Connected Thinking Blog - NACHRI Conferences

Annual Meeting of the Membership

The annual meeting of the NACHRI and N.A.C.H. memberships took place over lunch. Outgoing Chairman of the NACHRI and N.A.C.H. Boards Ned Zechman, president and CEO of Children's National Medical Center, welcomed members and presided over the meeting agendas.

Certificates of appreciate from both NACHRI and N.A.C.H. were presented to the following individuals for their dedication and support of the Associations through their participation on the Boards of Trustees and their committees and councils from October 2003 through October 2009:

• James Mandell, MD, Children's Hospital Boston
• Ora Pescovitz, MD, University of Michigan Health System, Ann Arbor, MI
• Teresa Stroud, Norton Brownsboro Hospital, Louisville, KY
• Frank Tiedemann, Children's Hospital & Research Center Oakland

The following hospitals were welcomed as new Association members:

• Children’s Hospital at SUNY Downstate Medical Center, Brooklyn, NY (NACHRI and N.A.C.H. 1-C Member)
• NewYork-Presbyterian Phyllis and David Komansky Center for Children’s Health, New York, NY (NACHRI and N.A.C.H. 1-C Member)
• The Nebraska Medical Center, Omaha, NE (NACHRI Associate Member)
• Saint Barnabas Children’s Center, West Orange, NJ (NACHRI Associate Member)
• Children's Hospital of Nevada at University Medical Center, Las Vegas, NV (NACHRI Associate Member)
• Cottage Children’s Hospital Santa Barbara, CA (NACHRI Supporter)
• CoxHealth, Springfield, MO (NACHRI Supporter)
• Renown Children’s Hospital, Reno, NV (NACHRI Supporter)
• Women’s & Infants Hospital of Rhode Island, Providence, RI (NACHRI Supporter)
• Nexus Health HealthBridge Children’s Specialty Hospitals, Houston, TX, and Orange, CA (NACHRI Supporter)
• Azienda Ospedaliero Universitaria MEYER(MEYER Children’s University Hospital) Florence, Italy (NACHRI International Member)
• Hospital Sant Joan De Deu, Barcelona Universitat (Saint John of God Hospital, University of Barcelona) Barcelona, Spain (NACHRI International Member)

New boards of trustees members were announced:

• David Berry, Arkansas Children's Hospital, Little Rock, AR
• Tom Bojko, MD, The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, NJ
• Marcy Doderer, CHRISTUS Santa Rosa Children's Hospital, San Antonio, TX
• Peggy Troy, Children's Hospital of Wisconsin, Milwaukee, WI

Re-elected trustees are:

• William Considine, Children's Hospital Medical Center of Akron, Akron, OH
• Richard Cordova, Childrens Hospital Los Angeles,
• Herman Gray, MD, MBA, FAAP, Children's Hospital of Michigan, Detroit, MI
• Randall O’Donnell, PhD, Children's Mercy Hospitals and Clinics

Board officers are:

• Chair -- Chris Dawes, Lucile Packard Children's Hospital 
• Secretary -- Herman Gray, MD, MBA, FAAP, Children's Hospital of Michigan
• Treasurer -- Margaret Perryman, Gillette Children's Specialty Healthcare

After the official meetings of the NACHRI and N.A.C.H. memberships, Zechman shared NACHRI highlights from the past year and priorities for the future.

Great Ideas Poster Winners

Attendees casted their vote for the poster that presented the most innovative or though provoking ideas. The Great Ideas Award winners were recognized at the closing plenary session.  This year there were two posters that attendees felt presented the best ideas.

Poster # 12
Turning Community Leaders Into Valuable Assets
John F. Garofalo, BS, MEd, CFRE
Patricia Swenson
Rainbow Babies and Children's Hospital
Cleveland, OH

Poster # 31
The Refusal of Care Algorithm: Communication is Key to Safety
Andrea Prentiss, RN, MSN, ARNP, CCRN
Baptist Children's Hospital
Miami, FL

View poster abstracts on the NACHRI Web site.

Safety Stores--best practices in PR & Marketing

Greetings to all who are interested in getting the word out about your safety stores.  I led an interactive, workshop-style session, immediately following the panel discussion of hospital-based safety stores.  Children's Hospital of Orange County is one of 10 NACHRI hospitals augmenting their injury prevention education by selling child safety products.  Since our program is in its embryonic stages, I wanted input on best practices.  We approached the topic with a communication plan structure.  Following are our thoughts from the session, and I invite you to add to these.  Jan Lansing, CHOC

Communication Objectives

• Generate traffic
• Encourage staff interaction

We also discussed a few risks that might accompany wildly successful promotion of the safety stores:

• Overwhelmed with interest and traffic
• Giving the impression that the hospital safety store = typical retail (it's definitely not)
• The location might not be readily accessible to customers
• Sales and education may put the hospital at risk (financial and reputational) due to inaccurate education and product recalls.  And, the store may be a financial drain (poor margins and high volume exacerbates the problem)

Target Audiences

We can reach out and communicate to:

• Daycare centers
• Schools
• CPR centers
• Hospital staff
  • Trauma staff
  • Residents/fellows
  • Nurse practitioners
• Baby Registries
• Birthing centers
• Physician educators

Communicate in multiple languages, of course.

Messages/Tactics

We agreed that since injury prevention education is so crucial, the sale of products needs to always link to that education.

Here are some of the tactics we discussed--ways you can leverage the distribution and promotion of the stores within your hospital:

• Be mobile within hospital – flex your locations to Ortho clinic or the ED, for example
• Use plasma screens around the hospital to promote
• Use your website, of course

Then, consider these external opportunities:

• Partner with Scholastic magazines & books, Babies R Us
• Birthing centers/adult hospital
• Integrate with Prenatal Education at those birthing centers.  Provide a "prenatal binder" that includes injury prevention/safety messages with other education, and promote the store there.

Final note:  We agreed that safety stores should not carry a separate brand.  Use the hospital brand to maintain the masterbrand's consistency and integrity.

Teaching Weight Management on a Slim Budget

With obesity front and center as public enemy number one -- at least in most media coverage of child health issues -- it's amazing how hard it can be to implement a weight management program to help guide children into a healthy lifestyle. The problem of course is money. Insurance isn't paying for obesity prevention or obesity management efforts, and few hospitals have the resources to feed money into a program that seems "optional" and is almost certain to lose money.

At Children's Hospital of the King's Daughters in Norfolk, VA, Barbara (Babs) Benson took it upon herself to put together a low-cost weight management program back in 2001. Her strategy for keeping costs low has been to do most of the work herself on a 30-hour-a-week salary, and to borrow everyone else as needed from other programs in the hospital.

She spends a lot of her time and energy to network, network, network. It's been her key to succeeding and growing the program. She serves on community boards related to children's health, volunteers through her program role to help at YMCA events, nurtures relationships with local media, and anything else she can think of to build mutually supportive relationships within the community. She has established herself -- and her program -- as community experts on child health and weight management, and that has created a lot of unexpected opportunities.

Babs teaches the 10-week weight management program to children ages 8-11 in sessions twice a week -- one lifestyle class and one exercise class -- and parents are required to attend. Getting parents involved has been one of the most successful aspects of the program, because it helps teach the entire family about better health and helps children see their parents are invested in improving their lives; the parents often lose weight, too.

Approximately 900 children have participated in the program since it started in 2001. The program has an annual budget of ~$100,000, which it meets. Thanks to early successes, Babs was able to bring on a half-time licensed clinical social worker to help her -- they are the only two paid staff.

Thirty-five percent of students are regular enrollees, charged the full $350 fee; 50 percent of enrollees are from families on Medicaid and are charged only $35; the remaining 15 percent of enrollees are charged an intermediate amount, based on need. Historically, about 75 percent of enrollees fulfill their financial obligation -- the 25 percent who default are never penalized (though this policy is not made public to students). Through experience, Babs learned it was necessary to charge Medicaid families some amount of money to ensure their commitment to the program -- when they offered it for free, more than half the students didn't show up.

Babs -- through her first-hand experience -- has a lot of solid advice to offer and a lot of proven success. The program has received a $60,000 grant to replicate itself in nearby Williamsburg, VA, and a $25,000 grant to fund a publication helping educate children on successful weight management. Babs says, "It's not about money, it's about doing what is right for our children."

The biggest drawback to the program has been its lack of any long-term metrics or follow-up studies to show the efficacy of the program. Short term, patients have seen small, but statistically significant improvements in the body mass index (BMI), but there is no evidence to show that they continue to make improvements after they complete the program. Babs has had trouble convincing people to return after the program for follow up assessments.

When the major focus of weight management education is enabling children to live healthier lifestyles, hopefully forestalling long-term health problems of diabetes, hypertension, joint injury, heart and liver disease, etc., there needs to be an evidence-based case that shows that education has a long-term effect on children's health. Because it will take evidence-based, long-term studies to make the case for other hospitals to implement similar programs and for insurance companies and government legislation to provide incentives for prevention and early intervention.

Listen to the audio recording. (MP3, 57 MB)

What do you think? What weight management initiatives exist in your area and what results have you seen that will help make the case for early intervention and prevention of childhood obesity?

Measure, Compare and Improve or our Future Is Health Care by Walmart

Closing plenary speaker, Joe Flower, CEO, Imagine What If, Inc., Fort Bragg, CA, painted a startling picture of the future of health care -- one in which many services become commodities so whoever can do them faster, better and cheaper wins. This is not immoral, he says, it is necessary for children's hospitals and the U.S. economy to survive.

Flower says there are four vectors that are converging to change the future of health care: 

1. Chronic disease -- We have poor management of chronic disease, which accounts for 70-75% of health care costs. Our payment system rewards acute care, not preventative care, and there is more pharmaceutical control of disease, which decreases mortality but increases morbidity.
2. Cost pressure -- Retail care and global competition will establish a floor for cost and quality. Imagine CT scans and x-rays at Walmart.
3. Consumer power -- They will be able to compare and have choices. You are not the only game in town anymore.
4. Transparency -- With data we can ask the value questions: How good? At what cost? What are the alternatives?

With the $720 billion worth of wasted U.S. health care spending (Flower's estimate), we could pay for health care for the WHOLE WORLD. This waste is not occurring by malice or fraud, but by not looking closely enough at our processes and outcomes to find the BEST way to do things. We have no feedback loops to tell us when doing more can actually do more harm than good. If we measure what matters, we could cut costs in half in 10-15 years and cover everyone, said Flower.

Flower offered 14 steps to change:

1. Digitize everything
2. Query -- Make your database an "n dimensional queriable database"
3. Automate -- Humans increase cost and decrease quality for data entry
4. Measure everything -- You can ask and answer questions you never thought you could
5. Compare and improve -- Look at who had the best quality outcome and replicate it
6. Make it public
7. Lean down -- Ask if it is the best way to do it
8. Safety -- We should have fireable offenses for compromising safety in health care
9. Put physicians on your payroll to build teams
10. Reorganize around medical conditions
11. Bundle services -- Sell what they are buying (e.g. a fixed knee)
12. Put a price tag on common conditions
13. Warranty treatment of specific conditions and do it well enough you never have to pay
14. Delegate -- If you are not world-class at something, don't do it

At the heart of all of this are three key elements: MEASURE, COMPARE, IMPROVE. Working together, children's hospitals have an enormous capacity to decrease costs and improve outcomes. Great examples of this include the tremendous recent success of the CA-BSI collaborative project and the powerful capabilities of comparative data in other NACHRI Research and Analytics programs.

What did you think of Joe Flower's points? What other trends will influence children's health care? Please post your comments.

Crisis Communications in the Blogosphere

The members who joined us in our Crisis Communications session this week at Creating Connections got some great advice from Tom Gonzalez, News Director of WSVN-TV (Fox) in Miami, and from Marcia Diaz de Villegas, Director of Marketing and Public Relations at Miami Children's Hospital.

Marcia reminded us of the importance of comprehensive "fore and aft" work - good planning with the right teams before the crisis strikes, and good follow-up with all involved after the crisis is over.  She used the examples of several recent hurricanes for great illustrations of the importance of that process, and its value for the next time.

She also talked about the incredible importance of keeping staff informed and secure - much of the face our hospitals show to the world are the faces of the folks who work with us.  They need to be on the team as ex-officio members, as well.

Tom Gonzalez let us know a frightening, if true fact:  we cannot hide from the media - he has reporters who will stand on the sidewalk outside until they get a quote from people exiting the hospital, and for pictures, he has a helicopter that can zoom in to the smallest details on the ground.  He urged us to be straight, be honest, and be frequent - make certain we talk to reporters, rather than issue once-a-day press releases.  He also promised he would reciprocate by being honest with us - and checking facts to make certain they are right.

Finally, my main points in the session were that the world of news dissemination continues to change, and sources of news about what's happening in a crisis doesn't neccessarily come from the major media outlets any more.  Blogging - hey, that's what this is - has more readers each day that the ten top newspapers in the U.S. Also, the fact that every cellphone is a still or video camera opens the door to wider exposure and less control over it during a crisis.  The cure:  there isn't one - just methods to manage the crisis to keep the flames down (more light, less heat) and the admonition that more allies outside your usual circle  of friends will come in handy when the storm breaks.

The obvious lesson here is that information will get out - it is in our hands to shape and deliver that information to generate perspective and understanding.

Overall, Creating Connections was a great opportunity to meet so many of you and hear your stories.  It was a fast and powerful education for me.  I learned so much more about the people, places and purposes of our NACHRI members.  Thank you all for that!

Jackson Bain
Vice president, Public Affairs, NACHRI

Risking PR Success

Have you ever skipped reading a whole book, instead going right to the last chapter to find out how it ends? Well, that's how I felt going into this session by Sara Burnett and Kristy Johnston of Le Bonheur Children's Medical Center in Nashville, TN. You see, I knew the ending of their case study but I gained so much by understanding the significant risk the hospital took. Let me explain.

In 2002, Sarah began pitching Le Bonheur's Neuroscience Institute and the physician at the forefront of this center of excellence to the Commercial Appeal. Mary Powers, medical writer, was interested and conducted multiple interviews, but no story came of it. Fast forward five years! Mary called Le Bonheur to say she had figured out an angle to the neuroscience sotry. She wanted to write about the day in the life of a busy brain tumor program. She wanted full access to patients and families and Le Bonheur granted it. Mary took up residence at the hospital March 5-9, 2007. The week was selected not knowing how many surgeries would occur or which families would agree to be intereviewed.

Three patients emerged as features and Mary's compelling and emotional three-part series, "The Last Best Hope" was published April 30, 31 and May 1, 2007. The series was a tremendous success. It generated three days of letters to the editor and an outpouring of community support...financially too.

Smartly, Le Bonheur's marketing team, led by Kristy, decided to leverage the series and developed a well-designed piece that incorporated the stories and importantly, the amazing photographs. The piece was distributed widely internally to strengthen the great pride hospital staff take in Le Bonheur. The piece also went to referring physicians, donors and elected officials. In all, 12,000 pieces were printed. The price tag--$25,000.

So now that you know the happy ending, pretend you don't. Would your hospital have taken the risk? Some patients die. Some families get angry with hospitals and retaliate through media. What led Le Bonheur to take the risk?

• the brain tumor program had one of the highest survival rates in the country
• the physicians bought in
• the hospital trusted and respected the medical writer
• the families and their wishes always came first
• leadership supported the effort

Risk was assessed and benefit weighed. Le Bonheur made the right decision, further enhancing its regional reputation.

Congratulations Le Bonheur!

Listen to the audio recording. (MP3, 47 MB)

VHS vs BetaMax: What Healthcare IT Can Learn

It happens all the time.  Someone comes out with a great idea/product, then someone has a slightly different version and so on and finally, the consumer is left to wonder which is better and choose.  And, in a perfectly free market world, price and quality would win out.  A quick look at technology's history, though, shows that big business, special interest and pure politics don't always allow the "best" to win out.  Before DVDs and TiVo, there was video cassetes.  And the two early leading formats were VHS and Betamax.  Arguably better, Betamax lost out to VHS due in part to great marketing on the part of VHS proponents. 

EMR standards could go the same way - the best standard not being the one adopted.  For electronic medical records standards, healthcare IT should not repeat the VHS/Betamax story. 

Healthcare information technology needs standardization.  While we all want the utopia of interoperability - a patient's "chart" can be viewed by any provider regardless of the information system they are using (or not using) - getting there is a daunting challenge.   Groups like the Certification Commission for Healthcare IT can help avoid a repeat of the VHS/Betamax story.

The mission of the Certification Commission for Healthcare Information Technology (CCHIT) is to accelerate the adoption of robust, interoperable health IT by creating an efficient, credible certification process.  As a non-profit entity, this commission takes input from pediatric communities, other pediatric health IT standards setting organizations and uses these input to create the functional and interoperability criteria to improve health care. 

Free market forces are always needed, but in healthcare IT, standards should not be based on "popularity" but rather start with the clinical needs of a patient's record.  With a number of electronic medical record vendors in place, spiraling of vendor specific standards already are occuring and the need for interoperability is already behind the 8 ball.    After all, we are not talking about how to watch a movie...we are talking about something slighly more important...patient care.

What do you think?  Is this a big deal?  Are there parallels between VHS/Betamax and what is happening with EMR standards?  Does this even matter as it will all eventually work itself out?

Enhancing Patient Safety Through the Implementation of Technology

In a panel presentation with representatives from Nemours Children's Clinics in Florida, Alfred I. duPont Hospital for Children in Deleware and Children's National Medical Center in Washington, DC, presenters shared how the implementation of pediatric health information technology has affected their ability to provide safe, effective care.

At Nemours Children's Clinics in Orlando, Pensacola and Jacksonville, a technology-driven push has been made to eliminate unsafe abbreviations, as defined by one of The Joint Commission's National Patient Safety Goals in 2004. A poignant story was shared about a young nurse who mistook a physician's poor handwriting for an order for magnesium sulfate (MgSO4) as an order for morphine sulfate (MS04) and administered the wrong drug to a patient with head-injury. The patient suffered no ill effects -- in fact, the patient requested more morphine because they liked it -- the nurse on the other hand went home traumatized. She never came back to the hospital. The presenter saw her a few months later, at the mall, selling cell phones. She was unable to overcome the thought that her potential error might harm someone. The story drove home the point that with unsafe abbreviations, there can be harm done on both sides of the syringe -- all the more reason to completely eliminate unsafe abbreviations.

Nemours implemented monitoring and correcting software on all of its computerized physician order entry (CPOE), and observed a 3 percent baseline use of unsafe abbreviations in the SIG field of its electronic medical records in April of 2007. Less than a year later, thanks to software that corrects or rejects any potential unsafe abbreviations from being keyed, they are down to 0.002 percent unsafe abbreviations -- almost total elimination of any unsafe abbreviations in their electronic system.

Administration attributes some of the rapid success of the program to the competition between different clinics, who were all striving to improve faster than one another -- a healthy competition and full disclosure of usage rates for unsafe abbreviations helped encourage all clinics to improve as quickly as possible.

Do you see competition in your hospital -- among system hospitals, clinics or even different departments -- as a catalyst to improving processes? In what ways do you see technology changing care -- for the better or worse -- in your hospital?

Listen to the audio recording. (MP3, 94 MB)

Marketing to Latinos: Understanding a Culture

Growing up Latina and bilingual in the ‘70s and ‘80s, I often wondered where the other Spanish speakers were in my class, in my neighborhood and in my Girl Scout Troops.

¿Donde estan mis hermanos y hermanas Hispanos?

Flash forward to 2008 and Latinos have not only multiplied to the point where 1 in 6 Americans will be of Latino as early as next year, Latino culture has seeped into the American psyche, as evidenced by the popularity of Ugly Betty, Jennifer Lopez, Dora the Explorer and salsa dancing. As a child, I could never have imagined that I would be with my Anglo colleagues enjoying papa rellena, mojitos and puerco asado during a business conference let alone sitting through a presentation on marketing a mi gente. ¡Que chévere!

Today, I had the pleasure of hearing Lisette Hoyo of Accentmarketing, a full service public relations, marketing and advertising agency, share her insights on reaching out to Latinos. The fact that there are several agencies specializing in reaching out to Hispanics speaks to the growing number and influence of my people in the U.S.

Some fast facts about Latinos that Lisette shared with the group:

• By 2050, 25 percent of the population will be of Hispanic descent
• 15 states have more than 500 million Hispanic residents
• 88 percent of Latinos learn Spanish as their first language
• 60 percent speak English
• Latino madres tend to put their family’s health above their own
• Latinos are three times as likely as non-whites to be uninsured
• 15 percent of Latino children do not have health insurance

Lisette mapped out a Latino DNA that resonated with my childhood.

• Latinos value group dynamics over individualism, which is why Latinos are so focused on the needs of la familia above el individuo. This may also explain why my parents are still annoyed with me for moving 40 minutes away from them as opposed to the 2 minutes down the road from them.
• Tradition is the foundation for Latino culture. Despite acculturation, Latinos tend to cling to traditional family roles and are dedicated to Latino culture, heritage and language. As a first generation Latina, nothing would make me more orgullosa than having my son become fluent in Spanish.
• Latinos tend to think more about the present and past, and seldom think of preventive health measures. Instead they prefer to have doctors fix their health problems, instead of maintaining their good health. This may explain why my diabetic father continues to indulge in sweets, but looks to medicinal solutions to keep him healthy.
• Latinos are incredibly spiritual and believe in fate and destiny. The state of their health is often attributed to fate, and is not viewed as something within their control.

So how does this translate to marketing a mi gente?

• Cultural relevance is key to connecting with Latinos but it goes beyond language, casting and music. In other words, keep the Latino DNA when building your campaign.
• Latinos are not oversaturated with non-traditional media messages. Tried and true marking tools such as direct marketing pieces, telemarketing and online communications are still a novelty in marketing to Latinos because these tools are infrequently used when targeting them. These tools are viewed as valuable means of becoming informed knowledgeable among Latinos, especially those new to the U.S.
• Empowerment tools and culturally appropriate educational and informational programs can make a great impact.
• Developing a two-way dialogue via educational offerings that include positive and culturally relevant consumer experiences is important.