In this month's mailbag, readers weigh in on recent articles, podcasts and blogs on the quandary of keeping high-quality care affordable, the emergence of nocturnists during the graveyard shift and population health strategies for super-utilizers of health care resources:

First off, reader Ron Hammerle, chairman of Health Resources, responded to H&HN contributing editor Bob Kehoe's podcast interview with outgoing Commonwealth Fund president Karen Davis:

"No industry ever reforms itself. Healthcare is no exception. Reform will inevitably come from outside. Regardless of the fate of the Affordable Care Act, the business community has begun its own reforms. Those already include Walmart's plan to become the largest provider of primary care in the U.S., the evolution and expansion of other national, retail-based clinics, the impact of venture-funded virtual care companies, the relocation of internationally-known Asian specialty hospitals to the Caribbean, the franchising of ambulatory care centers and the rapid development and retail sale of biometric monitoring and testing devices."

A reader identified as SRS weighed in on David Ollier Weber's recent column on nocturnists, or hospitalists working the night shift:

"Nurses have known this forever! It's great that Cincinnati Children's hospital has figured out that getting physicians to talk with nurses and collaboratively solve problems on the night shift improves care; I presume they got the idea from asking their nurses. Hardly a new idea for nurses, but glad to see their physician partners getting onboard."

Reader Lisa Sams responded to my recent blog on the population health initiatives developed by the Camden Coalition of Healthcare Providers, which aim to better treat high-utilizers of health care resources:

"Efforts such as this example are the avenue to changing our approach to inpatient care. Multidisciplinary and 'in the community' are essential. What is interesting is this type of project is not new; many case reports exist on the topic of meeting the patient where the patient 'is.' Community health nurses have been working in these trenches for years, making a difference one patient at a time because the disconnects within our 'nonsystem' of care delivery are profound. I do believe efforts such as this will be key in moving forward, but they need traction and commitment for the long term at the C-suite level to affect the culture of care today. The external drivers are many and we are on the verge of completely losing the patient in our efforts to not lose revenue."

And finally, reader Jake Poore responded to H&HN Daily contributor Joe Tye's recent article on applying physics lessons to health care leadership:

"Excellent article, Joe! I really like the laws of physics application.

Here are some other important keys, from trial and error, we have found to help in successful cultural transformations and sustainability.

Employees as Cultural Architects: Employee involvement in the cultural design versus imposing it on them creates immediate ownership, develops pride, helps to get critical mass thinking/participation — all care team members need to feel that they are part of the design or at least represented at the table.

Simplicity and Relevance: Keeping it incredibly simple — a litmus test to what is created in that every employee can say, 'This is understandable, relevant, and applicable to me and my job, and I'm psyched!' (no matter my role, language I speak or who my customer is)

Drives a Higher Purpose: At the end of the day, employees can't just be nicer and safer. We need to give them a True North heading on their workplace compass that grounds and inspires them to a higher-level purpose — At which hospital do you want to work or be a patient? Tulane: 'We are minds that heal.' Or Ochsner Clinic: 'We provide health care with peace of mind.' And then, how do you get the health care food service employee to move from 'I am a tray passer' to 'I provide food that heals'? Now, that is culture change! 

Everyone is on the Care Team: No matter where they work, and everyone contributes to the healing experience. The question then becomes, 'What does that specifically look, sound, and feel like where you work?'

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