CryerHealth Blog

Does Pharma Need to Fail (Faster?)

After reading, Wanna Solve Impossible Problems? Find Ways to Fail Quicker (Fast Company March 2011), I couldn’t help but wonder if the pharmaceutical industry should find ways to fail quicker to bring more innovative products to market sooner.

In this article, we find the story of Henry Kremer, who in 1959 offered a prize of £ 50,000 (present day: $1.3 million) to build a human-powered airplane, able to fly a figure eight around two markers set half-mile apart. Kremer also offered £ 100,000 (present day: $2.5 million) for the first person to fly in a human powered plane across the English Channel. It would take nearly two decades for a winner to emerge. The eventual winner, Paul MacCready, realized the failures of the past decade were due to the participants’ inability to retest and rebuild their models faster. For example, it would take a team a year to build an airplane based on theory alone, without any practical testing leading to a year’s worth of work being damaged in just minutes of testing.

Seems intuitive doesn’t it?

MacCready realized the problem was not being able to fly a human powered airplane between two markers, but the problem was “how can you build a plane that could be rebuilt in hours, not months?Reframing his problem, MacCready went through learning cycles at an extremely accelerated pace and eventually won both human flight prizes.

In a highly regulated industry focused largely on bringing innovative, safe, effective technologies to patients, only 1 in 10,000 pharmaceuticals developed, by America’s pharmaceutical manufacturers is approved by the U.S. Food and Drug Administration. But, what if, based upon MacCready’s theory above, pharmaceutical-research companies were able to rapidly “speed up the pace of failure” while keeping initial investment and testing at their current levels? In what is a rapidly shifting industry, should pharmaceutical companies be answering this very question? How can the industry reframe the innovation problem?

Although theoretic, these fundamental questions should be of strategic importance to the industry. If the pharmaceutical industry were able to speed up “failure processes” at the stage of molecular level modeling and subsequently  learn and develop new molecular models based upon more concrete data, then production of quality medical innovations may be introduced into the marketplace more rapidly.

Given the pace of software technology and the unraveling of the human genome, it may be only a matter of time for pharmaceutical-research companies to achieve this level of testing in a safe, quite possibly 100% software or technological environment.

Sources:

  1. Pharmaceutical Manufacturers Association (Phrma)
  2. Fast Company Magazine, March 2011

Observations from a Wound Healing Clinic

Dr. Christopher Attinger’s wound healing clinic at Georgetown University Hospital, with its complex case-mix, aggressive treatment approach, and support service infrastructure (technology and people), may be one of the most advanced wound healing environments in the world. Having been absent from the complexities of the direct patient care environment for some time, I found myself immediately saturated with dozens of managerial observations.

By 9:30 am, the clinic was in full-swing. I walked through the clinic’s waiting room counting approximately ten patients. Sitting next to each patient was at least a single caregiver; at a first assuming blush these caregivers were family members or nurses, this assumption would be later confirmed. The waiting room was near capacity, the smells permeating the clinic’s air were that of mild hospital soap mixed with ‘wound’—a smell reminding me of peeling a bandage or gauze from still healing flesh. While sitting in the waiting room, I noticed patients with prosthetic limbs, crutches, walkers, and wheel chairs, respectively. I found myself thinking about what each of these patients had to endure on their way to the clinic: the complexities of getting dressed, of waiting for or securing transportation to the clinic, and then the obvious stairways, access ramps, and elevators which had to be navigated on the way to the clinic.

While walking to the first exam room, Dr. Attinger provided a high-level scope of the clinic’s operations: 1,200 patients per year, six exam rooms, two operating rooms, four hyperbaric chambers, an electronic medical record interface, and diabetics comprised 60% of the case mix. From a patient care perspective, I was immediately struck by Dr. Attinger’s approach: noticeably quick, professional, and courteous. During the patient visit, Dr. Attinger asked the patient a series of questions, voiced his concerns or lauded praise with respect to healing progress, and took his notes within the electronic medical record system in real-time. Due to the nature of chronic wound healing (60% of chronic wounds never heal), Dr. Attinger carried a meaningful rapport with most, if not all, patients seen that day.

His staff primarily comprised of: residents, nurse practitioners, nurses, and a podiatrist, were well-tuned to the clinic’s pace. After leaving one exam room, it was immediately on to the next. From my vantage point, the clinic operated like an engine cruising at an efficient 65mph until lunch-time. As a multi-disciplinary wound healing operation, the clinic was even staffed daily with a readily available prosthetic specialist. The prosthetician was able to quickly suggest changes to/for custom prosthetics which would allow wounds to better heal. The prosthetician service alone created a continuum of care uncommon to many clinics, be they wound or otherwise.

Aside from normal clinic operations, I noticed several patient opportunities for improvement, which may take place at healthcare’s most strategic levels.

1. For example, several patients mentioned the complexities involved with navigating homes and/or jobs which seemed to be non-compliant with the Americans with Disabilities Act (ADA). This made me wonder who advocates on their behalf, what resources, be they legal or otherwise do they have at their finger-tips which could assist in making buildings more ADA compliant?

2. I also noticed the need for patient education resources. Patients (or their caregivers) with wound healing challenges should have a relatively high-level of working healthcare knowledge: i.e. they must know their medications, the kind and types of dressings used, etc. Patient education resources in wound healing should be developed for both patients and caregiver audiences and should be minimally bilingual for Spanish.

3. Wound healing education must extend beyond patients and caregivers and must also consistently include primary care doctors and nurses. It has been noted that some primary care doctors recommend a hydrogen peroxide regimen for chronic wound healing patients—this is false information.

4. There may also be an opportunity to discuss and decide what makes a wound healing clinic a wound healing clinic; i.e. the development of consistent wound healing clinic practices and services. At the very least, patients (or their caregivers) should have a basic understanding of what separates one wound healing clinic from another wound healing clinic.

As the combined projected increases in diabetic and elderly patients manifest, the societal burden of wounds must be seriously considered. Chronic wounds affect not only the patient, but their caregivers, and given the fact that 60% of chronic wounds never heal, scalable prevention measures must be taken into account as well.


Racing to Personalized Medicine

A June 2011 report by Science Progress, a project sponsored by the Center for American Progress, provides policymakers with ethical guidelines to consider and discuss personalized medicine within its broader context. The report, Addressing Race and Genetics: Health Disparities in the Age of Personalized Medicine, recognizes the now decade long sequencing of the human genome as a fundamental factor in decreasing the costs associated with genomics testing. The report also references a Price Waterhouse Cooper report, which currently prices the personalized medicine industry as a $232 billion marketplace and projects it to increase at a rate of 11% annually. It is my assumption, that for the qualitative and quantitative values of personalized medicine to be realized by its respective stakeholders, most importantly patients, personalized medicine conversations will have to become increasingly prominent, not only within communities of academia, research, and healthcare influence, but within those potentially conducive hubs of local community politics: coffee shops, restaurants, beauty salons and barber shops, and churches.

As there are currently no ethical guidelines in place directly influencing the aforementioned commonplace community-level conversations, the successful personalized medicine discussion may have to be framed, at social media and mass communication levels, within the context of an educated, open, non-racially or ethnically charged or motivated, dialogue. Of course the framework for this working dialogue assumes U.S. citizens have the maturity to participate in meaningful conversations across the potentially perceived boundaries of race, ethnicity, class, and politics, respectively. In a society that, in some ways, continues to come to grips with its distinct racial and ethnically divided history, or its currently perceived racial-ethnic xenophobia, proponents and direct beneficiaries of personalized medicine may have to take an active role in not just framing discussions for appropriateness of using race or ethnicity for particular disease proxies, but race and/or ethnicity in general. In a society in which, according to the Federal Bureau of Investigation (FBI), there were 8,336 hate crime victims in 2009[i], of which 5,166, or nearly 61.9%, were related to race (4,057 hate crime victims, of these 71.5% were directed towards black people) and ethnicity (1,109 hate crime victims), healthcare influencers and policymakers should also be aware of plausibly loud pockets of resistance to any form of productive personalized medicine dialogue.

The Science Progress ethical guidelines[ii] for personalized medicine are as follows:

–         There must be a frank discussion of the social and methodological appropriateness of using race or ethnicity as disease proxies.

–         Genetic variation research and clinical trials must systematically incorporate such discussions into their individual study designs and the research itself.

–         We cannot ignore structural inequalities in access to health care and in fact should seek to reduce them through research that looks at social, environmental, and behavioral contributions to health status as well as research on the outcomes of different care delivery models for different populations.

Within this construct, personalized medicine must also consider and propose solutions to: (1) propose additional cultural competence training within medical societies and spheres of influence, (2) address the challenges in minority clinical trial recruitment, and (3) introduce and create personalized medicine dialogue at community levels– those coffee shops, churches, and establishments within communities of color.


[i] FBI Hate Crime Statistics, 2009, November 2010. http://www.fbi.gov/news/stories/2010/november/hate_112210/hate_112210

[ii] Science Progress, Addressing Race and Genetics: Health Disparities in the Age of Personalized Medicine, Michael J. Rugnetta and Khusboo Desai. June 2011.


Washington, D.C.: Primary Care Hiring Microcosm

The Washington, D.C. metropolitan region healthcare system infrastructure may arguably represent one of the more competitive, complex, and innovative healthcare regions in the United States. According to a Washington Post article, Hospitals Courting Primary-Care Doctors (June 19, 2011), District of Columbia area hospitals are (and will be) taking an active role in hiring primary care doctors to achieve success under the Patient Protection and Affordable Care Act (2010) provision rewarding patient care teams for better coordinating patient services.

This article raises awareness of several key primary care issues such as: the evolving role of the primary care physician, the evolution of primary care networks, and the current and proposed future of primary care in the United States. However the immediate connection between an improved primary care network resulting in economies of scale, improved patient quality, and overall improved healthcare system efficiency is made only subtly transparent.

Primary care physicians operate as the healthcare system’s gatekeeper to specialty healthcare services. As a practice, strong primary care networks may allow for improved utilization and facilitation (less duplication) of healthcare services and procedures. Primary care physicians working nearby specialists may also provide increased knowledge transfer of healthcare information between physician groups, potentially of leading to improved healthcare outcomes.

From an urban perspective, primary care physicians with better coordinated access to specialists may significantly improve patient flow from emergency rooms, again improving utilization and system efficiency. At its most basic level, the perceived quality of patient care may increase, as patients relying on public transportation networks receive the benefit of improved access via primary care proximity to specialty services.

As a microcosm of the United States, Washington, D.C. area hospitals hiring reflects the following (Table 1):

Table 1: Washington, D.C. Region Current and Proposed Primary Care Physician Hiring
Hospital (Healthcare System) Primary Care Physician (PCP) Hiring Data Timeframe
Inova Health 200 PCP hires planned 5 years – 8 years
Montgomery General Hospital (MedStar Health) PCP system increased by 180 (represents a more than 20% increase) Increase over the last 18 months
Georgetown University Hospital (MedStar Health)
Washington Hospital Center (MedStar Health)
Suburban Hospital (Johns Hopkins Medicine) PCP hiring planned unknown
Sibley Hospital (Johns Hopkins Medicine)

As the hospital trend to hire primary care physicians continues, healthcare professionals should expect for hospitals to closely monitor the successes and challenges faced as primary care physicians. Moving forward, healthcare professionals and patients may also hear increased rumblings of physician shortages within primary care. The role of primary care networks in rural areas and hospitals may also come under increased scrutiny if rural or regional hospitals attract regionally-based, independent primary care physicians away from practice areas.


Designing Healthcare for Generations

At last week’s World Health Summit 2010 (Berlin, Germany), I was most surprised to learn that countries around the world are facing strikingly similar healthcare challenges. For example, the United Kingdom, the United States, Germany, and Japan are all faced with the challenge of providing healthcare services to an aging population without a robust tax-base to support them. Interestingly enough, this global demographic trend can be traced back to the post World War II “baby boom” generation.

Due to this “baby boom” generation, countries across the globe are in a phase where they are readjusting budgets, strategic priorities, and therefore laws, to finance and in many cases provide healthcare services. In terms of feasible solutions to address these issues, I believe there are only a few, long-term, feasible options that may have the desired impact on this large population subset (or at least, there are just a few options presented here). The desired impact aforementioned is to provide meaningful, comprehensive healthcare to an aging population (and to the disabled) without stressing the tax-base.

1.    Create Scalable Economies and Job Opportunities for Older Americans. Historically, in the United States, it has been generally accepted that after 65 years of age, one should (and has the right to) retire, live off Social Security, and receive Medicare benefits. Post the global financial market collapse, this thinking has started to shift. Still, given data that shows people are generally living and working later in life, we should continue to harness the intellectual capacity of the older knowledge and labor workers. These workers, with experience in business and skilled-trades could significantly support the United States economy, while lessening the reliance on the tax-base. The issue inherent is that we have to collectively mentally shift into supporting these workers as a substantial profit and productivity-add to the United States economy.

2.   Design Health into Society. I am borrowing or quite possible creating the term “Health Design” as a means to influence health behavior and population outcomes at the often unrecognizable subconscious level. At last week’s World Health Summit, I posed the question to Rob Moodie, Professor and Chair of Australia’s National Preventative Health Task Force, “How can we get populations to the point where they wake up and say ‘I want to be healthy?’” Paraphrasing, he said quite simply “You have to design it in.” The core of Professor Moodie’s presentation focused on the challenges and success of Australia’s public health campaigns .To glean the gist of Professor Moodie’s presentation you can take a look at Australia: the Healthiest Country by 2020 here—be sure to pay special attention to page 9, Figure 2—great graphic showcasing the effect of Australia’s public health interventions. During his answer, Mr. Moodie cited several “health design” examples. For example, showcasing art in stairwells to influence people to use the stairs—this without them realizing they are doing something for their health. I believe health design can and should be taken several steps further. Examples follow.

a.    In a recent office conversation, I found myself discussing recent headlines regarding the impending U.S. physician shortage. It just so happened that this colleague is a fan of the NBC series Scrubs. The question I posed to my co-worker was “Why haven’t we seen a television program with its setting in a primary care clinic?” The story line could be a lot more interesting than anything that takes place in an emergency room alone. Imagine The Office meets ER—now that sounds like must see television. For decades, television programs such as Scrubs, ER, and even the Cosby Show have had a significant influence on helping or suggesting healthcare career options. Although relatively difficult to measure, the subconscious influence of these programs cannot be shunned. I believe healthcare design should strategically work at this level of population influence to strategically affect psycho-social health behavior.

For further evidence, we can look at examples from the film Thank You for Smoking or the real life example of Patron Tequila. In the film Thank You for Smoking, the viewer witnesses the life of a tobacco lobbyist who faces the morality of explaining his profession to his son. During a key scene in the film, the protagonist discusses marketing cigarettes through movies. During this iconic dialogue, the film executive describes the perfect smoking scene. The idea of product placement is not a new, but why have healthcare workers not actively and strategically worked at this level of healthcare influence?

In the example of Patron Tequila we learn that John Paul DeJoria, Principal (also co-founder of Paul Mitchell—yes salon products) first marketed Patron through movies and television. Consumers were asking for Patron by name before it even reached bars saying “Oh, what’s that new tequila?” Through this marketing strategy John Paul DeJoria has become a billionaire (again) via Patron Tequila. Again, an example of the influence of subtle clues on psycho-social behavior.

b.   Create the Health Design Curriculum. Professor Moodie suggested we create teams of politicians, marketers, public health workers, healthcare lawyers, and health administrators to influence health outcomes in populations. I would like to take this concept a step further and propose the Health Design Curriculum. The health design curriculum would largely follow the case study method and would be comprised of courses in: politics, ethics, general and healthcare marketing, health law, economics, finance, media, film, organizational theory and design. Health designers could also specialize in any of the aforementioned categories. As the most subtle strategic architects of society’s health status, health designers will be able to engage and influence the stakeholders involved in creating laws, programs, products, and services across the entire health spectrum.

The design theory applied to business is not a new. The Rotman School of Management at the University of Toronto is built on this design concept. The design perspective develops systems-level thinking and creative solutions. The single message I heard repeated at the World Health Summit was that we have to think creatively to solve our problems. Integrating design level theories, at the educational level, may develop creative healthcare solution-finders.


Government needs to do more to engage patients in policymaking

CryerHealth has been privileged to have on board a team of brilliant hardworking interns from MPH programs around the world who contribute much to our efforts to create patient-centric solutions.  Here is an insight into one assignment:

I was recently tasked with an attempt to find opportunities for patients to act as policy makers and committee members at a governmental level.  This is an important and critical area because patients and their family members bring unique perspectives to government committees.  They provide personal experiences with or possess knowledge pertaining to specific illnesses and conditions.

At USAJobs, a database of federal vacancies, I discovered policy analyst positions at Health and Human Services.  Unfortunately, positions required pervious experience and employment in the federal government.  This is not really suitable for most patients and for those rare patients who do wish to look; this database is not easily navigated.  It is clear that USAJobs has postings for paying jobs as opposed to vacancies for membership on government committees.  It is a resource for those hoping to find governmental employment.

The Food and Drug Administration does have a FDA Patient Representative Program.  Patient representatives for the FDA are responsible for providing advisory committees with their particular and unique opinion and perspective.  They are able to serve on advisory committees when a product or therapy is under review.

I looked through a series of government entities for patient opportunities on committees to serve as patient advocates but had little luck.  I searched through the following:

1)    National Advisory Council for Healthcare Research and Quality http://www.ahrq.gov/about/council.htm
2)    U.S. Department of Health and Human Services
3)    The Agency for Healthcare Research and Quality (AHRQ)
4)    Patient Centered Outcomes Research Institute (PCOCRI)
5)    The National Institutes of Health (NIH)
6)    The Centers for Disease Control (CDC)
7)    The Institute of Medicine (IOM)

From my search I have discovered that there are not many committee openings for patients to become involved as patient advocates.  There are plenty of job openings or positions for clinicians, physicians, policy makers and analyst but none for advocacy from patients.  Navigation at government websites was also very difficult and tedious.  Expanding my search to consumer advocacy did manage to yield a few more results but even that was not very promising.

There is a clear disconnect between patients who wish to serve as patient advocates and interest or awareness from these government committees.  Sadly a huge opportunity is completely overlooked if patients cannot serve on these committees.  As e-health and patient advocacy expands in importance, there must be more opportunity from government agencies to seek the input of patients.  Accessibility and opportunity must be improved so that HHS can improve patient e-health and health IT, as these are their new agenda items.  Patients are a specific group that have a uniquely and irreplaceable experience that encompasses a particular and key perspective of patient care.  Without tapping into this demographic, a government committee loses this voice and does future patients and projects a disservice.  It is also high imperative that patients are not lumped into the group with consumer advocates.  Consumers include those who consume and use products used to treat patients, this does not necessarily represent those who are experiencing a condition or disease first hand but rather a group that has a monetary incentive in future policies.  The goals and vision of all consumer advocates does not completely match those of patient advocates, patients are not always put first with consumer advocates.

In order to improve patient advocacy, more patient spots on committees are a necessity.  From my search it is evident that only the FDA has made a legitimate attempt to seek input from patients and provide a way for this key demographic to voice their concerns, thoughts and ideas.  Patient committee members are able to put their own experiences and their voice forward to committees.  They are able to invoke an emotional and personal understanding with other committee members and have a direct impact on key decisions and policies.  Medicine and patient advocacy must not become a clinical experience where marketing and cost are the focus.  Without representation, biased and skewed decisions will stem from these committees and only patients will suffer.


What Does Healthcare Mean to You?

A recent Tweet from NACSmeetings read: “Healthcare: What it means to you? Tuesday Business Program Keynote with David Cutler, Harvard Professor, 2010 #NACDS Pharmacy Conference.”

Healthcare’s greatest inherent challenge is that it means something different to every person. Health is more oft than not, experienced primarily at the individual level. Healthcare is personal. The healthcare differences, definitions, and issues between any two people can be vast.

The World Health Organization (WHO) defines “health” as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity* .”
Within the context of the WHO definition, the patient-centric model may be viewed as such:

Within the framework of the patient-centric model presented (above), I believe “health” is wholly experienced at the micro-level when the patient (individual) is able to fully interact (communicate) with its “health influencers” in a meaningful way. These interactions assist in developing a global understanding of health factors and help produce the well-being framework necessary for a person to “feel” healthy. “Health influencers” may include everything from the macro-environment, to personal biases, beliefs, and behaviors related to health.

I believe individuals should feel empowered when approaching or interacting with the healthcare system and each respective “health influencer.” For example, these behaviors can be as simples as having a meaningful dialogue with a member of the patient care team, having a productive interaction with an insurance company, or commenting on a blog post from the Centers for Disease Control (CDC).

The doctor-patient interaction is by far one of the most complex “business” exchanges. This interaction also represents the greatest opportunity for improvement within the medical system. Many patients leave the physician’s office unsure of exactly what transpired. They generally know they were touched here, they were touched there, and a few test were conducted. The patient is then explained (in medical terminology) what is wrong or right. If this single interaction could be improved upon many patients would feel better about healthcare in general. I wish more doctors could be like Patch Adams. 

In a nutshell, that’s what healthcare means to mean. What does healthcare mean to you?

* preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.


Mobile Health in Action

Setting: Washington, DC, Capitol Hill East. My morning run starts at the top of 17th Street, SE, just blocks from the United States Capitol. Instead of taking a scenic jog towards the United States Capitol, my jogging route follows the road less traveled and heads south, towards Benning Road, NE.

The landscape changes quickly in this neighborhood: manicured hedges are soon unkempt; lawns are soon littered with glass, take-out boxes, and other random debris. Picket fences soon become mangled steel, protecting gateless, grassless lawns. There is always an edge in the air that contrasts sharply against the crisp morning air.

One morning I arrived at Benning Road and 17th Street NE, surprised to see the George Washington University “Mammovan.” I decided to observe. The presence of the Mammovan added a different element to the community. I noticed three staff members, two wearing t-shirts. People were comfortable asking the staff questions, they were clearly familiar with the Mammovan’s presence. Within moments the Mammovan became an integrated member of the community.

I believe the mobile health model can only grow and may be the “next” thing to take off in healthcare. I think this, not only for its current applications in underserved medical communities and the increased federal funding for mobile health, but I believe the mobile health model can also be applied in communities with dense elderly populations and quite possibly even in rural communities.

Imagine a completely kitted mobile health unit visiting an adult only condominium community. I think many in the baby-boomer generation would much rather receive medical care at home or from a mobile unit instead of in a home for the elderly. It only helps that the mobile health unit is showing significant return-on-investment.

Just recently, researchers from Harvard Medical School developed a ROI model depicting for every $1 invested, the mobile health unit returns $36* . This stat was also referenced in a Newsweek article A Little Van with a Big Impact. Since Massachusetts enacted its healthcare reform in 2006, costs have increased by 52%. The mobile health van has been shown to help defray some of that cost while providing a quality, highly accessible healthcare service.

It only helps that Kaiser Permanente unveiled a completely wired mobile health van in Hawaii in 2009. This vehicle was projected to impact an estimated 12,000 Hawaiian residents. The vehicle also comes with Kaiser Permanente HealthConnect®, Kaiser Permanente’s electronic health record. Stay tuned, the mobile health unit just may be the cornerstone for the future of community health delivery.

*BMC Medicine, online publication, June 2, 2009, “Calculating the return on investment of mobile healthcare”Nancy E Oriol(1), Paul J Cote(2), Anthony P Vavasis(3), Jennifer Bennet(4), Darien DeLorenzo(5), Philip Blanc(6) and Isaac Kohane(7)

Healthcare Happiness: Key to Creating a Patient-Centric Healthcare Organization

One of the keys to implementing a patient-centric model in healthcare organizations is for leaders to create an organizational culture of “happiness.” Yes, happiness. Recently, I heard a conversation by Dan Kennedy, known for coaching people to build what he refers to as the “success personality.” In this conversation, Kennedy references two key stats:

  1. Eighty-percent of all Americans are unhappy with their careers.
  2. Sixty-percent of Americans are unhappy with their personal lives.

When we consider these statistics within the context of the healthcare service delivery environment, a supposed “healing” environment, it goes without saying that with unhappy employees (physicians, nurses, and allied health workers) we are almost assured our healthcare organizations will struggle in providing quality care and customer service in what is arguably the most important service oriented environment.

“Happiness,” as an organizational priority should not be mocked or laughed at—rather it should be fully embraced. Tony Hsieh, CEO of Zappos and author of “Delivering Happiness,” is known for regularly asking his employees where they exist on the “happiness scale,” and if they are below a “10,” what it would take for them to get to a “10.” Building a business based on this philosophy, Zappos has quickly become an organizational model for profit and corporate culture–-this when many unbelievers said people would “never buy shoes online.”

What if hospital executives asked nurses where they exist on the happiness scale, would patient care improve?  Better yet, what would happen if doctors asked nurses where they exist on the happiness scale? In every patient room, in every United States hospital there is a “pain scale” chart. Providers regularly ask patients “where are you on the pain scale?” This scale has 10 faces ranging from 🙂 to 🙁 and everything else in between. The interesting thing about this scale is the smiley faces subconsciously reflect the patient’s “happiness,” and not just the patient’s “pain.” Are patients with more visitors happy? Do happy patients have a speedier recovery, thus a better patient experience and better outcomes?

It has been well documented that happiness directly affects the immune system. In The Immune Power Personality: 7 Traits You Can Develop to Stay Healthy,” author Henry Dreher, delves deeply into the connection between happiness and the immune system. With this much data on the subject, one would think more healthcare organizations would focus on happy patients and happy healthcare workers.

The break-up of the AT&T monopoly in the 1970s provides further evidence there are clear, undeniable linkages between happiness and healing. During the AT&T transition, employees that remained healthy were found to have the following traits: 1. sense of purpose, 2. sense of control, 3. acceptance of change, and 4. diversified interests

The science of happiness has actually been described by Marty Seligman, PhD, former president of the American Psychological Association (APA). In 2000, Dr. Seligman and the APA created the Positive Psychology movement. This after recognizing most of psychology’s research focused on mental illness vs. health and optimal living. Dr. Seligman authored a book titled, “Authentic Happiness,” where he explores the inner-workings of positive emotions, strengths-based character, and healthy institutions. As healthcare workers, it would do us a world of good to set aside 30-minutes to take Dr. Seligman’s Brief Strengths Test. This test suggests that we should focus on building our core competencies instead of focusing on developing our weaknesses.

When we apply this thinking to healthcare service delivery models we can be assured that these concepts may create “ripples” within management and doctor circles, but these tested principles can in fact have a dramatic influence on healthcare outcomes, quality, and customer service.


Money Alone Won’t Fix Primary Care

Secretary Sebelius and the Department of Health and Human Services (DHHS) should be commended for the immediate $250 million provisioning from the Prevention and Public Health Fund. Although this fund provides:

1. $168 million to train 500 new primary care physicians;
2. $30 million to encourage 600 nursing students to finish school and join the profession;
3. $32 million to create 600 new physician assistants;

it still may not improve the nation’s primary care “network.” The reality of the United States primary care network is there is no “network.” Adding more people (jobs) to an already uncoordinated, non-communicating system will not increase efficiency or the quality of care—it will only add to the complexity of the current environment and to the daily frustrations of the healthcare worker.

According to Landmark: America’s New Health-Care Law and What It Means for Us All, the workload of primary care doctors will increase by 29% in 15 years. In 2007, only 23% of internal medicine residents planned to enter primary care, down 54% from 1997.

The stark truth: in the medical community, primary care is more oft than not viewed as “the Lord’s work,” a “labor of love,” a thankless job where highly educated physicians (and practitioners) have to make dozens of follow-up calls, schedule treatments, run a practice, pay malpractice insurance, and try to figure out Medicare reimbursement rates. For a new physician, this reality is daunting and may possibly be the largest detractor to the pursuit of this career path for healthcare workers. Bottom-line, there is no George Clooney “marketing” primary care.

Researchers at the Center for Studying Health System Change examined the experiences of 2,284 physicians in Medicare’s fee-for-service program where each physician treated on average, 264 Medicare patients. The study found that for every 100 patients treated, a single physician may need to contact 99 other physicians in 53 practices to garner a complete “patient picture,” (?!?!?!?).

The $11 billion earmarked for the nation’s primary care “system” must consider the coordination and communication of practitioners in their respective communities. Technological investments must be made, at the community level, to lessen the administrative burden of these valued practitioners. In a Harvard School of Public Health study, of 2,135 physicians (all not primary care docs), 1 out of 3 physicians said they experienced increased administrative burden after the Massachusetts healthcare law was implemented. In general, recommendations to consider in improving the nation’s primary care system should include:

1. Subsidies for malpractice insurance for new primary care practitioners.
2. Improve the coordination of Medicare billing at the local level. Reduce reimbursement times from clinic billing to accounts receivable.
3. Expand the role of physician assistants and nurse practitioners in the medical practice. They have brains and experience; they should be put to good use.

Until the family practice joins the 21st century in its ability to communicate and connect with patients, providers, and provider entities in a medically safe and efficient manner, we can only expect the same.