Colorado Assoc of Healthcare Executives

I took the day off from work on Friday, left at 5am to drive to Glenwood Springs for a Colorado Association of Healthcare Executives (CAHE) conference.

One of the topics was "Using Lean Principles to Optimize Workflow and Quality in Cardiology Care". The speaker mentioned Deming (same guy that my statistics teacher had us read a book about). Basically, the talk was regarding applying Industrial Engineering concepts to healthcare (without calling them that). I spoke with him afterwards because I am still trying to figure out why the healthcare industry hasn't caught on to the basic concepts that most businesses have been doing for 20 years. I suggested my theory that even though there are plenty of people with their MBAs in the hospital, most of them have medical undergrad degrees or backgrounds. They get their MBAs but never leave healthcare, so they don't see it implemented in the real world and have a hard time doing it themselves. He agreed with me and encouraged me that my educational background and prior work experience could be very valuable if I continue in the field.

I'm just trying to figure out who's really running the show and what leadership position I would need to be in to make a difference. Plenty of hospitals have Process Improvement or Quality teams/departments. Even the hospital I'm at has one. They make departments choose a Performance Improvement project. I even get solicited from RNs that want to use the EMR to help them on a improvement project, so they can get a certification. To me, it is just like Bob Nardelli trying to bring Six Sigma to Home Depot. There is a group dedicated to Six Sigma. They all have their black-belts and guide those working on Six Sigma projects throughout the company; however, from my perspective few of the projects seemed to be completed. I'm guessing perhaps people got a little busy working until 4am on a Sunday preparing for a quarterly earnings call. There is a similarity in these examples, and it's that the leadership perhaps likes the idea and thinks it should be happening, but ultimately it is not a priority. The speaker made a comment that followed the information in "If Disney Ran your Hospital, 9 1/2 Things You Would Do Differently." The comment was that the culture change has to come from the top and not just mandated, but the top leadership has to really believe in it. Of course, you balance that with every other issue going on (just check out Eileen's blog), and it becomes difficult to manage. Ahh...then it just becomes like politics to me. Everyone has their one area they care the most about and they fight for that one. So the person at the top trying to make everything balanced and fair doesn't really stand a chance. I care about efficiency and processes because it's what I know. The only difference I see is the topic I care about most, if applied, could probably help in all the areas others care about. Streamlining and making processes efficient should save you time or money that you can apply to other areas. It just takes a lot of effort upfront, which what I've learned from trying to implement an EMR, no one has the time to give. I questioned how the speaker was able to make changes in the Cardiology department. He's the administrator and the key was he made changes to staff issues and left the doctors alone. They benefited from the change but didn't have to put in any significant effort to make it happen. Honestly, I wouldn't tell him this but the changes he made could have been done by an Industrial Engineering Senior Design project team.

He also mentioned to me that he thought healthcare was about 5 years behind getting traction on these ideas. He made a distinction between "lean" concepts and something like "Six Sigma". He said most companies implementing Six Sigma have already gone through the lean process. They are starting out with somewhat trimmed down, lean processes. The Six Sigma method then improves these. The lean concept focuses on "Plan, Do, Check, Act" (the Deming cycle). He thought most hospitals had problems with the "check" and "act" part of the process. He had to get help from an outside source when trying to implement changes in his own hospital because he didn't have the experience or education to do it himself. I've seen at my current work that people are asked to do things they have no experience in and are given no guidance. Often, there are good ideas but they get lost in poor execution. That's an interesting topic "poor execution". I saw it demonstrated at Home Depot and now the hospital. There is a book on the topic, perhaps my next read.

Where are they now?

My 10-year high school reunion is coming up in October, although I'm not sure I'll make it back to Atlanta. It's fun to see how much people have changed or what they're doing with their lives. Here's a few people I've tracked down in this little entry I like to call "where are they now?"

We knew him in highschool to be a phenomenal trumpet player, and Suzanne took him to prom twice. He went to Brevard, Baylor and Yale. I believe he married a clarinet player from Texas, currently conducts the Greater Erie Youth Symphony in PA and perhaps will become the new conductor of the Amarillo Symphony.
Yup, it's Eduardo Espinel.
Nice tux - looks very professional. I hope he beats out the other candidates for the symphony position.


Next, another high school friend; this one played the french horn. We were roomies on a trip to Savannah where we ordered room service of chocolate shakes and buffalo wings. We spent two summers at Brevard Music camp together. The first time I was in a small plane was when her father flew us from NC to GA. She went off to college at Florida State and now is a Special Education teacher at our old high school. It's Allison.

Now going a bit further back...
She was my best friend in elementary school. She wanted to trade me her little brother for Eileen (I wasn't trying to get rid of you Nins, she just always wanted a little sister). Our teacher in the 3rd grade let you take the day off on your birthday and hang-out in "the booth". It was a little room setup in the corner separated from the classroom with cubicle partitions. You got to invite one student in the class to hang out with you in the booth. There were movies, games and snacks. She was my guest on my birthday, and we got in trouble for laughing too loud.

You guessed it; it's Kimbree.
Last time I emailed her in 2001 she had just gotten married. She has own business, The Invitation Chicks. She also had a daughter! Above is a picture of us from the 4th grade (please ignore my bangs, it was the 80's in Texas). And here is an updated picture of her with her family; she lives in Texas.

Whale Done!

I borrowed the book "Whale Done!" by Ken Blanchard from a co-worker this past weekend. It's a quick read regarding "the power of positive relationships". It basically teaches you how to manage people and relationships based on how the trainers at Sea World manage their relationships with the killer whales. I enjoy reading on the subject of rewards in the workplace and evaluations. I have never agreed with most companies methods of evaluations. I'm always intrigued to read new ideas on the subject. The Sea World question: how do they teach the whales and get them to do what they want? Obviously they don't lecture the whales or hurt them if they don't follow instructions. The whales aren't just performing for the fish treats either or else they'd have to starve the whales before shows so the whales would be hungry enough to want to perform the tricks. So what do the trainers do?

An analogy used in the book is a toddler learning to walk. When a toddler stands up and takes a few steps, parents cheer, clap and smile. When the toddler falls down, the parents don't discipline him or her, they just wait for them to be successful again by standing up and the parents cheer again. It keeps the toddler focused on the positive...and you get better results. Interesting concept.

The other idea is regarding annual reviews where managers are forced to put their employees into categories of poor to above average performance. Somebody has to be a poor performer. The book points out that companies don't hire employees based on these categories - you hire winners or potentials winners. So if you don't hire people on a performance review curve, why grade them on one? In most companies I've worked in, there have been a few employees that just don't get it or are slacking off. But it's usually an exception and that person leaves the company anyhow. Forcing a few people to be put in the poor/low performer category just because you have to have a bell-curve is ridiculous. Many books I've read suggest categorizing people is ineffective, yet they don't offer other options.

And yes..."Whale Done" is a play on words of "Well Done".

Saki and Miss Kitty

I'm dog-sitting for Joan for the next few days. Miss Kitty has been at my side every minute. At night she sleeps on the floor right next to the bed. You'll notice in the picture that Saki (laying in the grass) has a bandage on her leg. Joan left me the materials to re-bandage it if it came off. The other choice was just to leave it unbandaged, but it looked pretty bad to me, so I redressed it this morning. It was a little difficult since she wouldn't stand up for me. If I were graded on my wound dressing skills - I'd definitely fail. I was surprised when I got home this evening that it hadn't fallen off yet.

Endoscopy

For work this week we were certifying the Gastroenterology clinic. When talking with the clinic we learned they were short a few faculty members and were having a difficult time finding gastroenterologists to hire. When I thought about it, I figured not too many med students would want to go into the field. It didn't sound like one of the most thrilling areas of the body to focus on. Later in the week, the clinic manager took us on a tour of the Endoscopy procedure area. We saw the room where they keep all the scopes and one of the RNs described each of them to us. I have to say, the technology that's been developed for the practice is amazing. Here's a pic of a scope. Each of the tubes inside the scope has a different purpose: camera, water, air, and something that can be used to take a biopsy. They also have ones with tiny ultrasound pieces on the end and cost about $50,000. It's amazing where technology has taken medicine. Some procedures that occur in the Endoscopy lab keep patients from having to get surgery.

Macy's in Denver

I went to the mall and walked through Foley's. I was excited to see the buyout by Macy's was finally happening. They got one of my favorite brands, International Concepts (INC) a couple of weeks ago.

Small Group

** Happy 28th Birthday to Billy and Matt **

I went to the bible study small group tonight that I've missed out on the past couple of months. I really enjoyed it back in May but got very distracted by school this summer. It's nice how easy it is to show up, and it doesn't matter that you don't know anyone, they are just welcoming. After the study, a group of us went to Wash Park Grill to grab a drink. The one girl actually works at the same hospital I do; she's applying to medschool right now. The other two guys I hadn't met before. Same story as last night, it was fun to hang out with a different group of people.

Dinner with the 20 somethings

I found an internet site, Denver Linkup, for events a couple of months ago. The events were always planned on nights when I had class. But tonight I was able to make the 20 something girls night out. We had dinner at Il Fornaio, the same place I went for my birthday. It was a good group of 10 of us. It's always fun to get together with a group from a variety of backgrounds. The most entertaining was the girl who is having a birthday next week. She was speaking about how she wasn't going to do anything special. She didn't feel bad about not celebrating because she said she celebrates everyday. And her example of something special was having strawberries in her cereal. It's nice when you can be grateful and value the simple things.

On a side note, I happened to be reading through an old journal tonight and came across an entry from exactly 2 years ago where I wrote, "The Denver trip was good. I think I'm going to move there." It's interesting to me to reflect back on that decision and how it came to be.

At the time, I was also working through the book, "The Path" by Laurie Beth Jones. One of the exercises was to describe your dream job. I wrote:
1) Help people - I get extreme sense of satisfaction delivering completed work to people and it helps them in some way
2) Not always at a desk
3) Performing calculations / working with data
4) Being creative/fun, design something
5) 1-on-1 interactions
6) Feel like part of team
7) Being the expert or "go-to" person

Technically, my job has all of those qualities. I get to help people use the software, I'm not at a desk all the time but in clinics, I work with lots of data and information, I get to design processes and tools, I have many 1-on-1 meetings with clinic staff, I work with a team daily and I definitely am the "go-to" person for all the things I've designed or areas of the software I've specialized in. It amazes me that I did find my "dream" job. Of course now that I've met those 7 and have more work experience I could add several more to the list.

Off to GT

Megan and I had dinner with Sarah tonight at PF Chang's in Lodo. Sarah is heading off to Georgia Tech in about 2 weeks. She was a winner of the Colorado Club's scholarship. Megan and I had fun giving her tips of what to expect her freshman year. It was fun to reminisce about the college days. It's such a shame that you don't realize how good you have it until you're out in the real world.

Now so others that attended Tech can reminisce, here's a document that floated around campus for awhile. I think it originated during Greek Week, a parody of a popular graduation speech at the time:

Ladies and Gentleman, Get Out.
If I could offer you one piece of advice, one goal for the future, getting out would be it. The social, psychological, and physical benefits of leaving this place have been documented by employers, doctors, counselors, psychologists, therapists, nutritionists and personal trainers. I can't give you detailed advice about getting out, I can only advise you about making the best of your time here. I shall dispense that advice now.

Realize the overworked student's need for relaxation. Meet this need. Party long, party hard, party often. Learn the difference between a pilsner and a lager, regardless of whether or not you drink them. Tear down a goal post. Tear up hedges. Keep parts of both. Don't wait for the Stinger, but know that the arrival of the Stinger is as likely as an A in Emag. The real Stinger is that bus that just pulled away as you walked up. It will be by again tomorrow. Wear your RAT cap. When you say BUDWEISER, you've said it all.

Learn that Brittain Dining Hall only serves twenty different foods. Learn to love these twenty foods. And when that isn't possible, learn to mix them together to make new entrees. Discuss strategies for stealing the T, even if you don't really plan on doing it. Scream at midnight during finals week.

Try not to berate people who forward emails. But let them know you don't appreciate it. Let them know that the Cancer Society isn't going to donate 3 cents to anybody. Let them know Disney World isn't going to send anyone on a free trip. Let them know that you deleted the last chain letter and you weren't mauled by pigeons like it said you'd be.

Drop a class. Join SGA. If you figure out exactly what it is that SGA does, please tell me. Climb the coliseum. Climb to the top of the EE building. Climb the fence around the Aquatic Center. Read the syllabus....even if you promptly forget what was on it. Rush.

Learn that SAC fields gives one mother of a rug-burn. Do not read the Dean's List; it will only make you feel stupid. Switch to semesters. Change your major to Computer Science once, but leave before your social life disappears. Change your major to Management once, but leave before your intellect disappears.

Maybe you'll get parking, maybe you won't, maybe you'll get housing, maybe you won't, maybe your class will be taught by a good professor, maybe your class will be taught by STAFF. Whatever happens, know that the faculty is out to get you. Order Junior's French Toast Special after an all-nighter. Visit Athens. Count the ways that we're better than UGA.

Accept certain inalienable truths, you will spend long nights on CS1502, and the ratio will become a reality, and you'll never find the word that you need, but you'll move towards graduation anyway, and when you reach your final year, you'll fantasize that during your first years you aced 1502, you had to beat the women off with a stick, and there was always someone willing to share their word. Share you word.

Realize that you probably can't dance very well. But realize that most other people can't dance very well either, so, comparatively, you're doing okay.

But trust me about getting out.