Every month in this space, I feature comments posted on H&HN Daily and emails sent to me in response to recent pieces. I'm pleased to say that it's getting harder and harder to pick which reader responses to highlight, as your conversation with our contributors and your fellow readers continues to grow. This month's mailbag includes responses to recent pieces exploring the role of family members in end-of-life care, the pros and cons of physician leadership initiatives and the correlation between a hospital's IT spend and its overall financial health.

David Ollier Weber's recent column, The End of A Life, explored one woman's experiences navigating her father's end of life care journey, and generated several passionate responses, including this one from reader Juli Stockberger:

"Thank you for your thoughtful and informative article about the options available to us when a loved one is nearing the end. My family (and many others) have endured Lisa's experience almost to the letter. I was one of the main translators for our family, and asked the doctors on our case repeatedly if recovery from the health downslide was even possible. I was continually given a non-answer like, 'I don't know' or 'it is hard to say,' when I knew in my gut it was not. …This kind of communication from specialists unfamiliar with the patient's full profile give the family unrealistic hope to hold on and keep intervening. It is my sincere hope that the concept of care coordination in the hospital takes some shape in the very near future.  Yes, this is about money but also about emotionally preparing patients and family for real life and death options."

The role of greater physician leadership in hospitals and health systems was the theme of H&HN senior editor for data and research Suzanna Hoppszallern's recent video interview with William Leaver and Alan Kaplan, M.D., respectively the CEO and CMO for Iowa Health System. Reader V. Alexander Lane wrote in to question whether the current trend towards hiring physicians in administrative roles is a good idea?

"So, we hire physicians to work as administrators, then we hire head hunters to find physicians to care for patients and are left with a shortage. Is this the highest and best use of their talent and training? I understand that we need physician leadership but is it starting to go too far when meeting after meeting you see this precious asset sitting around discussing meeting minutiae? I recently had to recruit a CMO and was shocked at the number of calls I got from physicians wanting zero clinical time. Young physicians with great skills wanting to become executives, should they not have just gotten their MBA and saved the cost of medical school? I highly support physician leadership however I also respect the significant need we have for clinicians in the care environment."

Lane's letter, in turn, elicited this response from reader Keith Marton:

"That's one way of looking at physician leadership — as a drain on clinical care. Another way to frame the issue is to think of physician leadership as yet another physician specialty, which is how I choose to think of the issue. For years physicians have figured out new and different ways to use their skills on behalf of patients. For instance, hospitalists could be seen as reducing the supply of office-based physicians, or as a way of improving the safety and efficiency of hospital care. In that light, I see physician leaders as folks who free up the creative talent of their colleagues in service of quality, safety, and improved overall health of their communities. To put it another way: those systems that have been the most successful generally have physicians at the helm."

And finally, Chris Fox responded to my recent column exploring the chicken vs. egg quandary of hospital technology spending; that is, do hospital IT investments drive financial success or are fiscally thriving institutions simply more likely to make those investments?

"I've seen both sides of the coin: strong organizations that wanted to drive greater efficiencies through the purchase of a technology solution, and struggling organizations that needed to get their houses in order and were attracted by the ROI. Often, organizations that are struggling have difficulties getting budgeting approved for technology expenditures because their focus is on cutting costs, not believing they can afford to invest in sustainable strategic initiatives that can both result in initial savings but also have a transformational, long-term impact to the financial picture of the organization. On the other hand, it often happens that stronger organizations don't feel the need to invest in a solution because they have successfully addressed inefficiencies elsewhere. The key, regardless of the organization's financial footing, is to look for technology projects that provide short term and sustaining ROI."

As always, we welcome your comments and feedback on all H&HN Daily videos, articles and blogs. Keep them coming!