We are in an era of elaborate medical technology, complicated medical procedures, sophisticated medications, detailed medical regulations, etc. That is reality. It makes this next point quite striking: simplicity is saving lives.

We first came across the utility of checklists in January. By February the powers-that-be declared them to be useful.

Here are some more examples.

Look-alike, sound-alike medications are a problem. Think Heparin. What’s the solution? Make the adult and child containers look as different as possible so providers never mistake the difference. Makes sense. But Paul Levy on Running a Hospital provides an example of an idea that makes Simple Sense:

Our head of pharmacy, Frank Mitrano, likes to say that he wishes that all drugs were packaged in exactly the same sized containers, with covers and lids of the same color, and with simple black lettering on a white background in the same font. Why? Because it is human nature to assume that a vial of medicine with a green cap and green lettering is, in fact, the medicine you were looking for, even if it is something quite different. And, also, the more layers of safety protection information systems and other technology that you have in place, the more likely you are to assume that you have the correct drug and the less likely you are to read — in detail — what the label actually says before administering the drug to a patient. On the other hand, if every vial were to look exactly the same, a human being would actually have to carefully read what is in it before administering a drug.

The Health Blog shares the story of New York City public hospitals and their ability to reduce ICU infections. “But if you find yourself in intensive care in one of New York City’s public hospitals, your chance of catching some nasty infections is way down. And you can thank some pretty simple measures for the improvement.” Simple Sense. Here’s the explanation:

“It’s not rocket science,” Alan Aviles, the hospital system’s CEO, told Health Blog. “It is really four or five or six relatively simple practices that need to be followed every time.”

One kind of hospital-acquired infection — ventilator-associated pneumonia — plummeted by 78% between 2005 and 2007 at the New York City Health and Hospitals Corp., the organization said. Another, central-line infections, fell 55%. Surgical-site infections fell as well, but not as dramatically.

Another way to look at it: The country’s biggest public hospital chain — with 11 facilities and 30% of its patients uninsured — has averaged 5.2 months without a central-line infection, and 5.8 months without a case of ventilator-associated pneumonia.

Mr. Aviles says the hospitals focused on specific “bundles” of precautionary measures to tackle each kind of infection: elevating the heads of ventilator patients and giving them periodic respites from sedatives that can worsen infection risks.

Or, to prevent central-line infections — blood infections acquired when doctors insert a catheter deep in the body — the hospital emphasizes hand-washing, deciding each day whether a patient really still needs a central line, and using drapes and other barriers to isolate the catheter’s entry point from other areas of the body that may be colonized by bacteria.

Birth can become a complicated medical procedure quite quickly.  Fierce Healthcare summarizes a USA Today story in which Premier research says that three of every 1000 infants are injured at birth—and that 80% of those injuries could be prevented.  They are using Simple Sense:

The project, backed by healthcare alliance Premier Inc., is designed to address the major sources of birth injury identified by the Alliance, including failing to recognize when a baby is in distress, failing to perform a timely C-section, failing to properly resuscitate a baby, inducing labor inappropriately with drugs, and using vacuums or forceps inappropriately.

Hospitals participating in this project have committed to following a set of guidelines proven to reduce harm to infants and mothers in each of these situations. Not only that, hospitals are drilling their staff on how to respond, with Harris Methodist Fort Worth Hospital, or example, offering staff the chance to practice with computerized simulators named “Mama Noelle” and “Baby Hal.”

Teams are also taking the time to develop clear plans ahead of time for how to deal with dangerous situations. For example, doctors and nurses are creating agreements on how many attempts to make before using a vacuum device to deliver a baby. While developing such strategies is time consuming, hospital leaders and Premier officials believe that the time spent will pay for itself in reduced expenses and fewer lawsuits.

Principle #18: Simple Sense makes sense.  We are on a mission of constant innovation and reducing complicated processes to their simplest, most effective possible iterations is an ongoing necessity.  Simplicity saves lives.  We need more of it.  our own system is committed to Simple Sense.

OK, so we know hospital and physician rating sites are going to be big sooner than later.  The fact that the rating information is so diffuse at this point allows us to breathe a sigh of relief.  But not for long.  This opportunity to “get the house in order” is a gift.  Act accordingly.

Dr. Michael Millenson writes in H&HN’s Most Wired Magazine on ratings.  Selected excerpts (link via THCB):

The “electronic medical grapevine,” to coin a term, is growing in importance. In 2001, the American Medical Association issued a press release suggesting that patients make a New Year’s resolution to “trust your physician, not a chat room.” As with much other New Year’s advice, this proffered piece of wisdom went unheeded. Today, online doctor ratings have become an integral part of an effort to intensify the interactivity of health care sites and thereby make them more attractive to users.

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If you think this is only the doctor’s problem, think again. Although a hospital’s reputation is woven from many threads, it all unravels without good physicians. Scattered positive or negative comments won’t have much impact, but a pattern of “best doctors” ratings or, conversely, ratings showing the “worst attitude toward patients” can be much more important in a competitive marketplace. To protect themselves, hospitals at the very least should check up on big admitters and prominent leaders of the medical staff. Like it or not, the first thing many “singles” do before a first date is search the Web for information on that potential partner. In that same spirit, keeping track of your physician partners is just common sense.

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We all know that in the real world, the importance of regulatory authorities isn’t going away. But in the virtual world, the electronic medical grapevine is growing in importance in a way that may someday rival the stamp of approval of regulators. These days, it pays to pay attention to the impact of both.

Soon market leaders will emerge in this health care rating business giving the industry needed credibility.  When that happens, it is only natural for the form of those ratings to progress.  And the natural progression will include specificity.

Take a look at SeatGuru, which gives travelers information about the best and worst seats on hundreds of airplanes around the world.  Or the newly launched TripKick which does the same for hotel rooms.  From Springwise:

While TripAdvisor (which acquired SeatGuru in 2007) gives travellers access to detailed hotel reviews by other travellers, who occasionally include info on which rooms to book, there’s definitely an opportunity in getting specific about individual rooms.

TripKick—”your hotel sidekick”—launched with about 250 hotels in 10 US cities, with more to follow. Coverage of each hotel includes detailed information on which rooms to request: which rooms are oversized (rooms ending in 03 and 04, for example), which have great bathrooms or are quieter than others. TripKick, which spent a year gathering all of this information, also points out which floors are better, and which to avoid. Guests are encouraged to add their own reviews and upload photos of rooms they’ve stayed in.

The impact of health care rating sites will be truly felt when the information gets specific.  Specific about departments, about visits, about procedures, about experiences.  Pictures included.  Are you making the necessary preparations?

Health 2.0 is growing quickly. Expect it to continue. A quick comparison from Health Populi:

How much time Americans spend researching:

• Medical procedure or surgeon: 1 hour
• Planning a vacation: 4 hours
• Picking out new appliances: 5 hours
• Deciding to buy/lease new car: 8 hours
• Thinking about a job change: 10 hours…

What is old is new again. I’ve been calling it the wrong name all along. Alas, we call it Direct Practice. Crossover Health compares the old and new physician practice models:

Current Hamster Wheel Model (Dr. running in between patients in 7-12 min increments)

• 2,500 patient population
• 12-15 minute increments
• Tons of paperwork, administrative burden, frustrations, lack of care coordination, ? quality
• Even when patients satisfied with the physician, they hate the experience (long waits, no personalization, unintelligible interactions with health care system)
• Avg Salary = ~$150,000

Direct Practice Model (Direct relationship with patients)

• 500 patient population
• $1,500 access/retainer fee
• Paced, minimal practice overhead, positive interactions, care coordination, increased quality
• Love the physician, love the experience (no headaches, no paperwork, transparent pricing)
• 24/7 access, same day appointments, multiple other amenities
• Avg Take Home = ~$500,000+ (this is conservative)

The Tom Peters blog had the top ten quotes from Mr. Peters at a recent event in London. One particularly caught my attention:

Brand inside is more important than brand outside for sustained success.

What you do inside your organization when the patient is present is much more important than the advertising you use to get those patients in the door. So true.

I have been fortunate (really!) to see the inside of many hospitals. In the great ones I could feel the culture when walking through the front door. Building that culture can be complicated. Signal vs. Noise provides some simple advice:

You don’t create a culture. Culture happens. It’s the by-product of consistent behavior. If you encourage people to share, and you give them the freedom to share, then sharing will be built into your culture. If you reward trust then trust will be built into your culture.

Artificial cultures are instant. They’re big bangs made of mission statements, declarations, and rules. They are obvious, ugly, and plastic. Artificial culture is paint.

Real cultures are built over time. They’re the result of action, reaction, and truth. They are nuanced, beautiful, and authentic. Real culture is patina.

Don’t think about how to create a culture, just do the right things for you, your customers, and your team and it’ll happen.

Instead of building culture, maybe it is Happening Culture.  If you’re trying to build a great culture, you are already on the wrong path.  Let it happen by doing the right thing.  Always.  For employees and patients and providers.

Continuing the brand conversation.

Noah Brier has created a simple-looking application that is allowing users to express their feelings about particular brands.  The collected tags are then displayed allowing companies (or whoever) the opportunity to see what words users associate with a particular brand.  It’s called Brand Tags.  And it seems to be a pretty big hit.

Chances are slim that your health care organization will appear on the site.  Seth Godin provides some advice for our localized organizations: “Superbrands have a mystical connection with people. Odds are, you can’t own one, but there’s no reason you can’t build a micro one, a local one, a brand that’s magical for a smaller group of people.”

Conversations rule the day in marketing. The thinking goes that if consumers have positive experiences they will share those thoughts with their inner-circles. Word-of-mouth marketing calls them influentials.

I believe that how patients feel about your health care organization is going to make a dramatic difference in their choice to patronize you or your competitor in the very near future.

In my personal experiences with those in my circle, hospitalizations and clinic visits are often discussed. Especially if they are exceptional (good or bad, but more often bad). Those conversations are no longer limited to inner-circles, however. Which is great news for the organizations making an effort in this arena. And terrible news for those who are choosing to let it go. The web has made these conversations more sharable, more possible, more influential. It is amazing how influential a hotel review on Priceline can be from someone I have never met. But I do know that as hotel guests we share common interests. And a bad experience makes me think twice about making a reservation, a string of three+ bad reviews makes me run. Look at EBay. Are you more likely to think twice about bidding on an item from a seller who has a rating below 90%? I say yes.

Those same ideas have arrived with Health 2.0. Their impact is still limited. But now is the time to make the necessary changes so you allow and encourage patients to share their *exceptional, outstanding, WOW* experiences with the world.

And it starts with providing a (positive!) experience that is worth sharing. An experience worth starting a conversation over.

From Matter/Anti-Matter:

In an era “when all of us, journalists, business people, and designers are making the transition from being leaders of thought to curators of conversations,” as Bruce Nussbaum describes it, designers, including product designers, evolve from information architects to communication architects. Interaction designers start designing interactions between people (a.k.a conversations) and not just interaction with machines. Mark Zuckerberg of Facebook, while typically not the most eloquent CEO, nailed the mantra of the Generation C(onversation): “The other guys think the purpose of communication is to get information. We think the purpose of information is to get communication.”

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The “aura” of the product is the people who talk about it. Products are the stories of products, and meaning is construed by memories, associations, and provocations. If product and user story match, at least partially, a narrative sandbox, a room of emotional resonance emerges that creates new, proprietary meaning: a third story, if you will. Call it “branding.”

Branding has been around for awhile. But for some reason health care (again) is late to the party. It’s not about making sure that advertisements in print, video, outdoor, online, etc. all match. It is your organization’s everything. It’s the marketing of the experience as soon as the patient is introduced to your organization. It continues with the visit. The cafeteria experience. The gift shop purchase. The bill. And every moment until…well, to be honest, I’m not sure when it ends. Think about the Mayo Clinic. You more than recognize the name. There are certain thoughts that go along with the words Mayo and Clinic. It has stories that people talk about worldwide. They are very good at what they do.

Think about your organization. Does that facility have a story worth sharing? You don’t have to be the Mayo Clinic to do this well. Do your patients enjoy interacting with your organization?  Will they share their experience with the world?

Take notice.

Why medicine delivered today is a 50/50 (split right down the middle) partnership between the physician and the patient.  And a whole bunch of other thoughts that just make sense.

Dr. Mark J. Lema guests posts at Health Commentary.  He urges the design of competent and thoughtful safety systems:

Relying on professionals to do the right thing out of a sense of duty or through fear (malpractice suits) totally ignores the fact that to err is human.  People will make serious mistakes because of misinterpretations, knowledge deficits or persistent habits of thought, even when they try to avoid them. Only systems that:

1.      Avoid Reliance on Memory

2.      Simplify Tasks

3.      Standardize Procedures and Equipment

4.      Use Constraints and Forcing Functions

5.      Use Protocols and Checklists Wisely

will move medicine out of its cottage industry practices into the modern world of systems design.