You Can't Make Me

Re: "The Problem With Free-Market Health Care" by Joe Flower, H&HN Weekly, Nov. 29, 2010

Love Joe Flower's overall article and message, but with one caveat. Joe asks, "What do I really want, as a customer of health care?," then provides four answers including "When I am well, help me stay well."

Sorry. I disagree with this statement. Americans as a whole don't—and in many cases, vehemently won't—do those things that have been clearly demonstrated as the most reliable paths leading to healthier, longer lives, namely, (1) stop smoking, (2) exercise regularly, (3) get adequate rest, and (4) eat a balanced diet. To this you could add (5) complete regular health screenings and examinations, and (6) receive vaccines to prevent contracting contagious diseases.

Why won't we? Because we're Americans! Just like burger peddlers have known for decades, we want it when we want it and we want it "our way." And, as Americans, we pride ourselves on being independent, so we don't like to be told, but we can be sold. Worse, we love conspiracy theories. Many people are more comfortable having needles with questionable provenance or maintenance stuck in them to create tattoos and piercings, than to accept vaccines demonstrated to prevent blindness, cancer or suffocating infections.

Finally, of course, as the other answers Joe provides suggest, Americans ultimately believe they will cheat death and disability because no matter what happens, drugs and technology will save them. After all, we are bombarded with promotions for a zillion solutions to deal with
nonlife-threatening conditions including erectile dysfunction and my personal favorite dreaded affliction, restless leg syndrome. So surely they can fix little stuff like pneumonia and diabetes.

Until we overcome these attitudes, until we truly acknowledge health risks and consequences, and accept responsibilty to mitigate or manage those risks, the system will always remain broken.

Terry Dunn
Vice President Operations & Chief Quality Officer
The Drake Center, Cincinnati

Why Hospitals Fail at Lean

Re: "Five Things We Have to Get Good at Fast" by Joe Flower, H&HN Weekly, Jan. 25

I couldn't agree more with Mr. Flower's suggestions. I have worked in the health care world for 35 years and the suggestion to build a better production system is right on. Problem is, we rarely view hospital operations as a production system. It's more a conglomeration of special services that haphazardly come together.

I find it interesting that some facilities have spent millions on Six Sigma and Lean programs and have only marginal benefits to show. In one facility I was involved with several years ago, they had 40—yes, 40—kaisan (Lean) specialists, yet they readily admitted that during the prior year there were 6,000 instances in which a patient could not be located and services such as meds or therapy could not be administered, all leading to delayed discharges, bed unavailability and ER backups. The solution they "leaned" to was to build a bigger ER!

In my experience both as an industry professional and as a patient, the failure happens most when there is a handoff from one department or caregiver to the next. Hospitals have done an admirable job in applying Lean in individual departments, yet have had little success in interdepartmental services coordination. As Toyota would tell us, true production control transcends all the activities it takes to build a car. It really doesn't help much that we can order a lab test in one second if, when we go to draw the serum, the patient is not there. The problem is even more acute when you consider the coordination it takes to simply discharge a patient.

Frank Poggio
President The Kelzon Group


•The January article "Why Board Diversity Matters" incorrectly quoted Frederick D. Hobby, president and CEO of the Institute for Diversity in Health Management, about the gap between the percentage of hospital trustees who are members of ethnic minorities and the number of patients who are from ethnic minorities. The quotation should have read: "Ninety percent of the people who serve on boards are white, but around 70 percent of the patients we serve are white."

•The February cover story on health information exchange reported that the state of Michigan funded two of its nine medical trading areas. The state funded all nine areas in two rounds of funding in 2007 and 2008.