It’s time for our monthly peek inside the H&HN Daily mailbag.

Earlier this week, regular H&HN Daily contributor Paul Keckley suggested that hospitals should look beyond HCAHPS when focusing on patient engagement. His column made that oft-made comparison to the airline industry.

Ron Hammerle, chairman of Health Resources, responded:
Paul's headline and goals for getting serious are certainly on the mark, as always, but I think the airline comparison deserves a bit more balanced application.

For on-time performance, most customers rank airlines far higher than hospitals.

Ditto on paying twice — or more — for redos and readmissions.

As for flight cancellations, if the bad weather or other safety concerns led to those decisions, hospital safety performance still has a long, long way to go before coming close to that of the airline industry, as the Institute of Medicine and the Institute for Healthcare Improvement have amply documented for many years. If airlines had jumbo jets crashing every two days and killing all aboard, "customer satisfaction" and "serious action" would certainly not be slow in coming.

As for charges, need one say more?

Marty Gutkin had this to say:
I think the point being made is that we (health care) must look beyond what is asked of us and push forward without being prodded like cattle. Perhaps my greatest disappointment in our industry is that it always seems to be reactionary to the winds of the next payment method, the next IHI report, the next penalty for lacking quality. We who are in the business should be demanding more of ourselves, leading the change.

And Kathy Lewton, principal at Lewton, Seekins & Trester, wrote:

It's somewhat disheartening to think that the current heavy emphasis on what I hear nurses call "the scores" seems, in many cases, to be occurring only due to concerns about penalties and payments and contracting networks. I see hospitals using all kinds of gimmicks to push patients to choose a specific numerical score, rather than asking how we can change what we do and how we do it so that these patients are genuinely happy with their experience here.

At the first urban tertiary care hospital I worked at, we were training employees in the 1970s, with a credo of treating patients with respect and compassion simply because it was the right thing to do, as human beings concerned about other human beings. This was pre-DRGs, and HCAHPS wasn't even a glimmer in some bureaucrat's eye.

Hard to see how you can get the culture of care that's needed by just focusing on scores. Patients can recognize genuine compassion when they encounter it, and as a patient in the past year, I sure could spot the "Hi, my name is Brenda and I'll be your nurse today" canned speech. Some of the superficial "Hi, we care" patter wasn't far from "Hi, I'm David and I'll be your server tonight — would you like still, sparkling or tap water?" If we need to look outward, Disney and Ritz Carlton seem to have created cultures in which the employees' concern is authentic.

As usual, Ian Morrison inspired some comments with his column on the innovation imperative.

Kathleen Lewton praised Ian’s thoughtfulness:
I've never read a piece by Ian Morrison that didn't leave me better informed, energized, focused, a bit terrified (at the enormity of the challenges out there) — and this piece was no exception. Kudos, Ian, for calling out "half-assed pilot projects or, as I hear employees saying over and over, "the initiative du jour." Thanks for that, and the Christmas tree ornament metaphor. The people who see right through short-term, poorly conceived fix-it-quick approaches are the people on the front lines, literally facing the patients.

George Cybulski added this:
A comprehensive summary that is well-done. However, the delivery system of health care is mired in the 20th century and training of providers and management is likewise archaic. The electronic medical record, the most uniform applied aspect of health information technology at present, is a glorified record system with little impact on the quality of patient care (see the VA with its vaunted EMR in place for approximately 20 years). As such, the increased access produced by the Patient Protection and Accountable Care Act is likely to push up both costs and tax (no pun intended) the ability of providers to cope. A true disruptive innovation a la Schumpeter will be critical to a real change in safety, quality and cost of providing health care.

Finally, Lisa Goren penned a column about physicians taking on more of a leadership role in hospital boardrooms.
Matthew Lambert, M.D., took issue with some of her assumptions.
The article makes an assumption that physicians can naturally move into leadership roles based on their education and training. I would suggest that physicians learn a certain style of leadership that is more "command and control" in nature and needs to be significantly modified to be successful in the current environment that demands a more collaborative approach. I agree with Dr. Angood's final comment that additional competencies are required, such as emotional intelligence and appreciative inquiry.

And since part of our goal in posting comments is to create more engagement with readers, here’s Lisa’s response:
I wholeheartedly agree with the points you've mentioned in the comments highlighting the importance of balance — there are some competencies that are easy to teach and some that are more elusive because they rely on innate characteristics. No matter what the case, I think our collective obligation is to offer comprehensive developmental support and the ability to meaningfully participate in conversations that impact both the vision and practice of medicine. At this point of widespread transformation, I believe we must ensure that physicians have the skills they need to lead clinical teams and complex organizations. Gone are the days when we (that is, administrative types) didn't want to bother physicians or take them away from patients. Our boardrooms need to mirror the interdisciplinary approach we expect throughout out hospitals and clinics. To do this, administrators must exercise the curiosity and willingness to cross clinical thresholds, and physicians need the language and skills to comfortably and confidently participate in conversations that fall outside of their traditional medical training. I no longer believe physician leadership training is a choice; rather, it is an imperative to surviving as a solo practitioner or a medical staff president and it is crucial to changing this unsustainable model of care.

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