An Invitation To Join A Journey To Next Level Healthcare Leadership

You already know healthcare is in a time of tremendous transition.

The Question is what role will you play in this change?  How will you skillfully navigate these waters as a leader in your organization or system?  How will you win or lose in the next 3, 5, and 10 years.

Without question you will get the organization and the success you are prepared to lead.  The greater your capacity there more your success – from revenue to influence.

How prepared are you to lead?  Do you have a comprehensive, cohesive and integral skill set that allows you to navigate and lead a team through the challenges coming at you today and as your role grows?

We are looking for a select group of leaders who want to play a key role for their companies and for the country in this transformation.  The format will be an interactive, collegial exploration of your personal skills in the context of learning proven and transformational leadership skills for groups, corporations, and systems (see attached .pdf).  This course if for lifelong learners who want to take themselves to the next level.

If you would be interested in learning more please contact us at and/or consider joining us Tuesday, May 26th for lunch at the Stagen Leadership – the PDF brochure on this course is attached below.

Again, please RSVP to

ILP Informational Session

When: Tuesday, May 26th


Where: 3535 Travis St. | Suite 100 Dallas, TX 75204

*Parking is available underneath the building.

Stagen ILP – February ‘Osler’ Class

Here’s to a great future for every person accessing the US Healthcare System – and here’s to the leaders who are going to make it happen.  Hope to see or hear from you soon.

Scott Conard, MD

Course Co-leader

Stagen ILP – Osler Class


Forbes Reports States Fail on Transparency – How Are You Doing?

By DrScott – Posted on March 27, 2014 on

Transparency transforms employee’s relationship with health care. Actionable data delivered in a way that allows informed decision making has the potential to save tens of millions for organizations and individuals at risk for health benefit expenditures.

The Accountable Care Act requires making transparency information more available and actionable for the public. This article points out that our states have not navigated this challenge successfully – yet. As Suzanne Delbanco executive director for Catalyst for Payment Reform states, “As much discussion and activity as there is around transparency, the truth is that today it’s a very rare instance when a consumer can easily find meaningful information about health care prices. We’ve got a long way to go.”

The challenge is even bigger than this article acknowledges. To go from an F to an A in the state transparency ratings all that had to occur is that the data had to be put on a web site. As the article states “In order to get a good grade, the groups say a state needs to provide public access to a “fully functioning website” as well as ensure regulations on price information are accessible for a long period of time.”

Engagement data suggests that having access to a web portal is only a beginning. Translating the web information into action often requires human support and interpretation. The moment questions like “is the MRI with or without contrast” are asked, many users are stumped and abandon their transparency exercise.

Avoiding the #3 Cause of Death in the USA: US Hospitals & What You Need To Know About It – Part 2

The gauntlet had been laid.  Don Berwick and the Institute for Healthcare Improvement had challenged hospitals in America to save 100,000 lives.  Time was ticking away, educational programs, mentoring, training had begun but would they achieve the goal?

Eighteen months later on June 14th 2006 at 9 a.m. – Dr. Berwick took the stage to announce the results: “Hospitals enrolled in the 100,000 Lives Campaign have collectively prevented and estimated 122,300 avoidable deaths and, as importantly, have begun to institutionalize the new standards of care that will continue to save lives and improve health outcomes into the future.”

But that was only the beginning.  Remember, if there are 5,723 registered hospitals in theUS, this initiative got 2,300 of them to commit in the first few months.  By the end of the campaign 3,100 hospitals had enlisted.  But thousands of Americans were still dying in US hospitals from preventable causes each month.  So the IHI moved the goal – in December 2006, IHI launched a second, expanded effort, the Five Million Lives campaign.   At its formal close in December 2008, the Campaign celebrated the enrollment of 4,050 hospitals, with more than 2,000 facilities pursuing each of the Campaign’s 12 interventions to reduce infection, surgical complication, medication errors, and other forms of unreliable care in facilities. Eight states enrolled 100% of their hospitals in the Campaign, and 18 states enrolled over 90% of their hospitals in the Campaign.

In 2011 the Secretary of the Department of Health and Human Services Kathleen Sebelius and Dr. Berwick launched the Partnership for Patients, which brings together hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in an effort to make hospital care safer, more reliable, and less costly.  The Partnership for Patients aimed to decrease preventable hospital-acquired conditions by 40 percent by the end of 2013, resulting in approximately 1.8 million fewer injuries to patients and more than 60,000 lives saved over the next three years. It also seeks to reduce hospital readmissions by 20 percent by decreasing the rate of preventable complications during transitions from one care setting to another. The Partnership was to be funded by up to $1 billion in federal money made available under the Patient Protection and Affordable Care Act, including $500 million through the Community-Based Care Transitions Program and up to $500 million through the Centers for Medicare and Medicaid Innovation.    At the core of this initiative are 26 Hospital Engagement Networks, which work with 3,700 hospitals, working with health care providers and institutions, to identify best practices and solutions to reducing hospital acquired conditions and readmissions.  Early results are showing strong progress in 8 of the 10 patient safety priority areas of the Partnership for Patients, more findings are scheduled to be released soon.

But remember of the 5,723 hospitals in the US only 3,700 are engaged.  Meaning over 2,000 hospitals are not on board and thousands of Americans are still suffering unnecessarily.  And this is looking at the prevention of adverse events, not at which institutions are the best at different procedures.  The best spine hospital may not be (and often isn’t) the best heart surgery facility in your community.

So how do you find the right hospital?  It takes research and time. It also takes a willingness to sift through a lot of different data to tease what information would be important to you. Let us think through a visit to the hospital – the quality of the health care a patient would receive depends on many things besides the skill of the surgeon. Many health care providers at a hospital will be directly involved in care before, during, and after surgery. The metrics a patient would want to know span from scientific data on mortality and complications associated with previous treatment of patients with the same condition to the less scientific how did patients respond to the physician and teams of care managing the care.

The result of the complexity of defining a good hospital is the proliferation of information sites that exist in addition to the payers (who are often dependent on contracting). Patients can go to anything from and Angie’s List (which also provide reviews on low complexity services like dry cleaning), to state report card sites or national sites such as Hospital Compare which may or may not have information on metrics associated with your condition. For heavier science aficionados, there are reporting agencies like CareChecks and The Dartmouth Atlas which may look at patient outcomes on a larger system level. Reports are also often put out by institutions such as the Kaiser Foundation or Commonwealth Fund that speak to hospital quality.  Somewhere in the middle of this very complex gamut are sites like Vitals or Health Grades. More traditional outlets such as Consumer Reports or the US News & World Report create hospital listings as well.

But it is not just the hospital.  The doctor and the care team he works with make a significant difference.  In the next blog we will consider how to find and use these best in class doctors.

Avoiding the #3 Cause of Death in the USA: US Hospitals & What You Need To Know About It – Part 1

By DrScott – Posted on March 18, 2014 on

Preventable Adverse Events (PAE’s) is the #3 cause of death in the US leading between 210,000 and 440,000 American deaths annually.  This must stop.  But how?  The answer involves one of the best stories in US healthcare history.

It started when Dr. Donald Berwick, the co-founder, president and CEO of the Cambridge-based Institute for Healthcare Improvement (IHI), was driving with his son, Dan to the airport.  Dan, a political campaign strategist, explained that he was bringing 350 volunteers to Florida for a weekend to knock on 50,000 doors for his candidate.

Awed by the numbers, Berwick, 57 at the time and a clinical Professor of Pediatrics and Health Care Policy at Harvard, shared IHI’s frustration about the slow pace of change in medicine when it came to adopting practices known to improve care and reduce errors.  As the former head of quality-of-care measurement for a large HMO, Berwick knew the numbers: As many as 98,000 American hospital patients die annually from poor care or medical errors. IHI researchers estimate that approximately 15 million incidents of medical harm occur in U.S. hospitals annually, roughly 40,000 every single day.

So, Berwick asked his son the critical question: “What makes your work so effective?” Dan explained what it takes to run a successful political campaign – coming up with concrete numbers (i.e. how many people you want to reach), establishing field offices to reach more people locally, inviting the widest possible participation, giving specific instructions to workers, and setting a deadline.

The IHI  only had 75 people on staff at the time and no way to mount the national campaign needed to create any significant change, or did they?  On December 14th 2004, Dr. Berwick gave a speech to a room full of hospital administrators.  He said, “Here is what I think we should do.  I think we should save 100,000 lives.  And I think we should do that by June 14, 2006 – 18 months from today.  Some is not a number; soon is not a time.  Here’s the number: 100,000.  Here’s the time: June 14, 2006.”

To accomplish this the IHI proposed six specific interventions for hospitals to adopt that had been proven to reduce unnecessary deaths.  If you have been reading the blogs on the book Switch by Dan and Chip Heath you will appreciate that the “rider” now had a clearly defined goal to achieve.

But this was a challenge for hospitals to embrace and get behind.  If they did it, it implied that unnecessary deaths were occurring in their hospitals.  So, Dr. Berwick made it personal.  At his speech he asked the mother of a girl who had been killed by a medical error to join him.  She said, “I’m a little speechless, and I’m a little sad, because I know that if this campaign had been in place four or five years ago, that Josie would be fine….  But, I’m happy, and thrilled to be a part of this, because I know you can do it, because you have to do it.”  Another guest on the stage, the North Carolina State Hospital Association Chair then spoke up: “An awful lot of people for a long time have had their heads in the sand on this issue, and it’s time to do the right thing.  It’s as simple as that.”  (Switch: the elephant was motivated).

The IHI made joining the campaign easy; hospital CEO’s only had to sign a 1 page form.  Once a hospital enrolled, the IHI team helped them embrace the new interventions.  Research, step by step instructions guide and training were provided, and regular teleconferences with the hospital leaders to share their victories and struggles were arranged.  Hospitals with early successes were encouraged to become mentors of hospitals who joined the campaign later. (Switch: the path had been made easy).

But would they achieve the goal? Eliminating errors and documenting the results had not been done this way ever in the US Healthcare system. As a patient, the challenge of finding an excellent facility and doctor to use can be daunting.

Will You Die from the #3 Cause of Death in the USA?

By DrScott – Posted on March 13, 2014 on

In the 2013 September edition of Journal of Patient Safety Article Asks: Will You Die from the #3 Cause of Death in the USA?

Ask most people what the #1 & #2 cause of death is and they will usually know they are heart disease and cancer. Ask them for the #3 cause and you are likely to hear infections, trauma, or pneumonia but few guess American Healthcare.

But the correct answer is the Hospitals in the US. The Journal of Patient Safety in September of 2013 revealed that between 210,000 and 440,000 people die from hospitalizations in the US each year. Here’s how they come to this conclusion.

To begin, it is important to understand the concept of preventable adverse events (PAE’s). These are unexpected and harmful experiences that occur because high quality, evidence-based medical care was not delivered during hospitalization. This can be;

  • Immediate – a side effect of a drug, or
  • Delayed for months – contracting hepatitis from dirty needles a few months after hospitalization, or
  • Delayed for years – getting pneumonia because a pneumonia vaccination was not given to a patient receiving a splenectomy years ago.

PAE’s are further categorized into;

  1. Errors of Commission – the wrong action or right action performed incorrectly on a patient,
  2. Errors of Omission – actions needed by a patient was not performed – for instance a medicine was indicated but not given in a vital situation,
  3. Errors of Communication – two providers or the provider and patient such as failing to give clear instructions during surgery or inadequate discharge instructions,
  4. Errors of Context – for instance when a patient is discharged who is unable due to cognitive ability to perform tasks needed for their safety, and
  5. Diagnostic Errors – resulting in delayed, incorrect, or ineffective treatment such as mis-identifying a tumor biopsy as benign when it is actually malignant.

To identify these PAE’s a systematic review of medical records was performed at hospitals by trained personnel with the Global Trigger Tool (GTT), developed by the Institute for Healthcare Improvement (IHI). The results were then validated by one or more physicians. Four studies with a total of 4,252 records revealed 38 total deaths associated with adverse events. The ratio projects to a death rate from adverse events of 0.89%.

There were an estimated 34.4 million hospital discharges in 2007,26 and the average percentage of preventable adverse events was reported at 69%. Thus, the best estimate from combining these 4 studies is 34.4M discharges × 69% with PACs × .89% death rate = 210,000 preventable adverse events per year that contribute to the death of hospitalized patients.

According to the Center for Disease Control deaths in the US are:

  1. Heart disease: 597,689
  2. Cancer: 574,743
  3. Chronic lower respiratory diseases: 138,080
  4. Stroke (cerebrovascular diseases): 129,476
  5. Accidents (unintentional injuries): 120,859

As you can see, 210,000 deaths puts US Healthcare squarely in the #3 position for annual cause of death.

But even this may be an underestimate.

This conclusion is based only upon medical records. This fails to account for confounders such as poor documentation, complications managed by non-hospital facilities or in the outpatient setting, the “wall of silence” of health professionals altering or omitting critical data when mistakes occur, and the fact some medical errors are not known by clinicians and only come to light during autopsies (rarely performed) to name a few. Thus the actual number of deaths is significantly underestimated by chart reviews by at least 50% given the high probability of these confounders. Given this the Journal Article estimates the actual number of deaths is closer to 440,000 deaths per year, making medical in patient errors the number three cause of death in the US by a significant margin.

A scary conclusion to say the least. What can be done to protect ourselves, and our employees, from this challenge? Join us for next week’s blog.

It is Time to Bend the Healthcare Cost Curve & Receive Higher Quality Care

By DrScott – Posted on March 11, 2014 on

Companies in America spend billions of dollars on medical care, expecting high value, safe and evidence based care. But are they getting it? Transparency data suggests they are not. Specific areas being questioned include;

  1. Are patients getting too much care? How can employers and employees minimize excess care?
  2. Is 30% to 50% of the care delivered worthless? How do we void these costs and reduce healthcare spend dramatically?
  3. Is US Healthcare really the #3 cause of death behind heart disease and cancer? How can employers and employees avoid being killed by American Healthcare?
  4. Do up to 80% of bills submitted to insurance companies contain errors, requiring time, energy and money for employees to correct? How can employees avoid paying incorrect bills?
  5. Are employees actually being driven into bankruptcy due to the medical care they are receiving? How can employers protect their employees from the time, energy and distraction of huge, and at times inappropriate financial challenges from health care bills?

Asked another way: Are employers paying billions for often inappropriate, misguided and expensive care?

What can be done to reverse this trend and to protect the employees and the financial bottom line?

In the next weeks we will explore these questions and discover how the Don Berwick and the IHI inspired hospitals to save over 200,000 lives in 18 months. We will also discover how to avoid paying 300% more for tests and services, how to protect yourself from incorrect billing practices, and how to avoid being hassled and bankrupted by the medical industrial complex.

One key is to make sure your employees are seeing the best providers.

Switching Employees On: Using Video to Entertain, Engage, and Educate

By DrScott – Posted on March 4, 2014 on

Third in the Switching Employees On: Using Video to Entertain, Engage, and Educate Series

Truck drivers can’t watch video’s while they drive! So one company’s president created a series of short 3 minute audios to educate and entertain his drivers while they drive throughout the US. This creative, educational, and motivational series follows all three of the major themes laid out in Switch, Making Change when Change is Hard by Dan and Chip Health. The rider is directed to take the next “baby steps” for health, the elephant is motivated with emotional stories – some funny, others tragic, and the path is made clear to stop by the onsite clinic, contact the Health Pro, and follow the other simple steps to qualify for the “I Care” health plan. Listen to the audio done by one president here.

Switching Employees On: Using Video to Entertain, Engage, and Educate

By DrScott – Posted on February 27, 2014 on

Second in the Switching Employees On: Using Video to Entertain, Engage, and Educate Series

Heart disease is the #1 killer of Americans. The problem is that we often “feel fine” until it is too late – 50% of men die the first time they feel chest pain; 66% of women according to the American Heart Association. To “turn the elephant” to a new path from unnecessary heart attacks and strokes to a long vital life requires creative interventions. In this video all three principles from Switch, Making Change when Change is Hard by Dan and Chip Health are addressed. The rider is directed “get your biometrics and screening done even though you feel fine,” the elephant is motivated “wonderful people who ‘felt fine’ did not get to be there for their spouse and children,” and the path to better care “contact your Health Pro if you do not know what tests are recommended for you, or you need a high quality doctor.” Using this and other tools this employer has been able to increase annual physicals from X% to Y%. Watch the video here

Switching Employees On: Using Video to Entertain, Engage, and Educate

By DrScott – Posted on February 25, 2014 on

First in the Switching Employees On: Using Video to Entertain, Engage, and Educate Series

Engaging and activating employees challenges every company. Creating videos has become less expensive and can be a very effective way to communicate change to employees. Chip and Dan Heath in Switch, making change when change is hard, point out the need for three major principles to be honored (see previous blogs). The rider must be directed, the elephant must be motivated, and the path must be clear. In this video two of the three major principles outlined in Switch are used – directing the rider exactly what to do, and laying out a new, simple, clear, and more convenient path. Thus the chance of “turning the elephant” from expensive, lower value care, to higher value healthcare is increased. Click here to see the video

Bending the Health Care Cost Curve. Making Sure Your Plan Can Succeed

By DrScott – Posted on February 13, 2014 on

Final Blog in the How to Switch On Your Employees Series

Engaging and activating employees to become more proactive in screening for and managing medical conditions when an employee “Feels Fine” is a challenge confronting every employer. Many companies are figuring out how, resulting in lower costs and healthier employees.

The authors Dan and Chip Heath, in the book Switch – How to Change Things when Change is Hard, point to key variables in any change management effort. Using the simile of a rider guiding an elephant down a path to your destination, they share three areas vital to success. Here are key variables scripted;

1. Directing the Rider. The culture and beliefs of a company are vital in identifying what will lead to successful change management. Start by;

  • Identifying successful efforts in the past and understanding why they worked,
  • Scripting the critical, necessary moves – like moving to outcomes based benefit design, and
  • Pointing to the destination – we are moving from providing insurance to providing a culture that supports proactive early intervention and saves lives, to insure every employee is there for their co-workers, family, and friends.

Mistakes often made by employers in directing the rider include: Failing to get C-suite support, not appreciating the politics and informal power structure within a culture, not making the key moves clear, not communicating clearly and repetitively, and failing to articulate the goal in a way that employees appreciate and understand the relevance to their whole life, not just their time at work.

2. Motivating the Elephant. Rational understanding of why and what to do is only one aspect of successful change. Elephants are large, have momentum, and don’t like to change from the well-known, understood, and worn path. Turning an elephant requires;

  • Appealing to the “heart” to touch, move and inspire action. “I have a dream” and “We choose to go to the moon,” united and solidified a change far more than, “here are the three things to be done and why we are going to do them.” Share inspirational moments along the journey so employees appreciate the difference being made by this change.
  • Create baby steps. Trying to bite off too much too quickly will choke the process. We all know the joke “how do you eat an elephant? One bite at a time.”
  • The importance of a learner’s mindset, being open to growth and change, is so obvious it goes without saying. However, making this as a theme of the change effort is often overlooked. To embrace a new way of thinking about proactive health requires a shift in mindset from, “providing insurance” to “insuring that we are doing what we know to do to empower employees to be healthy and productive at work and at home.”

This is an area of health benefit change that will need significant attention in most companies. As opposed to directing the employees (telling them what to do), motivating the employees requires the HR team to lean heavily on their EQ (emotional), SQ (social), CQ (cultural) quotients as opposed to only the IQ.

3. Shaping the Path. Employees are busy. Having to stop and figure out aspects of their life, like health benefits, is not central to everyday success at work and at home slows the development of “muscle memory.” Answering the question “how do I get employees to ‘do the right thing’ to utilize their benefits to the fullest, without having them have to “figure it out” every time is the challenge being addressed.

  • The environment must support the change. Making it easier to do what you want them too than going back to their old ways. Healthy on-site cafés, on site, near site, or mobile clinics, starting every shift with injury preventing stretching or activity, and on site activity centers change the environment and have been implemented (in the right situation) with success.
  • Building new habits such as “contact your Health Pro” for any benefit related question, simplifies and allows employees to confront new challenges in a “just in time” fashion with the development of one simple new habit.
  • Elephants (and employees) travel in packs. Behavior is contagious and reaching the “tipping point” where embracing the change you are advocating in the company goes from, “you did what?” to “of course, that is what we all do” does not happen overnight but will occur.

As I wrote this blog, I received an email from a human resources director at a rural production facility.

“Hi all. I just wanted to let you know that one of our employees had one of his age and gender screenings due to the new benefit plan. An issue was found at an early stage and he will be having surgery to correct it and is expected to be 100%. He told me that if it hadn’t been for our new health plan he never would have gotten the screening and in about a year would have been in a much worse state. So, thank you for the new health plans.”

This is a recurrent theme. Plans that encourage and support effective change make a difference. If you enjoyed this blog series, I encourage you to read Switch – How to Change Things when Change is Hard. This only begins to scratch the surface of this revealing, well done book. The research and stories shared from Vietnam to radishes (and many others), in Switch provide more examples of how to navigate change successfully and will both entertain and motivate your team.

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