Improving Quality

I’m reading Stephen Pinney‘s book called How Hockey can Save the Healthcare System and highly recommend it. Why?

The section on Quality addresses one of the most important lessons for Administrators….don’t always trust your reports. Dr. Pinney highlights the problem in his example with the Pre-Operative Surgical Checklist.

According to the Administrator, the checklist was preformed consistently for two years without issue. The problem was that it wasn’t performed correctly. Significant errors resulted and were unreported.

One of the most important lessons that I have learned from working closely with Medical Directors is that they know the business and when they say something is wrong, something is wrong. Administrators need to dig into the details to get to the bottom of the issue rather than dismissing them.

Dr. Pinney and I have uncovered the same issue. Data is often missing and when data is missing – the reports are wrong. For Administrators, they need to understand why the data is missing and take the steps needed to ensure it is consistently captured. It’s a matter of life and limb – literally.

According to Dr. Pinney, these types of quality and process improvements are key to systematizing medicine and achieving the third aim.


Transparency is the key to consumer engagement in healthcare. Why? In one word – trust. 

Yesterday I participated in a film being made by a US physician who’s trying to wrap his brain around the patient – physician relationship. The film is being presented at a US Public Health event later this year. I’ll be sure to share the link.

Trust is one of the themes that has come up in several interviews that he’s had with both patients [aka: healthcare consumers] and professionals. Reportedly, no one knows who to trust when it comes to healthcare.

Trust has been eroded in both Canada and the US but for slightly different reasons. 

In Canada, the lack of choice and ability to actively participate in treatment decisions is eroding patient trust. Canadian physicians have no financial incentive to invest the extra time needed to educate their patients. 

In the US, the lack of pricing information and network participation is eroding patient trust. American physicians need to educate and almost sell their patient on their plan but patient trust has been undermined with various out-of-network and billing strategies.

When I ask people if the 80/20 rule [80% right thing done] applies in healthcare – most don’t agree. The responses are pretty dismal.

Trust is clearly a problem. Transparency will help to re-establish trust.


After 20 years of talking about consumerism in healthcare it’s easy to loose site of progress made and the benefits realized.

I spoke with an executive of Infoway yesterday and realized that Canada and the US are in much the same spot.

EHRs have for the most part have been purchased and implemented across the US and Canada. It’s taken longer than most of us in the industry expected. There have been a lot of mistakes made, lessons learned and yes – successes!

One thing that I really enjoyed is reading are the benefit studies done in Canada that highlight how the EHRs and other solutions have reduced the number of redundant tests, negative drug interactions, ER visits and admits.

Professionals in both countries are tasked with doing more with less. However, both countries are still struggling to get the financial incentives right to improve access and outcomes.

The US is shifting to more risk based models to reduce over utilization and improve outcomes. While in Canada, they need incentives to increase thru put and reduce the waiting times for non-emergent services.

The engaged consumer is the answer to both challenges. The problem is the word consumer doesn’t resonate with Americans or Canadians in the context of healthcare.


Millennials may be rejecting the ACO model.

As prices for comprehensive health insurance increase, millennials seem to prefer on demand service purchased at time of service [aka: fee for service].

Primary care physicians work as the coordinator and gatekeeper in the ACO model. They care for, triage and refer patients to specialists as needed.

However, new reports indicate that most millennials don’t have a primary care physician. Instead they seek care on demand from walk-in clinics and urgent care centers as needed. Both are fee for service business models.

Millennials seem to be cost conscious healthcare consumers that will likely engage in care decisions and explore self-care solutions over traditional healthcare.

What we expect from millennials in 2019:

1/ Many millennial purchasing health insurance on the exchanges will purchase the Copper Plans over comprehensive coverage.

2/ They will continue to use the healthcare system as needed and pay on a fee for service basis.

3/ They will leverage technology to the fullest extent possible to manage their health, direct their care and store their health records.

What’s the impact to the exchanges?

The cost of comprehensive coverage is going up. Reportedly, the population covered is again using more healthcare expenses than expected.

The concern about the viability of the ACA comprehensive insurance plans seems to be playing out as many expected.

Post: Workplace Wellness

Fundamentals of wellness in the workplace.

Wellness is for companies of all sizes. It doesn’t take a lot of money to provide employees with a workplace that promotes wellbeing and empowers them to do their best work.

1/ Environment: The workplace itself matters. Fresh paint that enhances the light and a well organized space will promote a feeling of calm.

2/ Tools: Get creative. White boards and colorful markers are great tools to engage people in problem solving.

3/ Location: Reduce travel time. Incorporate collaboration tools to enable remote work and work from home programs.

4/ Travel: Reimburse and reward healthy choices. Allow for expenses the promote walking, healthy meal choices and exercise.

5/ Education: Provide a path for growth. Online education is an affordable way for companies to promote continuous learning.

6/ Coaching: Provide diversity and equality training. Appropriate behavior and conduct for the workplace needs to be defined so that people are clear about what movements like metoo means to them.

7/ Compensation: Provide equal pay for equal work. Compensation is the foundation of health.

Everyone wins with the fundamentals.

Post: Networking

How often are you networking with intention?

Why do I ask? New opportunities often come from the people you know and who know what you do.

I started thinking about this after meeting with another small business owner who told me his entire business comes from referrals.

I couldn’t help but do a little research into networking and how people are getting referrals. I’ll share a few things that I’ve learned so far about networking with intention.

Tips for Intentional Networking:

1/ Networking Groups. Find a business group serving the same industry or types of people that you would like to meet. Regular attendance matters.

2/ Schedule 1:1’s. Schedule a one hour meeting with everyone in the group to develop a more meaningful connection. During the meeting, share your name, what you do, the types of clients you serve and the types of connections that would be meaningful to you.

3/ Connect people. Some people make connections naturally and others have to be prompted. Don’t be scared to ask for a referral.

Social Networks:

LinkedIn is a great way to research people and build a network. It’s pretty meaningless if you don’t use the connections.

Start with a message about why you want to connect as part of your request and follow up with a call or meeting. If you don’t know why you want to connect, don’t send the request.

Follow them to get insight into who they are and what they do. Then if you think it would be valuable to connect with them, send the request to start the conversation.

Health and Fitness: Hello Workout is another good way to network if you’re in the business of treating and caring for others. Get more information or sign up Free.

Automation + Motivation

Learn what you should be doing now as automation changes the way people work and get rewarded.

Last week I read about a recent Bain & Company report estimating the automation of 40 million jobs [25-30% of US jobs] within the next decade. White color jobs are not immune from outsourcing or automation.

That’s eye opening but technology has made the world feel a lot smaller since the dot-com boom. When I first started my online training business in 2000, a healthcare CEO asked me where my colleagues were located. Everyone was scattered around the US. It seemed to make him feel uncomfortable, but even then high speed internet access enabled my development team to communicate and collaborate in real time.

The tools are better now but technology is also getting smarter. In 2009, I closed my online training business for two reasons:

1/ Much of the revenue cycle work and financial reporting in healthcare could be automated.

2/ The companies that needed a training program were more focused on extrinsic rewards.

Algorithmic Work:
Revenue Cycle work for the most part is algorithmic work or in other words, work that requires routine processing. At least 90% of revenue related transactions can be automated now if companies have invested in their systems. Old patient accounting systems that relied heavily on data entry as a source of information are now the problem because much of the information contained in them is dated and incorrect. There are better ways to obtain, use and store the patient data needed for transacting business.

Heuristic Work:
Automating revenue cycle transactions also changes the skillsets needed to manage the systems and do the remaining 10%. The work becomes less about routine processing and more about creative and analytical problem solving also referred to as heuristic work. Given the nature of the work, heuristic work typically cannot be outsourced or automated.

Many healthcare companies still rely on incentive based reward structures to motivate people to work. Productivity goals made sense when much of the work involved routine processing. Unfortunately, it doesn’t work the same way for people intrinsically motivated by the work itself. In fact, “if then” rewards are often counter productive because it turns something that people enjoy doing into the drudgery of work. Worse yet, decreases in intrinsic motivation can lead to destructive behaviors.

Goals may cause systematic problems for organizations due to narrowed focus, unethical behavior, increased risk taking, decreased cooperation and decreased intrinsic motivation. ~Drive by Daniel Pink


Referring back to #2 of my reasons, companies led by people who are driven by immediate extrinsic rewards underperform over the long term simply because they underinvest in training, systems, research and development. Same is true for publicly traded companies who provide the most earnings guidance to Wall Street analysts.

Drive by Daniel Pink is a book about Motivation that does a good job of connecting the dots of several leaders in modern behavioral research.

Extrinsic rewards are addictive particularly for type A personalities but at a certain point, they don’t make people happier. In fact, people driven by extrinsic rewards are more likely to feel anxious and depressed than intrinsically motivated people.

Three Ingredients of Motivation:

1/ Autonomy: According to Tony Hsieh, founder and CEO of Zappos and author of Delivering Happiness, perceived control is an important component of one’s happiness. When performance goals are tied to compensation it become more about the money and less about the work. Plus when performance metrics are varied they are harder to finagle.

2/ Mastery: Tony Robins recently posted on LinkedIn “All my past failure and frustration were actually laying the foundation for the understandings that have created the new level of living I now enjoy.” That’s mastery. It’s a lifelong period of effort to improve performance in a specific domain. According to Carol Dweck author of Mindset, the effort that it takes to master something meaningful [aka: pain] is what gives meaning to life.

3/ Purpose: The most deeply motivated people – not to mention those who are most productive and satisfied – hitch their desires to a cause larger than themselves.” There are some good examples in Drive of companies leading with purpose. One of which is Toms shoes and another good example not in the book is Patagonia.

For me, our online training program was about giving our students a career path to better job opportunities and a brighter future. That’s why I remained so passionate about it for so long.

So what do you need to do now:

1/ Figure out what type of work motivates you.

2/ Invest in your skillset rather than relying on your employer for training.

3/ Deliberately practice so that you improve.

4/ Identify your Why or in other words, your purpose.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.


Success with Wellness

There is no silver bullet for increasing engagement in wellness programs. However, successful programs with higher than average participation have common elements. 

5 Elements of Successful Wellness Programs:

Offer choice so that you meet people where they are at on their journey for better health.
Working out should simply be time for everyone to do something physical and enjoyable. Offering choice is the easiest way to meet people where they are at on their journey to better health. Many corporate wellness programs make it easier for employees to move throughout the day by implementing walking meetings, standing desks and treadmill desks. Personal trainers, including Harley Pasternak now believe that people can get lean in life just by standing more and walking at least 10,000 steps/day which is about 5 miles/day. 

Lean is not enough. People also need to be strong [and flexible]. Some companies are encouraging employees to workout at their desks or wherever they feel like it because just 5 minutes of resistance training each day improves health over time. Others are offering on-site classes, access to company gyms or contributing to workout related expenses by adding a fitness benefit

Make the healthy choice the default choice.
Subtle changes in what you offer and how you offer it can have a big impact on choice and waistlines without causing mutiny. Target makes the healthy choice the easy choice [aka default choice] by giving employees an extra discount on healthy food and workout clothing purchased from their stores. Other companies such as IDEO are finding success simply by putting the water on the top shelf and soda on the bottom shelf in company fridges. Employees are now drinking more water than soda. 

Reflect your cultural values in your program
Think about what your company does, who your company serves and what the company values for ways to link your wellness program to the core mission. Target successfully aligned their business with their social mission to reinforce their cultural values of wellness in the communities where their employees live and work.

Engage people who can inspire healthy changes and support the program
Dayton, Ohio RTP [Fat Bus Drivers] took a risk by adding a health coach and it paid off over time by reducing healthcare costs. The “secret” to their success is that they truly care for their people and it’s reflected in everything they do from privacy to celebrating milestones. Having a boss that has walked a day in your shoes probably helps too. Mark Donaghy, CEO of RTP shared at the recent FitBit Captivate conference that he started as a bus driver and to this day still identifies as being a bus driver. Can you imagine having a boss that not only relates to where you are now but also shows you the path to a more successful life? That’s powerful.

Reward Healthy Behaviors
Share the healthcare savings with employees who participate and meet their goals. The Dayton Ohio RTP program rewarded employees who participated with enough money to cover the increase in premiums each year. Doing so reinforced the fact that healthy behavior lowers healthcare costs for all.

Successful wellness programs do more than lower healthcare costs. Publicly traded companies with wellness programs are outperforming their competitors with better recruitment, retention and productivity.

About the Author: Shannon Smith is a healthcare strategist with over 15 years of helping companies achieve greater success and the founder and CEO of Hello Workout, Inc.

Keep it Simple

Einstein was famously quoted saying “Make everything as simple as possible…”.

Keep it Simple may sound like common sense for some however, making a product or process simple takes a lot of work.  For large companies it is the latest transformative concept being used to recruit and retain good employees. Technology is now enabling large companies to offer employees more control over their work life. How you ask? It starts by giving people more flexibility over when and where they work. For instance:

Virtual office environments and collaboration tools are enabling people to work from where they feel most comfortable whether it’s at home, in a coffee shop or at the office. Large employers are realizing that people don’t need to be in the same physical location or even in an office to collaborate effectively and that employees are more productive when they can choose where they work.

Employee portals provide access to information and people on demand and now guide employees through essential processes so that they get the right information tailored to them at the right time. Employees can complete their on boarding paperwork, quickly build their internal network by connecting with coworkers, managers and other colleagues, find courses and training programs and manage their benefits from one place. 

Sounds good but like with all technology the effectiveness depends largely on how it is implemented and embraced by the organization. For example virtual offices can be plagued by the same types of biases as physical offices if the focus is still on presence [people logged in] rather than performance.

Transparency is a key ingredient for an initiative like Keep It Simple to be truly transformative.  Companies need to be transparent about the things that matter most to employees like pay and performance measures.

Compensation: Pay is still a problem for most companies largely because salary history is still a function of the compensation formula or at least a benchmark used to set future pay. What people were paid in the past or at another company has nothing to do with the value of their contribution in a new role.  Replacing salary history with a base pay for everyone would eliminate past inequities especially for women and minorities and properly value the work being done.

Performance measures: Job descriptions rarely make the priorities of a job clear. Often they contain a long list of duties but rarely spell out how success on the job will be measured. Think about it….what is the elevator pitch for your job?  If you can’t articulate what you do, your job description is likely too vague and it’s time for a chat with your manager. If you have a pitch, try it out on your manager. It’s probably the fastest way to find out whether you’re in sync or if there is a gap in understanding that needs to be closed.

We all have lists of things that we’d like to do and then there are things that we have to do whether we like it or not. If we want people to focus on things that they have to do for the company to succeed, the nice to dos have to eliminated from the job description. In fact it may be time to replace “job descriptions” with job summaries that highlight the top 3-5 responsibilities and personal qualities needed to succeed in the role. Make them real so that employees can see into the job [be transparent about a day in the life] and decide whether it’s right for them now or not.

About the Author: Shannon Smith is a strategist with over fifteen years of experience helping companies achieve greater success.