10 December 2005

Parents: “Advocate” Means You are the CEO in a Turnaround Situation

In the business world, there are different kinds of CEOs: Entrepreneur CEOs are good are creating something from nothing, starting a company from scratch, and building it into an organization with people, products, and profit. But one who creates something that might not have otherwise been is not always trained to manage it going forward. In fact, most CEOs are good only at running stable, steady-state organizations that someone else created and that are not going through serious crisis and bring in specialists as needed – this is analogous to what your family pediatrician’s job is.

Then there are turnaround CEOs – those individuals brought into save a bankrupt airline, return a near-failing auto company to market success, or rejuvenate a deteriorating firm before it’s too late. Figure out what’s wrong, take control, make immediate and major changes to fix the root problems, garner a quick success, and then move on and let someone else manage it. Unfortunately, there is no medical equivalent to this necessary role. The US healthcare system is not set up that way.

As a parent with a child in the Hospital, there are two things you need to realize.

One, you are the CEO of your child’s medical care – not an advocate, or advisor, or team member. You are the boss. You don’t hold an MD degree, or aren’t an RN? That’s OK, many CEOs have no training or background in the field of the company they are running. (More on that in the next blog entry.)

Two, you are in a crisis turnaround situation. No matter how “routine” or “elective” the reason your child is in the hospital, once they are here they are in a potentially life-threatening situation – whether from the ailment that brought them here or from medical errors, oversights, allergic reactions, anesthesia, and infections.

As CEO, you have responsibility for the same things a CEO of an airline or bank (or hospital) should be doing: defining how the team is organized, who is on the team, what the performance standards are for the team, determining when someone should be removed from the team for poor performance, and so forth. What? You didn’t know you had the responsibility, let alone the authority, for those things? Well, you do. Hospital-based care for children is a far too serious business to allow us parents to merely think of ourselves as the customer or consumer.

If you want your child to survive this experience and thrive afterward, if they are already an inpatient, and you haven’t started doing your CEO job, then you’re already behind. Get moving. Hopefully you’re reading this prior to admission, so you can hit the ground running in your new job.

The next few entries to this blog will give you detailed steps for succeeding as CEO of your child’s turnaround situation. Stay tuned.

Note: Remember this is a blog, so you’ll need to read from the bottom up to read the series in the intended order.

08 December 2005

Seattle Children's Hospital Will Need to Reduce Patient Care Says CEO Tom Hansen

Seemingly eager to continue to shift Seattle Children's priorities away from quality patient care toward his personal research interests, CEO Tom Hansen was quoted in the Seattle Times on December 5:

"Cuts in Medicaid impact our choices and what we can do for everybody," said Hansen, noting that Children's serves four states. "Loss of income could mean reducing services, leading to longer waiting times for major surgeries. And it means that in ranking spending, investments such as those for new diagnostic procedures are impacted," Hansen said.

Let’s remember that in his Seattle Times editorial on November 18 he scarcely mentioned patient care, instead emphasizing his interest in more research. And now that the government may reduce payments to Seattle Children's Hospital, where are the cuts coming from? Patient care. I am appalled that he threatens our children with longer wait times for major surgeries as a political tactic to ensure funding for the Hospital.

He of course does not mention that another potential source of funds would be to reduce expenditures on his new research focus to ensure that our children actually get the care they need today.

If you as a parent are, or are not, outraged by this management attitude at Seattle Children's Hospital, please contact me. Patient care is deteriorating and this is how the CEO is responding -- Give me money or I'll reduce patient care even more.

07 December 2005

Parents: Ask for a Care Meeting

We'd like to think that our children’s medical care is being executed as well as one of the notable Seattle Seahawks offensive plays in this week's game. Unfortunately, the care more often resembles a soccer game of 4-year olds (have you seen the "blob"?). We'd like to think that before the "play" the quarterback has huddled the players and assigned specific roles, defined alternatives that may be communicated through audibles, and maybe passed along commands from the coach via the QB's in-helmet headset. This portrays an image of action, up-to-the-minute responsiveness, full communication, and most importantly teamwork. We'd also like to think that, like the football team, after the game the medical team has gathered to watch game films for hours to understand where they were weak and how they can improve, individually and collectively, in the next game.

This is not what happens with our children’s healthcare. First of all, there is no "team." Instead, players often gather on the field at the last minute, sometimes not sure who the other team is, not having seen the playbook, and not even knowing the other players. The ball is in play, and the scrambling begins. When the play fails, or God forbid the game is lost, this sets up the conditions for finger-pointing. I couldn't catch the pass, it was a bad throw. I couldn't run through the line, there was bad blocking. I don't know what happened; I just never got the ball. Nobody showed me where the goal line was. I didn't know. It's not my fault - it's just how the system is. And they move on to the next patient. Oh well.

As a parent who has experienced the horrors of this, I can tell you that there is only one solution: be the quarterback. This is not a popular action and it is likely that no one at the Hospital will suggest it to you. Doctors, nurses, and administrators may all think they are the quarterback or, more likely, that they are soccer stars that need no quarterback. But they do.

There is no process at Children's Hospital - or at most hospitals - for calling the team together for a team huddle. It will only happen if you do it. You may find a lack of interest in such a meeting, in which case you will have to start aggressively pushing on the system (more on that in a future blog entry). You, Dad and Mom, are the quarterback. You, or your insurance, are paying for this. You are the customer. Your child's life is at stake. You have the right to call the shots.

Quarterbacks aren't the most skilled at running, catching passes, piercing a line of 300-pound defensive players, or kicking a field goal. Their job is to pull the team together to execute the play out of a playbook already defined for them. As parents, this is our job. The Hospital likes to call it "advocacy" which is a wimpy way of saying that if we don't do it, it will not get done.

Do it. Schedule a care meeting and mandate attendance by ALL caregivers involved with your child. If anyone no-shows for any reason other than being paged for a life-threatening situation, report it in writing. We cannot afford to have the equivalent of excited 4-year olds madly chasing a soccer ball around the field not understanding that the objective is to score a goal. Our children’s health, and lives, are more important than that. And despite the foregoing analogy, this is NOT a game.

If you need help, Tom Hansen, the new CEO of Children's Hospital, would be the person to contact as he is ultimately responsible for this. His assistant Susan can be reached at 206-987-2001.