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‘Why Not’ Concept
A Good Mantra for Organizations?

During the holiday break of my freshman year in college, I joined a few dozen other students on a three-day ski trip to Steamboat Springs, Colo. At the time, I had never skied before. Additionally, I was only six months removed from having knee surgery from a high school football injury. This surgery to repair meniscal tears occurred during the summer of 1978, when arthroscopic surgery was still in its infancy stage and not used by my Ottumwa-based surgeon.

Looking back, especially as a novice, I had no business barrelling down a mountain with a tender knee that was still fragile and sore. But as an 18-year old, I considered myself invincible, and besides, I could rely on a knee brace for added protection.

Why Not

The first slope I encountered at Steamboat Springs was a black diamond, simply labeled, ‘Why Not.’ Based on skiing abilities, slopes are assigned different colors and shapes. A green circle may represent an ‘easier’ slope, a blue square may be ‘more difficult,’ and a black diamond is considered ‘most difficult.’ The slope name, I felt, clearly represented my philosophy about tackling difficult obstacles. I attempted to ski down ‘Why Not’ every possible way but the right way. The slope introduced two primary obstacles – steep terrain and heavy moguls that required technical maneuvers at increasing speed. My abilities were clearly overmatched.

After many failures of descending this expert slope, I decided to take beginner lessons on a nearby ‘bunny’ hill. Applying those lessons eventually allowed me to navigate ‘Why Not’ more prudently (though, not expertly!).

Taking Risks

Organizations and their teams are constantly looking for innovative ways to be curious and experimental while encouraging team members to develop fresh solutions for new products or services. Past management protocols typically allowed managers to take the safest and more predictable routes – similar to hanging out on a bunny hill. These practices many times ran contrary to allowing individuals to initiate a more creative ‘laboratory’ of experimentation.

An article in Harvard Business Review by Sara Critchfield does a great job of describing how organizations can develop new ways to train their cultures to foster ‘divergent thinking,’ which is different from creative thinking. Divergent thinking is not about finding one right answer to a problem, but rather, promote a more intense process of exploring many different possible answers that may include:

  • Coming up with 15 solutions to a problem the organization is currently facing.
  • Rearranging company space to make work more efficient with staff, from executives to interns. From this, make 20 mockups for every design change.
  • Managers must stop answering questions, and instead, respond with “What do you think?” Wait for a response, then ask, “What else?’ Repeat this five to seven times.

Critchfield believes that team members who come up with the ideas must not be segregated from testing these ideas themselves, which allows for experimental learning. Empowered team members have the support, structure and time to do thoughtful, careful, creative testing – a recipe that allows cultures to thrive. Setting baseline failure and success rates will help initiate realistic team member expectations. Knowing that failure is always a possibility will both cushion and promote creativity.

Making the analogy of an novice skier with organizations allowing team members to fail might be a bit extreme. Yet, it was only through adaptive learning did I finally make my way down a problematic slope – and live to write about it!

Allowing employees and their team members to exercise their God-given creative juices is not a new concept. But finding new and different ways to confront risks within the work environment just may improve the culture in which employees are required to perform.

What do you think?

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Malpractice Caps Won’t Protect Harmed Patients

Medical-malpractice reform bills currently moving forward in both the Iowa House and Senate (SF 465) attempt to place a $250,000 cap on non-economic damages, such as “pain, suffering, inconvenience, physical impairment or mental anguish.” The push to limit non-economic damages comes from the provider community, which includes doctors and hospitals.

Both sides of malpractice reform offer persuasive arguments on the merits of these reforms. Injured individuals and their lawyers argue against malpractice reform, saying patients won’t be protected against negligent providers. Because of errors, healthcare costs are higher.  Botched care requiring fixes often happens without patient knowledge and involves additional patient and insurance payments. The social and economic costs of medical errors are also enormous.

Doctors and hospitals, on the other hand, usually push for reform, saying it will protect patients from having to pay the high costs of malpractice insurance and help curtail defensive medicine practices – presumably through lower health insurance premiums – and perhaps increase accessibility to some healthcare services.

Interestingly, a recent report from personal finance website, WalletHub, indicated that Iowa is the best state for doctors to practice medicine, when comparing 14 different relevant metrics, and Iowa is the fifth least-expensive state for annual malpractice liability insurance.

But here’s the fundamental question that gets lost: Will capping non-economic damages provide the necessary incentives for providers to alter their practices enough to eliminate avoidable medical errors? This should be the most critical question regarding malpractice reform being debated in Iowa and elsewhere. Unfortunately, the Iowa bills fail to address this issue.

Patients expect to be safe when they receive healthcare from the providers they trust. Yet, solid evidence suggests this trust is routinely violated. We’ve made relatively little progress in reducing preventable medical errors since 1999, the year the Institute of Medicine released their book, ‘To Err is Human.’ In the last year, using national estimates on preventable medical errors, my organization extrapolated that a mid-range estimate that 85,000 patients are harmed in Iowa hospitals yearly due to preventable medical errors. This number does not include harm occurring in physician clinics, outpatient surgery centers, nursing homes and other care locations.

I don’t represent trial lawyers nor healthcare providers and I have become rather apostate regarding political parties. In my opinion, tort reform should be about reducing medical errors – the root cause of why we have malpractice issues in the first place. By working toward the elimination of the root cause – medical errors – malpractice and its negative side effects will also disappear. This more logical approach will benefit patients, providers and our overall healthcare system. Adopting safe care practices would substantially reduce the costs of botched-care fixes and defensive medicine – in addition to enhancing the quality of life for patients and their caregivers.

As the Iowa bills demonstrate, we continue to seek ‘quick fixes’ that gnaw at the edges of the problem. But these laws seldom address the core reasons of why many medical errors happen.  Medical errors are, unfortunately, a fact of life.  But many are avoidable. In our healthcare world, we have well-meaning and very capable caregivers. Too often, however, we also have broken organizational cultures that inadequately address patient safety protocols and burned-out physicians and staff who are required to “produce” at unsustainable levels. Any meaningful reform must begin at the healthcare organization level, ensuring we all receive appropriate and safe care. Organizations providing impactful interventions to help promote safe cultures of care can greatly improve safe care practices.

Misguided malpractice reform can actually exacerbate rather than eliminate medical errors. Placing caps on damages, economic or otherwise, insulates the medical community from high monetary awards, yet offers little, if any, incentives for healthcare organizations to establish clear and genuine protocols to ensure a culture of safety. The right incentives matter, especially when it comes to the safe care we trust we’ll receive.

Isn’t it time for provider organizations to adopt a culture of safety, rather than seek malpractice caps that do nothing to protect us as patients?

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Why It Matters to Have Private Health Coverage

I should not be astonished, but I am.

In 1910, Dr. William J. Mayo wrote his view on making patients a central reason for his organization to exist: “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.”

But 107 years later, the healthcare landscape has changed, running opposite to Dr. Mayo’s credo.

A March 15 article in the Star Tribune revealed a healthcare system truth that some have suspected for years – that it’s a tier-system of care dependent on the type of health insurance card you carry in your wallet or purse. If you are fortunate to have private insurance coverage through your employer or have personally purchased it through a commercial insurance company, you should feel somewhat privileged. However, if you have Medicaid or Medicare coverage, please step to the back of the line.

Dr. John Noseworthy, CEO at the famed Mayo Clinic, was videotaped speaking to his staff last fall about giving preference to patients with private insurance over lower-paying public coverage (e.g. Medicaid and Medicare). “We’re asking…if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so…we can be financially strong at the end of the year to continue to advance, advance our mission…”.

It is important to note that, regardless of payer source, Mayo will always take patients when they’re unable to find medical expertise elsewhere. However, when given two patients who have equivalent medical conditions, the Mayo health system will “prioritize” the patient with private insurance – private plans pay Mayo (and all other providers) more than public coverages. Noseworthy continued, “If we don’t grow the commercially insured patients, we won’t have income at the end of the year to pay our staff, pay the pensions, and so on…so we’re looking for a really mild or modest change of a couple percentage points to shift that balance.”

Hospitals are not allowed to discriminate against patients seeking care in the emergency room. Outside the ER walls, however, providers can choose to accept (or decline) Medicaid and Medicare patients. Mayo recently indicated to Modern Healthcare that Medicare and Medicaid patients account for half of their services, but with more baby boomers becoming eligible for Medicare, coupled with Medicaid expansion, Mayo is looking to have higher-paying private insurance offset the shortfalls received from public health plans.

The ‘dirty little secret’ of establishing a pecking order of patients, based on payment sources, has not been widely known. In that sense, kudos to Mayo for their honesty, as it appears they are not attempting to sweep this fact under the rug. Yet, the Mayo acknowledgement that commercially-insured patients would get preferential consideration in certain situations should raise questions for those of us who are covered by private payers.

If the provider community establishes a pecking order between public and private payers, could special consideration also be given AMONG private payers? Think about it. If margins are so thin for world-reknown providers like Mayo, why wouldn’t other medical providers seek similarly-related practices with all sources of revenue?

For example, if insurer A reimburses hospitals at a higher rate over other private insurers within that particular market, would insurer A patients receive preferential consideration, much like what Mayo described? If so, are you better off purchasing health coverage at a higher premium from insurer A because their reimbursement rates will guarantee preferential service compared to other insurers within that market?

This raises questions about the potential practices initiated by the provider community. Having a particular insurance card provides a ticket of entry into our healthcare system. But does it also determine the level of care we ultimately receive?

What’s in your pocket or purse? In healthcare, it just might matter a great deal.

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