deal with a budget shortfall.  Excerpts: The financial ‘stretch targets’ and emergency measures imposed by NHS regulators will fail to make significant inroads into the total provider sector deficit, analysis by HSJ reveals. Providers had forecast a combined year-end deficit of £2.1bn at the start of 2015-16, which prompted Monitor and the NHS ...

The worth of a city can be measured in part by the caliber of the people who devote themselves to its improvement.  By that measure, Boston has much to credit from the engagement of Vivian Li as long-time head of the Boston Harbor Association , created to promote a clean, alive and accessible Boston Harbor.  Many have considered her the unofficial mayor of Boston's waterfront for the last quarter century, and that would not be a bad summary. She's now off to new adventures in Pittsburgh , and there is a farewell celebration for her tonight.  For today, I'll skip her many accomplishments but rather focus on her approach and demeanor.   I don't know of anyone in this city who has worked with Vivian who doesn't admire her and consider her a friend and colleague.  Those of us who worked at the Massachusetts Water Resources Authority certainly viewed her in that light. Invariably pleasant and respectful in her dealings--even in the most contentious disputes--she...

As we consider the leadership failures that led to the current debacle at Volkswagen, we can take a lesson from English history. Henry II, facing a disagreement with Archbishop of Canterbury Thomas Beckett in 1164, is reported to have shouted out in frustration, “Will no one rid me of this troublesome priest?” Four knights heard what Henry had shouted and interpreted it to mean that the king wanted Beckett dead. They rode to Canterbury and did the deed. This story exemplifies the term myrmidon . From this source , we get the following definition: " A loyal follower ; especially : a subordinate who executes orders unquestioningly or unscrupulously." One of the dangers for a CEO is the tendency for your subordinates to take what you say and execute it to a degree you never intended. Now, let's take a quick look at the VW story, courtesy of the New York Times : Martin Winterkorn, Volkswagen’s chief executive, took the stage four years ago at the automaker’s new plant...

For several years, I've had the pleasure of expanding my role as referee of youth league soccer games to officiate in high school games.  Although covering some of the same age groups, there is a different feel to these school games.  School loyalties are different from town team loyalties.  Coaches are more often professional and paid rather than being volunteer parents. One of the things drilled into the referees is that the matches are "part of the school day." We're told that the main value of the athletic endeavors is that they are part of the curriculum. The coaches, we are advised, have a teaching role, just like in the classroom. Indeed, many of the coaches are classroom teachers, too, during the previous hours in the day.  Our job is to defer to these teachers in matters of deportment and discipline (while of course officiating the game in a fair manner and one which helps ensure the safety of the teenagers.) So, what happens to all that when the coach loses...

My Australian friend Marie Bismark and colleagues published an article a couple of years ago about the role of boards in clinical governance in over 80 health service boards in the state of Victoria.  There was one remarkably revealing quote about the 233 board members who answered the survey: Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service. In an earlier article , Ashish Jha and Arnold Epstein found similar results: When asked about their current level of performance, respondents from 66 percent of U.S. hospitals rated their institution’s performance on the Joint Commission core measures or HQA measures as better or much better than that of the typical U.S. hospital.  Only 1 percent reported that their institution’s performance was worse or much worse than the typical hospital. Among the low-performing hospita...

Noam Chomsky is one of the world's treasures, the greatest living expert in the field of linguistics.  When you get a hear him talk, it is like absorbing great music.  If you are like me, you don't grasp a lot of what he says.  After all, how do you even begin to assimilate his 60 years of research in the field into your own head as he presents his points of view and his evidence? Nonetheless, it is a wonderful experience, and I was so pleased to have a chance to watch and listen at an MIT seminar last week. What follows is a short exposition of what I thought I heard and learned! I follow with an extrapolation to issues of negotiation and leadership. Turning briefly to the popular literature, Deborah Tannen wrote a great book a few years ago, called You Just Don't Understand , about how "women and men live in different worlds...made of different words." She demonstrated how miscommunication is rampant between the sexes. Noam goes well beyond this characterizatio...

There are several archetypal lies in America (and other countries!): "The check is in the mail." "I'll still respect you in the morning." "I'm from the government, and I'm here to help you." "I'm from academia, and I'm here to clarify things." And many in the medical world have now added: "Our patients are sicker." The last Lake-Wobegon-inspired one occurs when you present a hospital leader or a doctor with risk-adjusted data showing that their record on quality and safety is below that of other places.  (An accompanying phrase is often, "I don't believe the data.") A study from the Annals of Surgery a few years ago (Volume 250, Number 6, December 2009)  refutes this view of the world.  A friend summarizes: Some people thought that hospitals with higher mortality rates had higher complication rates, but that seems not to be the driving factor behind increased mortality, at least according to th...

At a recent training program in quality and safety improvement, one focusing on the topic of communication in clinical settings, a second year resident said firmly, "I don't trust nurses. I don't pay attention to what they say." Now, this might be a case of extrapolation from something that residents are often told, "Don't trust anybody." In that context, "trust" is not used the way commonly understood. No, in that case, it means, "Do your own analysis of the patient's condition and don't assume that what you heard from someone else is still correct." That's fine. But that wasn't the context of this young doctor's remark. Here, rather, was an affirmative statement about the value of nurses and about their judgment. We could consider this an isolated case of an arrogant person and let it go at that, but I fear what we saw here is a more commonly occurring disrespect for those "underneath us" in many clinic...

Those of us involved in sports coaching are often told that the most effective mix of positive reinforcement to negative comments is 5:1.  I think this ratio might derive from research in the 1970's by Robert and Evelyn Kirkhart.*  They found that children in classrooms thrived when the ratio of feedback was 5 parts positive feedback to 1 part constructive feedback. In contrast, children sunk into despair if the ratio fell down to 2:1 or 1:1. Not just any praise worked.  It was more effective if praise was truthful and related in real time to a specific event. It also had to be sincere and credible to have an impact. I'm told, too, that a video analysis of the practice sessions run by John Wooden, arguably the greatest coach of all time, showed that 87% of his comments were positive reinforcement. Hmm, about a 5:1 ratio. By the way--and maybe (or maybe not) a bit off our topic today--it was John Guttman in the 1990s who extended the research to married couples, showing t...

If our goal is to lead our places to be learning organizations, we must help our folks understand that near misses are gems that should stimulate us to focus on underlying process failure. Why? Well, for every adverse event that is reported in a service or manufacturing organization, there are literally hundreds of near misses.  Each one represents an opportunity to correct a systemic problem that could someday lead to a catastrophic event. Let's look at a recent example from health care. Bud Shaw published a powerful and deeply disturbing story in the New York Times this past week.  Shaw, a surgeon, was at his daughter's bedside in the hospital when he recognized that she had a serious problem: I’ve been watching the monitor for hours. Natalie’s asleep now and I’m worried about her pulse. It’s edging above 140 beats per minute again and her blood oxygen saturation is becoming dangerously low. I’m convinced that she’s slipping into shock. She needs more fluids. I ring f...

To my loyal readers: I've been writing this blog for over 9 years, starting during my tenure as CEO of Beth Israel Deaconess Medical Center,  and continuing now over four years later.  During that time, I've had a chance to tell many stories and express lots of opinions with regard to various aspects of the health care industry, and you have rewarded me with your readership and your comments.  I am deeply grateful for that opportunity and for that connection with so many of you. As my life has moved on, my other activities have evolved. While health care will always be an underlying interest for me (and anybody else getting older!), I am getting more and more distant from the day-to-day policy issues and industry struggles.  There are other people who are better suited to write about those matters. So, starting after the Labor Day break, I am planning to shift the focus of this blog to topics where I might be able to contribute to people in a broader range of industr...

Here's some nice work from the Massachusetts Health Quality Partners , a part of their Practice Pattern Variation Analysis (PPVA) program. There are 40 conditions identified by MHQP where they have identified significant differences in the use of medical services for similar conditions. The idea is that: Clinical leadership can address the causes of the variation and determine whether the variation is clinically warranted, how to initiate change if it is not, and consider how the variation impacts quality, safety and cost. Through PPVA, the medical community can work  toward adoption of community developed standards and actions that will improve quality care for patients. I think this is a thoughtful approach to variation, one that is engaging and respectful of clinicians.  I was interested to see this recent example: One of the conditions MHQP's PPVA program identified as a strong opportunity to better understand variation was the frequency of ultrasounds during preg...