The Ankota Healthcare Delivery Management Blog

Care Coordination and Checklists are How We Heal Health Care

One of the people I've come to greatly respect is Atul Gawande.  He's a doctor and an author and we've featured him numerous times on the Ankota blog including as the author of Ankota's book of the year The Checklist Manifesto.  Some of the key themse that we strongly embrace at Ankota are as follows:

• Coordinated care systems work better than isolated efforts
• It's not necessarily true that the most expensive care is the best care
• Checklists can vastly improve the quality of care

Today we bring him to you in video, courtesy of TED talks.

If you enjoyed this post, you may enjoy some prior posts inspired by Atul Gawande, as follows:

• Home Care Can Dramatically Reduce Health Care Costs - Here's Proof!

   

6 Lessons for Home Health Care from Fifty Shades of Gray?!?

Maybe you don't want to give a copy of Fifty Shades of Gray to your elderly home care patients, but you might just learn some valuable things from the block-buster novel. If you are a physical therapist, you might not want to read from it while your client rehabs with you from a fall. And, if you are an infusion nurse, as tempting as it might be, your oncology patient might not be the best one to share the book with (or maybe she is!!). Either way, here's an interesting twist on the book: 6 business lessons you can apply to any post acute care operation. 

Have you heard that it's a little dirty? You HAVE heard about Fifty Shades of Gray -- right?!?

In the American Express Open Forum, Rieva Lesonsky writes, "If not, either you’re a guy who has no woman in his life, you’re living in a cave or you’re a guy living alone in a cave. Women everywhere are buzzing about this bestselling erotic novel, which tells the story of a wealthy entrepreneur’s affair with an innocent college student. First-time author E.L. James has been mobbed at book signings, interviewed on TV and given a seven-figure contract with Vintage Books. Ellen DeGeneres read snippets from the novel aloud on her talk show, Barbara Walters discussed it on The View and Time magazine named James one of its 100 Most Influential People of 2012."

Lesonsky explains that, as she read Fifty Shades, she kept drawing lessons from the book that applied to business. Despite my healthy skepticism that anyone can read this book and think about how it might apply to their business, I am a guy, I do have a "cave" of sorts in my basement, and I will defer to someone who has actually read the book. So, I share these with Ankota's readers here along with my disclaimer that says "I don't know much more about this book...though I don't live alone in a cave."

So, what do you think? What can home health care and other providers of post acute care learn from Fifty Shades of Gray? There must be something smart you can say about Physical Therapy or Infusion, at least. 

I think it's time for me to go back into my cave. 

The Six Lessons can be read in its entirety here

 

 

NPDA Is In The Private Home Care Social Media Conversation

The warm weather that many of us have experienced lately might make us think of finishing up our studies, but in the Private Home Care field, there is always more to learn! 

A number of educational and "trade show" events are coming up designed to help us innovate and grow our business.  I was directed to these events by Merrily Orsino (Twitter handle: MerrilyO).  She is a Home Care Marketing Expert from Corecubed and she focuses on Internet marketing, website design, SEO, and social media marketing.

Will you be attending any of these events?  If so, please let me know how they went for you or comment below about your past experiences!

Home Care Conferences, Live Events, and Web Events

Southwest Regional Home Care Conference & Exhibition

April 24-25, 2012 - Oklahoma

For more information and to register, click here: Register

Association for Home Care & Hospice Private Pay Conference: Think Big!

May 8, 2012 - Texas

For more information and to register, click here: Register

Executive Leadership Forum

June 5-6, 2012 - Dallas

For more information and to register, click here: Register

New York State Association of Health Care Providers’ 2012 Annual Management Conference & Exhibition

October 16–18, 2012 - New York State

For more information and to register, click here: Register

 

National Association for Home Care & Hospice Annual Meeting & Exposition

October 21–24, 2012 - Florida

This one involving Merilly seems particularly interesting.  From her website: "With my breakout seminar on, “Inbound Marketing: A Natural for Home Care with Mobile Apps, Website Resources, and Social Media,” I’ll be talking about all things mobile. More and more, the mobile phone and tablets are fast becoming the hub for much of home care sales and marketing. Growing a business is more about having the right information available in a variety of online ways, and interacting and responding appropriately. Attendees will leave ready to get social!"

For more information and to register, click here: Register

National Private Duty Association (NPDA) Webinar: The Agency Website as the Core of Marketing Strategy

April 25, 2012 - Online

Another interesting one from Merrily:  As more people search for resources online, the agency website has become the core for marketing services. Making the most of the agency website, not only in design, but in content, and having the search engines rank the site on the first page, are key goals for marketing. Learn the basics from Will Chatham and me, in this interactive webinar where live sites will be used as examples.

For more information and to register, click here: Register

New Report Says That More Senior Living Communities Needed

From ALFA (Assisted Living Federation of America):

Presenting the results of the American Housing Survey, a new report describes the housing challenges presented by the increasing senior population and strategies for facing these challenges, including expanding affordable housing choices for older adults.

The report, created by the non-profit Center for Housing Policy, states that many of the senior housing challenges we are facing now, will be exacerbated in the coming years.

What are your thoughts on the article?  Any comments you'd like to share?

Please let me know if you have any blogs, articles, or other resources that you'd like to suggest to our readers.  Let's share the wealth of knowledge out there so we can all become more informed and more successful!

Ankota provides software to improve the delivery of care outside the hospital. Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care. To learn more, please visit www.ankota.com or contact Ankota

The Best Home Care Leaders are good at Seeing the Big Picture

The home care industry is blessed with some great veteran consultants who share their expertise with the industry.  We're pleased to have met many of them at conferences, to learn from them and to share their insights on our blog.  Today's article is from Stephen Tweed who leads Leading Home Care.  We've featured Stephen on the Ankota blog numerous times in the past, including this piece sharing Stephen's tips for selling home health to physicians, and this more recent and somewhat controversial piece where Stephen shares the insight that social media doesn't seem to work for home health - in the piece his points are contrasted with a piece by Merrily Orsini about how to make social media work in home care.

Seeing The Bigger Picture

by Stephen Tweed

In January of 1997, I was sitting in the office of Chip Liversidge, the CEO of Community Health Services in Portland, Maine.  We had just finished a board of directors planning retreat and we were reminiscing about Chip's 30 years as a CEO in home health care.  Chip made a very interesting comment. 

He said, "One of my big regrets is that we, as an industry, have not invested enough in developing the next generation of home care leaders."  This one statement led us to more conversation and an industry survey of home health care CEOs.  That one conversation ultimately led to starting this company, Leading Home Care.

Chip and I surveyed over 200 home health care CEOs to identify the top characteristics of highly effective home care leaders.  The results were a vast set of ideas, information, data, and opinions about what makes great leaders in home health care in Amercia.

Clearly, the number one factor identified by those CEOs they called, "Seeing the Bigger Picture."  As we have continued to study that concept over the past 14 years, we are much clearer about what that means.

Home Health Care Leaders who "See the Bigger Picture" are leaders who have:

• A clear model of strategic thinking.
• The ability to objectively assess the current reality of their home care business.
• An understanding of the forces and trends shaping the future of our industry.
• A clear picture of the business of home care.
• A clearly defined source of competitive advantage in the marketplace.
• A keen awareness of the factors that drive the economic engine of home health care.
• Tools and Techniques for measuring results.

That research and the revelation that the key characteristic of highly effective home care leaders is "Seeing the Bigger Picture" has driven much of what we have done over the past decade at Leading Home Care.  We created the Academy for Home Care Leadership™, and a series of keynote speeches and learning seminars based on those results.  This research, combined with my first book, Strategic Focus: A Gameplan for Developing Competitive Advantage, helped me to refine our Model of Strategic Thinking.

To learn more about Stephen's Model of strategic thinking and more great content, we'd encourage you go to Stephen's website at http://leadinghomecare.com/ 

Billy Graham's New Book Offers Compelling Perspective on Elderly Care

Renowned spiritual leader Billy Graham spent his life career inspiring people to live lives of grace, faith and charity. Now, at the age of 93, Rev. Graham is inspiring us in the final stages of life. His new book, "Nearing Home: Life, Faith, and Finishing Well" addresses the process of growing old and approaching the end of life and doing so gracefully and with an eye toward God.

In a recent article in USA Today, Graham discussed why he chose to write this book at this stage in his life.

"No one prepares you for loneliness, for pain, for the grief of losing your soul mate, he now writes. When his wife, Ruth, died in June 2007, he was stunned that she died before he did. He had never envisioned his life without her.

Graham says he wanted the book to be the handbook he never had — spiritual, pragmatic and fearless." (Read the entire article here.)

Graham has Parkinson's disease and is confined to a walker or wheelchair. He also has macular degeneration and can no longer read. He dictated "Nearing Home" to staff members. Yet he continues to live out his life to the fullest, still taking advantage of opportunities to minister to his global congregation. This time, Graham's words encourage seniors to turn to scripture for wisdom in how to proceed in the twilight of their lives.

While many people have written books before about dying and growing old, few have the same clout with generations of people across the country, across imaginary boundaries of income or race as the Rev. Graham.

Through Graham's experiences and his decades of devotion to people's spiritual well-being, "Nearing Home" can bring comfort and hope to anyone facing their own end of life or those who care for the elderly. We can all take away several lessons in patience, compassion and grace from Graham's work.

Fall Prevention Can Be the most Critical Home Care Delivery

Sobering statistics show that falls resulting in injury can be the beginning of the end for seniors--not only of independence, but also their lives.  Among the dangerous consequences of falling, hip fractures sustained in a fall are tragically common among seniors.

Shockingly, injuries resulting from falls kill tens of thousands of seniors each year.  Falls affect nearly 1 in 3 seniors annually--about 300,000 seniors will suffer a quality-of-life threatening incident this year.

It follows that preventing falls from happening is key in extending the lives of seniors. 

Importantly, fall prevention also preserves quality of life.  Home care is a major factor in keeping seniors attended, functional, significantly safer, and able to live the independent lives they deserve. 

Home Care can extend their clients' lives by preventing falls.

Previous coverage on the Ankota blog explores this topic and its relation to your agency.  Find it here.

The blog post shares a simple yet crucial piece of advice: when shopping for Home Care, look for an agency's record in fall prevention as a true measure of quality care.

A new article in AARP magazine makes the case compellingly clear.  The article lays out the numbers, which are not at all encouraging.  Yet it also provides a comprehensive list of measures to take to significantly reduce this all too common threat to the quality of life for seniors.

"The Deadliest Break" gives an example of a 91-year-old woman who was able not only to survive, but also to thrive after her fall resulting in hip fracture.

Unfortunately, it goes on to explain, she is in a select minority of seniors who are able to resume activities of daily living unassisted after such an incident.

Does aging itself necessitate a resigned attitude toward inevitable decline of one's own abilities and capacities?  The article explores an insidious bias, while giving clear directives for restoration and renewal.  It shows how to overcome a prevalent notion--that recovery from hip fracture or other fall-related injuries will not result in fully restored vigor.

Why are falls resulting in hip fractures particularly deadly to seniors?  The article looks at co-morbidity factors affecting this population, plus takes on other damaging factors, including "the vanishing" of continuing care at a crucial juncture--care which could restore an injury sufferer to previous levels of functionality in daily life.

The article is followed by a list of definite measures--some perhaps surprising--to bolster a senior's chance of preventing an incident.

Naturally, prevention is paramount.  Yet early treatment, thorough rehabilitation, and continuing care at the right time are the simple yet uncommon measures to improve the situation for seniors and those who care for them.

Find the full article here:  "The Deadliest Break."

What is your agency doing to prevent falls?  Please share your best practices in the comments.  If you have a great story to share, we want to hear it.  Be sure to contact us and we'll feature the best in our blog.

Don't Let Being a Home Care Exec Melt You Down

I recently conducted an informal and wholly unscientific survey of homecare CEOs, including CEOs of home medical equipment and a physical therapy businesses, and found some major overriding stresses that keep them awake in a cold sweat at night, including:

We all know it intuitively, but most of us don't do anything about the stress.  The Japanese have a word for it when it reaches extremes: Karoshi. It's the corporate equivalent of Hari-Kari and literally means "death by overwork." The Japanese government recognizes it as a cause of death and has campaigns to reduce Karoshi. Families of the deceased can and do successfuly sue employers when a family member dies from overwork. Officially, the Japanese work 20 hours less per year than Americans, although some argue that they work more off the books than their American counterparts.

So what's the point of this blog post? I don't presume that we have a prevalence of home healthcare workers about to fall victim to Karoshi. We do, however, widely recognize caregiver fatigue, whether it be family or professional caregivers. We have a responsibility to better undertstand it and help mitigate the risk of caregivers, who are already stressed, becoming even more so. Entrepreneurs rarely acknowledge the exhaustion that often develops among their ranks. I speak with hundreds of home healthcare executives and their counterparts at Home Medical Equipment (HME/DME), Therapy and Private Duty home care businesses who seem to be determined to make Karoshi a common word in US households. They have the best of intentions and, like the caregivers they employ, are fully committed to their professions and their clients.

Today's post is an effort to encourage our current and future customers--Home Health Care agencies, Therapy, HME and Private Duty companies--to AVOID KAROSHI!

"This is not good for my mental and physical well-being," says Douglas Heddings of New York City in a recent article in Entrepreneur entitled "Don't Melt Down."

The article continues, "Researchers agree. Frequent long hours can increase stress and touch off a host of health hazards, including insomnia and high blood pressure. Poor decision-making starts to creep in. And unlike your laptop, your system doesn't have an internal fan to cool it down.

"Entrepreneurs are, of course, an action-oriented bunch by definition. That's usually a good thing. But a bias toward action can get in the way of the thinking needed to set limits and work smart. Too many entrepreneurs default to reactive behavior, reflexively jumping to the chime of a new e-mail, the pressure of a ticking clock and other external pressures and interruptions. They let technology and time manage them. This leads to the burnout model of work--they just keep going until the paramedics arrive."

What can you do? Well, we don't have all the answers, but there are several that fit within our area of expertise and that have been proven to reduce some of these stresses and dramatically improve business performance at the same time. 

A few helpful hints from Ankota on avoiding Karoshi by better preparing your business to run well and run consistently:

 

For more on improving business performance and making life in charge a bit easier, click here or on the Ankota logo and ask Ankota to help.

For more on avoiding Karoshi, click on the Geekpreneur logo here:

Must discharge planners offer Home Health Choices?

I've been to numerous home care leadership conferences and this question seems to come up a lot.  Here's a clear and succinct answer courtesy of "Home Care Insider Q & A" available here or by clicking the banner below.

Q: Is there a requirement that states that hospital discharge planners must offer a choice of home health agencies to patients who opt for those services?

 

A: There is a requirement that addresses this and all patients have the right to choose their healthcare providers. Federal regulations require hospitals to develop a list of home health agencies that: ask to be on the list, are Medicare certified, and provide services in the area where the patient lives. They are then required to present the list to patients who are to receive services. If a hospital has a financial interest in a homecare agency and that agency is included on the list, the financial interest must be disclosed. The Centers for Medicare and Medicaid Services offers guidance regarding non-discrimination in post-hospital referral to home health agencies by requiring that hospital discharge planning may not limit qualified providers of home health services, must include the availability of home health services in the area, must disclose financial relationships with home health service entities, and has advised agencies to contact their regional office to report suspected violations of these requirements. It is important to remember that your agency must request to be on the list of home health agencies.

While the answer is simple, it's not easy.  I've heard that some discharge organizations require you to wait a long time or to reprint their lists at your expense in order to get on.  There's also the diffence between being on the list and actually getting referrals.  What can you do so that when the discharge planner is asked "which one would you choose  if you were me?" that your agency rolls off of their tongue.  In 2011, it comes down to a lot of things, as follows:

• Having the discharge planner know you, know you care, and know that you're easy to deal with
• Have differentiators that immediately come to mind, like "I love working with Hazel's agency because I can make a 30 second phone call and know that you'll receive great care"
• Prove that you reduce readmissions.  Can you make this claim and back it up with stats?
• Go upstream and have the doctors refer you.  Stephen Tweed has a seminar on selling homecare to physicians that you can learn about here

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota 

Sell Home Health to Physicians in Order to Grow, per Stephen Tweed

A big focus of the Ankota Blog in 2011 is Home Care Entrepreneurship.  We introduced this topic in our post entitled For Home Care, the way forward requires you to think like a start-up, where NAHC's Bill Dombi talks about both the opportunity and the way non-home-care companies are looking to capitalize, and how Right at Home is setting an example.  Earlier this week I learned that home care expert Stephen Tweed is leading a seminar intended to help home health agency increase referrals by selling to physicians (as opposed to focusing on discharge planners).  Stephen's seminar is directly in line with our focus on entrepreneurship.  Ankota had a chance to interview Stephen and learn more about this opportunity.

Why has it become harder to get referrals from discharge planners?

There are two primary reasons why it's harder to get referrals from discharege planners:

1. They are under great pressure to get patients out quicker, and they don't want to take time to see home health sales reps.  Most discharge planners are bombarded by home health sales reps as the competition increases.  There were 10,581 home health agencies at the end of 2009 as compared to 6,681 at the end of 2001.  With a 58% increase in the number of agencies, you can see why discharge planners are overwhelmed.  Many hospitals have set new policies prohibiting home health sales reps from calling on their discharge planners because it's taking up too much of the Dx planners time.
2. With the proliferation of hospital based home health agencies, and the rules about patient choice and freedom of choice, it is more difficult for discharge planners to make referrals to a specific non-hospital based agency. 

Why, then is it more effective to get referrals from Physicians?

 
Based on the facts and data above, it just makes sense that there is a much larger opportunity for most home health agencies to generate referrals that turn into admissions by calling on physicians and their office staffs.  However, the increase in the number of home health agencies means every physician practice is being bombarded by home health sales reps.  Just getting past the gatekeeper is much more difficult than ever before. 

The highly effective home health sales rep has a proven process for selling, and is focused on a clearly defined set of current referral sources and high probability prospects.  When a skilled sales rep applies this proven process, they are able to generate measurable increases in referrals. 

We see way too many sales reps who struggle with selling home health to physicians because they can no longer get in to have a meaningful dialog with the doctor by bringing donuts or buying lunch.  It will require a whole new skill set for successful sales to physicians.  There is no better way to develp that skill set that my role playing sales calls with a real doctor. 

How important is it for home health agencies to consider new offerings and sales approaches in 2011?

As the marketplace continues to become more and more competitive, it will be critical for growing companies to consider new approaches.  This means new approaches to clinical programs and services, and new approaches to sales and marketing. 
From a clinical perspective, the big opportunity will be to partner with hospitals and physicians to reduce re-hospitalizations for CHF, Heart Attack, and Pneumonia patients under the Patient Protection and Affordable Care Act.  From a sales and marketing perspective, it will be about creating new sources of competitive advantage, and the marketing and sales message to go with them. 

Because of these factors, and our experience working with highly successful home health sales and marketing professionals, we've developed our "Selling Home Health to Physicians" workshop.  We'll kick it off on February 25th, 2011 in Tampa Florida, and follow up with a program in Pasadena, CA on June 16th, 2011. 
http://www.leadinghomecare.com/selling/selling_home_health_care.html

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota 

The Superbowl of Home Care!

Please stick with me—I swear that Superbowl advertising is relevant to Home Health Care, HME, Infusion Therapy businesses, Private duty Home Care, and other Ankota customers. If you have read this blog before, you may know that I like analogies. They make terrific learning tools and can help reframe a problem with a fresh perspective, often triggering more innovative responses. So take a look at the ads and read on, it might make you think about how you make an impression on your customers and important influencers in your business.

How do you get your customers attention? What makes your prospective clients think of you?

Superbowl ads fascinate me, and it’s not because of the beer, the over the top special effects, or the humor (though I really enjoy the humor!). What fascinates me is the formula that advertisers use to build winning ads. I’ve always been surprised that more attention is not paid to this side of the business, as it provides an excellent opportunity to learn about branding and communication.

How do you formulate a business message and communicate it in such a way that your customers will care about, listen to…or remember?

The Superbowl is the world’s largest stage for advertising. Quite literally, it is the Superbowl of advertising! It attracts the biggest dollars, the most creative people, and potentially, the biggest payoff. A lot can be learned from the mechanics that advertisers and their top-notch agencies employ in creating winning Superbowl advertisements.

Advertising professionals know that creating innovative TV commercials is more effective when using patterns embedded in other innovative commercials. That’s a fancy way for saying “use what has been effective before.” Professor Jacob Goldenberg and his colleagues discovered that 89% of 200 award winning ads fall into a few simple, well-defined design structures.  Their book, "Cracking the Ad Code," defines eight of these structures and provides a step-by-step approach to use them.

Here are the eight tools:
   1. Unification
   2. Activation
   3. Metaphor
   4. Subtraction
   5. Extreme Consequence
   6. Absurd Alternative
   7. Inversion
   8. Extreme Effort

Here are a few ads that I thought were particularly effective…for very different reasons, starting with the VW-Darth Vader ad, above. It was entertaining, cute, and easily related to by most people. Which ones did you like? Or dislike? post the links so we can all see them!

Enjoy!

Chrysler: Imported from Detroit with Eminem. One of my favorites. I am not a fan of Eminem, but there is no arguing his mega star status with an important demographic that the autos need, and he is closely associated with Detroit. Incredibly effective and well done.

 

(Unification) I can easily recall the ad because of the extreme and amusing nature of the product placement.