Room for Specialized Hospitals, Too

Re: “’Winning’ by Defeating the Triple Aim” by Joe Flower in H&HN Daily, Nov. 16

Must it be either/or? If a hospital or system with a specialized role makes a sensible strategic decision that it is not well-positioned or experienced in providing primary care-level wellness-based population health care — but, rather, is much better prepared to handle complex, sophisticated care and specialized diagnoses at quatrenary care levels — why is that automatically bad? MUST one size fit all?

Surely there is room for some hospitals to be specialized and focused exclusively on the most complex care or a specialized diagnosis or narrow population. So if we accept that quite obvious reality, then must we accuse and demonize those systems or institutions as trying to defeat the (some feel quite flawed but now a mantra) Triple Aim? Surely a leading academic medical center can be focused on quality and service — but be focused on a "population" that is narrower than everyone in a geographic area? Why can’t an AMC say it will do this kind of care and do it well, while community-based systems handle the most appropriate level of care for their expertise?

Using Triple Aim as a Holy Grail that ALL must pursue is shortsighted, because the mantra itself is flawed — many leaders talk about Triple Aim Plus One (because Triple Aim makes no mention of the role and engagement of physicians), and others have pointed out that at the core of everything we do are the employees who make it happen. So is it Triple Aim Plus One and Plus One More, or Triple Aim Plus Two? At the heart of all of this, whenever we’ve seen health care organizations rush like lemmings to the next latest, greatest, newest, coolest “this will solve all our problems” solution, we've watched with just as much interest as that doesn't pan out and leaders are off to the races in search of the next totally hot, "save us" trend.

The Triple Aim is a strategy that has great strengths in focusing organizations on quality and service and cost effectiveness, and shifting focus from procedures to health. But there is a continuum of types of health care organizations that can play different roles for different populations.

— Kathyinct


This Is What Matters

Re: “Beyond the Abstract: Health IT Is Still about the People” by John Glaser in H&HN Daily, Oct. 12

My deepest sympathies. My mother, an 86-year-old retired nurse is remarkable in the fact that she not only is still independent in her own home, but also monitors her day-to-day health without missing a beat. We are lucky. It was she who instilled a sense of respect for the medical community and a sense that we are participants in our own care. And under your direction, in two of the companies you have served, I have been glad to be reminded why I chose this business as a focus and the how the work we perform matters.

Sharon L. Smatusek Harris


Tales from the Revolution

Re: “Where Will You be During the Revolution?” by Lola Butcher in November’s H&HN

Kudos to Lola and H&HN for another on-the-mark story about (r)evolutions in health care.

In a 2000 article for another national health care magazine, I labeled many of the same cast of "Health Market 2.0" companies "stealthcare providers," but too optimistically predicted the timetable for them to impact traditional providers and consumers.

In another mea culpa, for more than a decade, I publicly predicted Walmart would become the "800-pound gorilla" in health care reform, not just domestically, but internationally. Many other astute health care professionals agreed. While the company deserves credit for the success of its $4 retail prescription drug program in the United States, in most other areas of health care, where it truly had an opportunity to become a major industry disrupter, several of the other mentioned companies have blown past them.

— Ron Hammerle


Kudos for Blog about Nurses

Re: “Nurse Watch,” a new blog by Marty Stempniak that appears every Wednesday in H&HN Daily

I appreciate the research and information provided in this quick format. Being located in the Southeast, it is interesting to see more of a national forum regarding nursing salaries and job satisfaction. Insightful! Thanks!

— Kristi


Another Fan

Re: “Nurse Watch”

Glad you are doing this column. I suspect that the stories will fill the Library of Congress!

— Betty