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What you should care about in healthcare today, from the editors of Becker's Hospital Review

15 quotes from healthcare executives reporters knew they had to write down

More than 150 hospital and health system executives gathered in Chicago a few days ago to discuss their industry, organizations, strategies, challenges and passions as part of the Becker's Hospital Review 6th Annual Meeting. Needless to say, our reporters left with notes upon notes when the event wrapped up.

Looking back, a few quotes really caught our ears when the executives first spoke them. Here are 15 of them, fresh from our notes, in no particular order.

1. "We shouldn't feel sorry for ourselves. A lot of us say, 'Oh my God, how could this be happening. Look at all the unpredictable things happening all the time.' These are happening in every industry."

Michael Dowling, president and CEO of Great Neck, N.Y.-based North Shore-Long Island Jewish Health System

2. "The biggest [surprise] is just how hard it is to move our patient satisfaction scores. Our other one is just how slow the rate of change actually is despite how breathless we all feel. We talk a lot about how pay is reforming, but I don't know a system that is not still on fee-for-service."

Kate Walsh, president and CEO of Boston Medical Center

3. "We work hard every day to engage physicians fully as partners. They literally can bring your system down, but when they're with you, there's nothing you can't do together."

June Komar, corporate executive vice president of strategy and administration for San Diego-based Scripps Health

4. "[Physicians] are going to look at you sideways if you ask them to align, but if you ask them to be the leaders and determine what the future will look like, they will rise to the challenge."

Lucy Hammerberg, MD, chief quality officer of Northwest Community Hospital in Arlington Heights, Ill.

5. "When I go back to my hotel room, I will answer every email that has come to me while I was making this presentation."

Scripps Health President and CEO Chris Van Gorder on his open-door email policy and diligent correspondence with employees and colleagues who write him.

6.  "I need to create the end of patients needing to see us."

Rod Hochman, MD, president and CEO of Renton, Wash.-based Providence Health & Services, referring to the goal he has in mind for his system's population health efforts.

7. "I don't think the president or HHS administrator is being coy when they say they don't have a plan B. It is inconceivable to have a plan B."

John Jay Shannon, MD, CEO of Cook County Health and Hospitals in Chicago, on the King v. Burwell decision.



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"I never use that word, retire"

The inspirational trait B.B. King and a nurse in Tacoma, Wash., have in common.

B.B. King, one of America's most revered blues legends and renowned guitarists, never gave up his love for music and performing, even through his advancing age. Mr. King died in his sleep Thursday at his home in Las Vegas at the age of 89, according to the New York Times.  

Mr. King had his first taste of fame in the 1940s, around the time he picked up the name B.B., which stood for Blues Boy. One of his first recordings hit the top of the rhythm and blues charts in 1951, and after that, there was no turning back. Mr. King played 342 "one-night-stand" performances in 1956 and anywhere between 200 and 300 shows per year for the next 50 years, garnering international acclaim, according to the Times.

"Mr. King married country blues to big-city rhythms and created a sound instantly recognizable to millions: A stinging guitar with a shimmering vibrato, notes that coiled and leapt like an animal and a voice that groaned and bent with the weight of lust, longing and lost love," according to the Times on Mr. King's unique sound.

Mr. King was "married" to the greatest love of his life, his guitar, and didn't stop performing until 2014. In his trademark tale, Mr. King was performing at a dance hall in the early 1950s when two men knocked over a kerosene stove during a fight. Mr. King ran out of the burning building, but ran back inside to rescue his $30 guitar. After learning the fight was about a woman named Lucille, Mr. King called all of his guitars "Lucille" for the rest of his life.

Mr. King's commitment and passion for his art is only truly understood by just a handful of professionals across different industries. Few people remain active in their jobs for their entire lifetime, driven by the intrinsic satisfaction their work brings them.

While every leader need not strive to work into old age — hard-working people deserve retirement! — those who show a lifetime of commitment to their job and the mission that job stands for deserve recognition. It is important to approach each day on the job — whether at age 40 or age 80 — with the same enthusiasm and determination.

Bill Considine, president and CEO of Akron (Ohio) Children's Hospital for 36 years, told Becker's Hospital Review how he approaches each day. "One of my main guiding principles for 36 years now has been to keep those promises alive. Not a day goes by that I don't think about [the hospital's promise], or the values that are part of the organization: Respect, trustworthiness, caring, fairness, responsibility and citizenship. Making sure my actions speak louder than words relative to keeping those promises alive, embracing those values and being a family care-centered organization is what is important to me."

Mr. Considine's long tenure is unique in healthcare, especially amid rising turnover and burnout. Another hospital worker made headlines this week for her own remarkable tenure. Like Mr. King, Florence "SeeSee" Rigney skipped out on retirement to continue doing what she loves.



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Friday Feel Good: Flood doesn't stop physician from delivering babies

A dose of feel-good to kick off the weekend.



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What Jay Z's failed music app can teach healthcare about branding, consumerism

Less than a month after its launch, Jay Z's music streaming app Tidal dropped from its rank as the 19th most download app to No. 664, according to Business Insider. By comparison, Spotify, the most in-demand music streaming app, rests as the 17th most downloaded app in the U.S. Beats Music sits at No. 58 as it undergoes a major makeover from owner Apple.

While almost all "hot new apps" experience a big drop in demand after the hype of its initial launch dissipates, this doesn't appear to be Tidal's problem, according to the report.

Instead, observers have cited the app's ill-delivered marketing campaign and expensive price tag as the main sources of its limited success. Healthcare, an increasingly consumer-driven industry, could take note of a few strategies not to borrow from Tidal.

Tidal's premise is to ensure musicians are compensated more for their music than other streaming companies, such as Spotify, which pays artists mere cents per stream. While its mission has merit, Tidal's marketing strategy failed to convey this effectively at its launch ceremony, where Jay Z, Beyoncé and several other highly successful and wealthy pop stars introduced the app. Madonna, Jack White, Kanye West, Daft Punk, Rihanna and Nicki Minaj — all of whom own equity in the app — were there in solidarity, according to the report.

"I think they totally blew it by bringing out a bunch of millionaires and billionaires and propping them up on stage and then having them all complain about not being paid," Ben Gibbard of Death Cab for Cutie told Business Insider.

Additionally, the Los Angeles Times reported that Tidal pays 75 percent of its revenue to artists and rights holders, not much better than Spotify, which pays 70 percent.  

Another, more significant issue that is likely responsible for capping Tidal's potential: It is only a paid service. Unlike Spotify, which offers a free, ad-supported tier to attract users, Tidal only offers a $9.99 basic package or a $19.99 premier package for lossless, high-fidelity audio — superior audio quality with minimal noise and distortion and more accurate frequency response — which only true music fanatics would be willing to pay extra for.

To attract and retain customers in the most fundamental way, Tidal must offer consumers a highly superior service than existing competitors, or present a more convincing case that music streaming as it operates today is harming the music industry. While some listeners would be willing to pay more for access to exclusive content, most consumers are just interested in cheap access to high volumes of music. Furthermore, consumers are not likely to care about music artists enough to voluntarily pay more for services available elsewhere at a fraction of the cost, at least not as an abstract category.

Likewise, in healthcare, prospective patients are taking a much more engaged and proactive stance when it comes to shopping for medical care.

"For every strategy we have, at some point in this decade consumers will take charge. Consumerism will be the new normal and there will be nowhere to run and nowhere to hide," said Keith Pitts, vice chairman of Tenet Healthcare Corporation, according to the Huron Healthcare CEO Forum report "Leading the Journey: Cultivating Success in Healthcare."

With "nowhere to hide," hospitals will be forced to take a number of actions to attract consumers, maintain a competitive edge and hold onto their market share.

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15 quotes on leadership, teamwork from NCAA Final Four coaches

In the NCAA Tournament, every player must lay his heart on the court for his team to have a shot at making it to the championship. Each team trains relentlessly to acquire the athleticism, endurance, communication and teamwork skills required to take home the trophy, but no team can achieve this without the strong leadership of its coaches.

The head coaches leading the teams in the upcoming Final Four games — Mike Krzyzewski of the Duke Blue Devils, Tom Izzo of the Michigan State Spartans, John Calipari of the Kentucky Wildcats and Bo Ryan of the Wisconsin Badgers — each know what it takes to lead a team through high-stress, highly competitive circumstances. Their strategies for selecting, developing, challenging and motivating players through high-stakes games resonate with those of healthcare leaders guiding their systems through a period of complex change.

The following quotes on leadership and teamwork come from the Final Four coaches.

Duke Blue Devils coach Mike Krzyzewski. Mr. Krzyzewski, or Coach K, serves as the U.S. men's national basketball team's head coach in addition to his duties at Duke. This year marks his 29th season leading the Blue Devils. During his tenure, Coach K has been named National Coach of the Year 12 times. In 2001, he was named America's Best Coach by Time magazine and CNN, and that same year he was enshrined in the Basketball Hall of Fame.

"Communication does not always occur naturally, even among a tight-knit group of individuals. Communication must be taught and practiced in order to bring everyone together as one." — Mr. Krzyzewski

"When you are passionate, you always have your destination in sight and you are not distracted by obstacles. Because you love what you are pursuing, things like rejection and setbacks will not hinder you in your pursuit. You believe that nothing can stop you!" — Mr. Krzyzewski

"During critical periods, a leader is not allowed to feel sorry for himself, to be down, to be angry, or to be weak. Leaders must beat back these emotions." — Mr. Krzyzewski

"Every leader needs to remember that a healthy respect for authority takes time to develop. It's like building trust. You don’t instantly have trust, it has to be earned." — Mr. Krzyzewski



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Hospitals: The new villains in the story of American healthcare? (What Slate has to say)

Online magazine Slate is known for its contrarian and strongly worded headlines.

"Fat People Might be Better Off Staying Fat Than Trying to Lose Weight"
"Thank Aldi for Sending British Supermarkets Into a Death Spiral"
"Update: The Job Market for Academics is Still Terrifying"

If you're like me, a shocking headline doesn't make you blink twice anymore. You're even less tempted to click on it. Yet, when browsing Slate yesterday, one headline made me do a double take:

"Hospitals Are Robbing Us Blind."

Forget Obamacare, read the deck. The real villains in the American health care system are greedy hospitals and the politicians who protect them.

With fewer than 2,000 words, Slate columnist Reihan Salam simply skewers hospitals in this piece. "Whether you're for Obamacare or against it, you can't afford to ignore the fact that America's hospitals have become predatory monopolies," he writes. "We have to break them before they break us."

Mr. Salam touches on many issues, including consolidation, contract disputes with private payers and Medicare's payments to hospitals as they compare to other sites of care. "As for why hospitals charge such high prices, it's fairly simple: They do it because they can," he writes.

When someone or something tries to tame a hospital, lawmakers or local politicians run to the rescue. Politicians see the value in having hospitals on their side, he says. The health sector employs more than a tenth of all U.S. workers, and hospitals hold the key to any meaningful change in the industry. As Mr. Salam writes: "One of the reasons President Clinton's 1993 health reform effort failed is that he never won over the hospital lobby." When it was his turn, President Barack Obama knew better.

Despite all of the arguments he made, what struck me most about Mr. Salam's piece was the word villain. Or crooks. The phrase bleeding us dry. Such terms are not unusual to a magazine like Slate, yet in the broader narrative of American healthcare, these words aren't often used to describe hospitals. The piece is the latest in what has been a series of scrutiny, following Steven Brill's book "America's Bitter Pill" about healthcare and, specifically, hospital prices and profits. It's an expansion of his TIME story, which won the 2014 National Magazine Award for Public Service.

In speeches meant to inspire, I've heard the phrase, "We're rewriting American healthcare." If healthcare is changing, maybe the villains are, too. For so many years, the insurance and pharmaceutical companies were painted as the antagonists in the Great American Healthcare Story. In 2009, then House Speaker Nancy Pelosi said payers were villains and the health insurance industry was "immoral all along." That same year, 13 percent of Americans ranked the biggest problem in healthcare as insurance company greed (3 percent said it was hospital or physician greed). 

In the early 2000s, drugmakers were cast as the bad guys. A Kaiser Family Foundation poll found 70 percent of people thought pharmaceutical companies prioritized profits over the development of new drugs. "Rightly or wrongly, drug companies are now the number one villain in the public's eye when it comes to rising health care costs," KFF President and CEO Drew E. Altman said in 2005.

It's too simplistic to say hospitals were ever heroes in this story, but they held a certain place in our collective conscious. Drugmakers and insurers — distant and faceless — were somewhat easy to paint as villains. But most people know someone who works in a hospital, or they have donated money to one or spent time there as a volunteer. After all, for most of us, life really began the day we were brought home from where? A hospital.

A professor in health policy recently told me, "There are no villains here." He is like the many writers and authors who sit in the camp that there's no such thing as villains at all. Snidely Whiplash was a cartoon for a reason, they say. You don't meet people who rub their hands together, twirl their mustaches and set out to do evil. At their core, villains are no more than flawed people with problems on their hands.

While authors and professors are fortunate to have such a textured appreciation of good and bad, it seems many Americans would really appreciate a healthcare villain right now — especially a new one.



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5 healthcare films we're watching

From the silence surrounding cancer, to the 'quiet revolution' in healthcare practices across America, to the cacophony of the vaccine debate, we've picked a handful of documentaries, films and talks that provide fodder to spark discussions — at any volume — about some of the most salient issues in healthcare.



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Upsets and Cinderella stories: What March Madness and hospital rankings have in common

The first weekend of the NCAA Tournament is complete, and despite my best efforts, it's safe to say my bracket is pretty much busted.

Upsets abounded in the round of 64 and continued in the round of 32 in this year's tournament. No. 1 Villanova couldn't catch up to eighth-seed N.C. State. No. 2 Virginia was ousted by Michigan State, a tough seven seed.

And just as there were surprises, other games went as expected. Namely: Kentucky continued dominating, extending its perfect season.

To be sure, upsets happen every year — each tournament has its own special "Cinderella story." Who could forget Florida Golf Coast University in last year's tournament, when it became the first 15-seed team to win two games in the Big Dance? Some teams are just better conditioned and prepared to play than others come game day.

But some upsets could be telling that the seeding process for the Tournament could use some change. Each year, the NCAA Men's Division I Basketball Committee — made up of 10 members who spend "countless hours evaluating teams during the regular season," according to the NCAA website — chooses teams, then ranks, seeds and divides them into four regions on a bracket. If a team doesn't win its conference tournament, its post-season fate is entirely in the hands of these 10 men and women. Fans are hardly ever completely happy with the committee's choices.

"The committee failed again," Paul Klee, a sports reporter with the Colorado Springs Gazette, wrote after Selection Sunday. "It fails every year."

Complaints range from teams that get snubbed (Mr. Klee was pleading the case of Colorado State) to how a particular team is seeded to how teams are arranged on the bracket, among others.

While all of this uproar over rankings is happening in the college sports world, it is simultaneously occurring in another industry: healthcare. Though it's not a perfect analogy since the stakes are much different, the choosing and ranking of teams by the selection committee is similar to how various rating systems in healthcare select hospitals.



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Friday Feel Good: Tying the knot in the ICU

A dose of feel-good to kick off the weekend.



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What Rahm has shown us: Leadership and 'rubbing people the wrong way'

Leaders are constantly faced with tough decisions, and must consistently negotiate between the need to be an effective leader and a likeable one. But exactly how much does likeability influence efficacy?

Democrat Rahm Emanuel's brash leadership style has helped him drive through the ranks in his career, according to the Wall Street Journal. He has risen from senior White House aide to a congressional leader to chief of staff for President Barack Obama, but now he is fighting for reelection as Chicago's mayor.

Mr. Emanuel's failure to capture the 50 percent plus one vote to win a second term as Chicago's mayor, leading him to an April 7 runoff against Cook County Commissioner Jesus "Chuy" Garcia, may suggest leaders do need to be likeable to be effective — or at least elected.

The mayor's fight for reelection is proving difficult — Mr. Emanuel received 45 percent of the vote, and Mr. Garcia finished the race in second place, garnering 34 percent of the votes, according to the WSJ.

Mr. Emanuel's demeanor is one of his defining characteristics and has become a magnet for media attention. The tale of the politician, in his younger days, sending a dead fish in a box to a pollster who was late delivering results is infamous. He earned the name "Rahmbo" and "Rahmfather." He has a penchant for cussing. He sliced off part of his right middle finger while working at Arby's in his early days. President Obama would later joke the accident "rendered him practically mute."

In the realm of healthcare, too, the manner in which a leader forms and sustains relationships, works with other groups and wages influence are crucial elements that can open doors to new opportunities, or severely damage a leader's potential to get things done.

Mr. Emanuel's tough leadership style has been a point of criticism against him by voters and local politicians, especially those who opposed his decision to close underutilized mental health clinics and schools in a consolidation move, according to the report. Positioned against "nice guy" Mr. Garcia, Mr. Emanuel's brusque leadership style has arrived at the forefront as a potential deciding factor in his reelection bid.

In a recently aired campaign commercial, Mr. Emanuel acknowledges that his style rubs some people the wrong way, but stresses his toughness comes from a love of the city and a genuine desire to make decisive, positive changes.

"They say your greatest strength is also your greatest weakness. I'm living proof of that," said Mr. Emanuel. "I can rub people the wrong way, or talk when I should listen. I know that. But I'm driven to make a difference… I'm not always going to get it right, but when it comes to fighting for Chicago and Chicago's future, no one's going to fight harder."

Scott Becker, JD, CPA, publisher of Becker's Hospital Review and chairman of the healthcare department at McGuireWoods, says Mr. Emanuel's leadership style "issue" is a difficult and complex one.



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