Why additional money may not be needed to solve your EHR problems

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Have you ever done any sort of group problem solving exercise like Outward Bound to help you to think as a team? Suppose there was an exercise for healthcare and IT executives, whose goal was to get the executives to think about how to best deploy can EHR system. To do this they are given a problem and access to ‘technology.’

Here is the scenario and the rules as they are presented to the group. They are given ten dollars. The executives are presented with a bathtub filled with water, and told that the winning team will figure out the best use of money and time to empty the bathtub. Also available to them is a bucket which costs ten dollars and has a hole in it, a four-dollar cup, and a collection of wooden spoons which are free.

Any idea what the right combination is? Is there a best answer? Bucket? Cup and spoons? How would you solve the problem? Sometimes the best answer is so obvious it’s silly. Kind of like call centers? What’s the best use of the available tools? Faced with the option of buying more technology to solve the problem, when was the last time you saw someone refuse the funds?

Figured it out?

Pull the plug from the drain.

In many cases, we already have everything we need to solve the problem, we just need to know how to use it.

Just like Dorothy in the ‘Wizard of Oz.’  She had the ruby slippers the entire time, she just didn’t know how to use them. I think most EHR strategies can be improved without spending requiring millions more in technology.

That’s my story and I’m sticking to it.

can you apply social media to Patient Relationship Management (PRM)

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A consultant was on one side of the river; his client was on the other side. The client hollered, “How do I get to the other side?”  The consultant thought for a moment and hollered back, “You are on the other side.”—don’t try this at home kids, we’re professionals.

It goes without saying that rarely am I regarded as one with a high capacity of tolerance.   When things get tough or when meetings are exceedingly dull I like to go to my happy place. Sometimes I get to go to my happy place when I least expect it. Like the time my coffee machine started leaking all over the floor.

Having met such unheralded success repairing my mixer, naturally I took apart my Capresso coffee maker. Not many parts. I put it back together thinking the simple act of dismembering it might have caused it to self-heal. Fill it. Turn it on. Puddle. I called Capresso started to explain my problem. Before I had a chance to finish the rep told me what caused the problem, asked for my address, and said they would mail a new gasket overnight for free, as in F-R-E-E. No proof of purchase needed.

Talk about managing the customer experience and taking the lead on social networking.  What types of things could you be doing to improve Patient Relationship Management (PRM)?  How could social networking help you improve PRM?

Let’s talk.

my newest column in Chief Medical Information Officer Magazine CMIO

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http://www.cmiomagazine.com/?p=311

Interoperability-this is the problem

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How does one depict the complexity of the mess being presented as the national roll out plan of electronic health records (EHR) via the national health information network (N-HIN) using Health Information Exchanges (HIEs) designed by Regional Health Information Organizations (RHIOs), with the help of regional extension centers (RECs) without Standards (Standards) and with N too many vendors?

Class?  Ideas?  Class?

If this looks dumb, undo-able, unimplementable, uninteroperable–it’s because it is.  your vision is fine.

Remember the idea behind all this is to get your health record from point A to point B, any point B.  It’s that little word ‘any’ that turns the problem into a bit of a bugger.

Find yourself in the picture below, pic a dot, any dot (Point A).  Now, find your doctor, any doctor (Point B).  Now figure out how to get from A to B–it’s okay to use a pen on your monitor the help plot your course.   That was difficult. Now do it for every patient and every doctor in the country.

Now, do you really think the DC RHIO-NHIN plan will work?  If EHR were a Disney park, who’s playing the Mouse?

Should you hire a swim coach?

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Swimming with guppies

Got the new bike, got the new bike shoes, got the uni (uniform-not unitard).  I’ve written about my desire to compete in a triathlon.  Actually, I miswrote.  My desire is not to compete, it’s more accurately a desire not to make a fool of myself during the swim, more specifically not to drown.

The swimming is one of those events where having the coolest outfit doesn’t help, as there are no coolest swimming outfits (men do not let men wear Speedos).  There aren’t enough North Face labels for me to wear to make me look like I know what I’m doing in a pool.

What to do?  Here’s my thinking.  I made a new friend, and as a bonus, she happens to be pretty sharp on the pharma side of healthcare.  She swims—fast.  She swims—a lot.  Did I mention she swims?  Longtime readers know I like to color outside the lines.  Maybe I could hire her to take my place during that part of the race.  Then we get back to the issue of the uni.  One way or another that becomes an issue for one of us.

She offered to teach me.  Lesson one was today.  Lesson two will begin right after the EMTs finish their CPR on me.  Rule one, no matter how cool you think you are, you can’t breathe under water.  That took a few laps to master.  More breathing, stroke, legs.  Lots to learn.

“Let’s get a pool boy to help you not drag your legs,” she suggested.

I have difficulty passing up the opportunity to comment.  She could see I had the broccoli in the headlights look in my eyes.  “You hold it between your legs and it helps you float.”

I scanned the pool.  There we the two of us…and the lifeguard.  “It looks like he’s busy,” I offered somewhat sheepishly.  “Besides, if that’s what it takes, I think we’re both better off if I drag my legs.” (A little un-PC pool humor, but why not, I was already wet and being out swum.

So, what does this have to do with why we’re here?  Here’s the take away.  Sometimes, no matter how smart, no matter how big your ego, you need help.  Sometimes it makes a huge difference to have someone on your side who’s been there, done that, got the T-shirt.

Not with me yet?  A guy (man or woman guy—send me an email and let me know when we can let go of this PC thing and just write) is walking down the road, not watching where he’s going, and he/we/she/it falls into a deep hole.

An engineer walks by.  “Help me,” shouts Hole Person.

The engineer thinks for a moment, writes some ideas on a piece of paper and tosses them into the hole.

Several hours later, a finance guy walks by.  “Help me out (literally)” yells Hole Person.  The CFO tosses down a cheque (I use the Canadian spelling to distinguish it from someone from the Eastern Bloc as it would make no sense to toss another person into the hole.)

Days later, Hole Boy (not the same as Pool Boy in case anyone is still reading) is at the end of his rope.  The work plan failed. The Check bounced.

A consultant passed, saw the man, and hopped into the hole.

“Why did you do that?  Now we’re both stuck.”

The consultant smiled in a Grinch-like fashion—please see prior blog for the segue.  “I’ve been down here before, and I know the way out.”

Kind’ a like a swim coach.

EHR projects have more zeros than you can count.  What if you could hire someone who knew the way out?

I may know someone who can help.

Dear Sir Richard Branson:

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For those who care about how your patients view you.

REF: Mumbai to Heathrow 7th December 2008

I love the Virgin brand, I really do which is why I continue to use it despite a series of unfortunate incidents over the last few years. This latest incident takes the biscuit.

Ironically, by the end of the flight I would have gladly paid over a thousand rupees for a single biscuit following the culinary journey of hell I was subjected to at thehands of your corporation.

Look at this Richard. Just look at it: [see image 1,].

I imagine the same questions are racing through your brilliant mind as were racing through mine on that fateful day. What is this? Why have I been given it? What have I done to deserve this? And, which one is the starter, which one is the desert?

You don’t get to a position like yours Richard with anything less than a generous sprinkling of observational power so I KNOW you will have spotted the tomato next to the two yellow shafts of sponge on the left. Yes, it’s next to the sponge shaft without the green paste. That’s got to be the clue hasn’t it. No sane person would serve a desert with a tomato would they. Well answer me this Richard, what sort of animal would serve a desert with peas in: [see image 2,].

I know it looks like a baaji but it’s in custard Richard, custard. It must be the pudding. Well you’ll be fascinated to hear that it wasn’t custard. It was a sour gel with a clear oil on top. It’s only redeeming feature was that it managed to be so alien to my palette that it took away the taste of the curry emanating from our miscellaneous central cuboid of beige matter. Perhaps the meal on the left might be the desert after all.

Anyway, this is all irrelevant at the moment. I was raised strictly but neatly by my parents and if they knew I had started desert before the main course, a sponge shaft would be the least of my worries. So lets peel back the tin-foil on the main dish and see what’s on offer.

I’ll try and explain how this felt. Imagine being a twelve year old boy Richard. Now imagine it’s Christmas morning and you’re sat their with your final present to open. It’s a big one, and you know what it is. It’s that Goodmans stereo you picked out the catalogue and wrote to Santa about.

Only you open the present and it’s not in there. It’s your hamster Richard. It’s your hamster in the box and it’s not breathing. That’s how I felt when I peeled back the foil and saw this: [see image 3,].

Now I know what you’re thinking. You’re thinking it’s more of that Baaji custard. I admit I thought the same too, but no. It’s mustard Richard. MUSTARD. More mustard than any man could consume in a month. On the left we have a piece of broccoli and some peppers in a brown glue-like oil and on the right the chef had prepared some mashed potato. The potato masher had obviously broken and so it was decided the next best thing would be to pass the potatoes through the digestive tract of a bird.

Once it was regurgitated it was clearly then blended and mixed with a bit of mustard. Everybody likes a bit of mustard Richard.

By now I was actually starting to feel a little hypoglycaemic. I needed a sugar hit. Luckily there was a small cookie provided. It had caught my eye earlier due to it’s baffling presentation: [see image 4,].

It appears to be in an evidence bag from the scene of a crime. A CRIME AGAINST BLOODY COOKING. Either that or some sort of back-street underground cookie, purchased off a gun-toting maniac high on his own supply of yeast. You certainly wouldn’t want to be caught carrying one of these through customs. Imagine biting into a piece of brass Richard. That would be softer on the teeth than the specimen above.

I was exhausted. All I wanted to do was relax but obviously I had to sit with that mess in front of me for half an hour. I swear the sponge shafts moved at one point.

Once cleared, I decided to relax with a bit of your world-famous onboard entertainment. I switched it on: [see image 5,].

I apologise for the quality of the photo, it’s just it was incredibly hard to capture Boris Johnson’s face through the flickering white lines running up and down the screen. Perhaps it would be better on another channel: [see image 6,].

Is that Ray Liotta? A question I found myself asking over and over again throughout the gruelling half-hour I attempted to watch the film like this. After that I switched off. I’d had enough. I was the hungriest I’d been in my adult life and I had a splitting headache from squinting at a crackling screen.

My only option was to simply stare at the seat in front and wait for either food, or sleep. Neither came for an incredibly long time. But when it did it surpassed my wildest expectations: [see image 7,].

Yes! It’s another crime-scene cookie. Only this time you dunk it in the white stuff.

Richard…. What is that white stuff? It looked like it was going to be yoghurt. It finally dawned on me what it was after staring at it. It was a mixture between the Baaji custard and the Mustard sauce. It reminded me of my first week at university. I had overheard that you could make a drink by mixing vodka and refreshers. I lied to my new friends and told them I’d done it loads of times. When I attempted to make the drink in a big bowl it formed a cheese Richard, a cheese. That cheese looked a lot like your baaji-mustard.

So that was that Richard. I didn’t eat a bloody thing. My only question is: How can you live like this? I can’t imagine what dinner round your house is like, it must be like something out of a nature documentary.

As I said at the start I love your brand, I really do. It’s just a shame such a simple thing could bring it crashing to it’s knees and begging for sustenance.

Yours Sincererly

XXXX

  • Paul Charles, Virgin’s Director of Corporate Communications, confirmed that Sir Richard Branson had telephoned the author of the letter and had thanked him for his “constructive if tongue-in-cheek” email. Mr Charles said that Virgin was sorry the passenger had not liked the in-flight meals which he said was “award-winning food which is very popular on our Indian routes.”

My submission to an NPR writing contest

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Cleaning my desktop, I found this.  They provided the first line and set a 600 word limit.

The nurse left work at five o’clock.  A twelve-hour shift—only lost one, better than some nights, worse than others.  Two hours before sunup, the icy wind gnawed at her ankles.  With her caffeine gauge on empty, she ducked into Starbucks, glancing waywardly at the plethora of coffees posted overhead on the menu board.  “Do you guys actually pay someone to think up all this stuff?”  She asked rhetorically.

The still groggy looking twenty-something guy behind the counter ignored her, not a bright move on his part.  His hair looked like it was cut with an ax; an errant flap of it fell over his right eye with each movement of his head.  His right ear lobe was pierced in three places, although he only wore one earring.  The nurse noticed a barbed-wire tattoo around his left bicep.

Intent on continuing the conversation, even if it was to remain one-sided, the nurse inquired, “I suppose you guys have marketing gurus who make these monumental product decisions.”  However, nobody who knew the nurse would ever accuse her of being chatty, she never wasted words.

“That word “venti,” that’s Italian, right?”  Twenty-Something occupied himself by steaming a pot of skim milk.  “So, help me think this through,” she implored.  “Since venti is the one in the middle, it must be Italian for medium.  And, “Grande,” that must mean large.  Right?  So, here’s where I’m confused.  The one labeled, “Tall.”  Something tells me that doesn’t translate to small in any language.  If you take a small cup of coffee, and make people order it as a tall cup of coffee, maybe they will actually think it’s larger than it really is.  QED.  Quod erat demonstrandum.  That’s Italian for cut the crap.”  The nurse felt she was jousting with an idiot.  Nonplussed, Twenty-Something merely rolled his eyes and asked her what she wanted.

The nurse was usually not a half-caff, double mocha, skimmed latte kind of person.  In fact, it troubled her that some people were, troubled her a lot.  The person she tied up and left in the trunk of her car was one of them; he hadn’t known when to shut up, so she had done it for him.  By the time she had checked on him during her break, he’d frozen solid.

“Any ideas?”  The Twenty-Something foolishly pressed the nurse.

“What do you recommend for somebody who just wants a cup of coffee?”

“Do you want regular or decaf?”

“What’s the strongest you have?”

“Ethiopian.”

“Give me your largest.”

“Shall I leave room for cream?” asked Twenty-Something.

She looked at the prices.  Two dollars for a cup of coffee.  Why would anyone pay that much and then hide the taste of the coffee with cream, she wondered.  “No cream.  Instead, give me a latte grande with skim milk.”

“One grande latte,” Twenty-Something replied, correcting her syntax.  “Is that all?”

“Better give me a large orange juice.  That’s what’s it’s called, isn’t it, or is that also a grande?”

Her wit was lost on Twenty-Something.  “Large,” she murmured through her teeth.

“And a bagel, plain.”

“Toasted?  Cream cheese?”  She knew he was toying with her.

She’s had enough, grabbed the coffee, and headed for the door.

He hollered for her to pay, but the look she gave him to him to let it go.

Too bad the trunk couldn’t hold two.  She’d come back tomorrow to visit the boy.

How the Grinch stole healthcare

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(n.b. Pelosi, Reid, and the term Payor may be changed to the names of your favorite vilans without materially altering the story.)

Every Congressman
Down in Congress-ville
Liked Health reform a lot…

But the Payors,
Who lived just North of Congress-ville,
Did NOT!

The Payors hated Health Reform! The Congressional reform season!
And as everyone’s heard there is more than one reason.
Was it the fear of losing their monopoly right.
Worried, perhaps, that Congress might indict.
But I think that the most likely reason of all
May have been that the uninsured took them all to the wall.

Staring down from their man-caves with indemnifier frowns
At the warm lighted windows below in the town.
For they knew every Congressman down in Congress-ville beneath,
Canted an ear to hear them gnashing their teeth.

“If this passes, they’ll kill our careers!”
“Healthcare reform! It’s practically here!”
Then they growled, the ideologues nervously drumming,
“We MUST find a way to keep Reform from coming!”
For, tomorrow, they knew…

…Stumbling home from the tavern at a quarter past two                                                                                                                 What each Congressman, intern, and page might just do

And then all the milieu. Oh the milieu, the milieu
The thing the Payor hated more than mom’s Mulligan stew.

Then all the Congressmen, the left and the right, would sit down and meet.
And they’d meet! And they’d meet!
And they’d MEET! MEET! MEET! MEET!
Implement full provision; cover pre-existing…how sweet
Which was something the Payors couldn’t stand in the least!

And THEN
They’d do something Payors liked least of all!
Every Congressman down in Congress-ville, the tall and the small,
Would stand close together, their Healthcare bells ringing.
With Blackberrys-in-hand, the Congress would start pinging!

They’d ping! And they’d ping!
AND they’d PING! PING! PING! PING!
And the more the Obligators thought of the Congressman-Health-Ping
The more they each thought, “I must stop reform-ing!
“Why for all of these years we’ve put up with it now!
We MUST stop health Reform from coming!
…But HOW?”

Then they got an idea!
An awful idea!
THE Indemnifiers
GOT A WONDERFULLY, AWFUL IDEA!

“I know what to do!” The CEO Payor laughed in his throat.
And he made a quick Congressional hat and a coat.
And he chuckled, and clucked, “What a great Payor raucous!
“With this coat and this hat, I’ll look just like Saint Bacchus!”

“All I need is a pass…”
The Payor looked around.
Since Congressional passes are scarce, there was none to be found.
Did that stop the old Payor…?
No! The Payor simply said,
“If I can’t find a pass, I’ll make one instead!”
So he called his aide Max. Then he took some red paper
And he dummied up the pass and he started this caper.

THEN
He loaded some bags
And some old empty sacks
On a Benz 550
And he rode with old Max.

Then the Payor called, “Dude!”
And the Benz started down
To the offices where the Congressmen
Lay a-snooze in their town.

All their windows were dark. Quiet snow filled the air.
All the Congressmen were dreaming sweet dreams of healthcare
When the Payor came to the first office in the square.
“This is stop number one,” The old Warrantist – a winner
And he slipped passed the guard, like sneaking to a State Dinner.

Then he slid down the hallway, Harry Reid was in sight.
Reid was chumming Pelosi, he planned quite a night.
He got nervous only once, for a moment or two.
Then he realized that the leadership hadn’t a clue
Then he found the Congressional stimuli all hung in a row.
“These Stimuli,” he grinned, “are the first things to go!”

The Payor slithered and slunk, with a smile somewhat mordant,
Around the old Cloakroom, and looking discordant!
There were copies of the bill stuffed in jackets and on chairs,  He even found a copy tucked under the stairs
And he stuffed them in bags. Then the Payor, very neatly,
Started humming a tune from Blue Cross rather Cheeky!

Then he slunk to the Senate Chamber, the one facing East
He took the Senators’-copies! … didn’t mind in the least!
He cleaned out that Chamber and almost slipped on the floor.
Saw an Internet router, and thought of Al Gore

Then he stuffed all the copies in the trunk of his Benz.
And he thought to himself, “Why don’t I have friends?”                                                                                                                    “There’s always TW,” he said with no jest                                                                                                                                                    But TW’s being chased by reporters, those pests.

The Payor spotted the Grinch having trouble with his sacks
And he lent him a hand—he offered him Max                                                                                                                                           Max was quite pleased, for he knew this December,
That the Grinch would become the Payor’s board member.

The Grinch was all smiles–he’d made quite a killing
Offering to help pillage if the Payor was willing.
He stared at the Payor and asked, “New glasses?”
The Payor simply smiled, saying “These people are such (You did that to yourself, not me.)

And, you know, that old Payor was so smart and so conniving
When he next saw Pelosi he found himself smiling!
“Why, my dear little Nanc’,” the Bacchus look-alike stiffened,
“Botox in this light makes you look like a Griffin.
“I’m taking these home,” he said pointing to the copies.
“There’s a comma on one page that looks way too sloppy.”

And his fib fooled the Griffin. Then he patted her head
And he gave her a wink, and he sent her to bed
And as Speaker Pelosi shuffled off to her army,
HE said to himself, “What a waste of Armani!”

Then the last thing he needed
Was to mess up HITECH.
Then he went to HHS, the DOD and the VA,
Stuffed mint jelly in their servers so that they would not play

And the one EHR
That still worked in the DC
Was the one bought from CostCo and tucked under the tree.


Then
He did some more damage
To HIEs, and the N-HIN

Leaving PHRs
Far too trashed
For a doctor who did knee-shins!

It was quarter past dawn…
None in Congress were his friends
All the Congressmen, still a-snooze
When he packed up his Benz,
Packed it up with their copies of reform in those bags! Stacked to the leather ceiling,
Manila envelopes with name tags!

Three miles away were the banks of the river,
He was poised with the bags all set to deliver!
“Pooh-pooh to the Congressmen!” he was Payor-ish-ly humming.
“They’re finding out now that no Reform is coming!
“They’re just waking up! I know just what they’ll do!
“Their mouths will hang open a minute or two
“The all the Congressman down in Congress-ville will all cry BOO-HOO!”

“That’s a noise,” grinned the Payor,
“That I simply must hear!”
So he paused and the Payor put a hand to his ear.
And he did hear a sound rising over the snow.
It started in low. Then it started to grow…

But the sound wasn’t sad!
Why, this sound sounded merry!
It couldn’t be so!
But it WAS merry! VERY!

He stared down at Congress-ville!
The Payor popped his eyes!
Then he shook!
What he saw was a shocking surprise!

Every Congressman down in Congress-ville, the tall and the small,
Was singing! Without any health reform at all!
The Congress didn’t care, a few were disgraces,
All they wanted, it seemed, was TV with their faces

And the Payor, with his Payor-feet knee deep in the muck,
Stood puzzling and puzzling: “Man, there goes my bucks.
It could be about healthcare! It could be global warming!
“It could be Al Qaeda, Afghanistan and desert storming”
And he puzzled three hours, `till his puzzler was sore.
Then the Payor thought of something he hadn’t before!
“Maybe Congress,” he thought, “simply needs a free ride.
“Maybe Congress…just needs to look like they tried.

And what happened then…?
Well…in Congress-ville they say
That the Payor’s small wallet
Grew three sizes that day!
And the minute his wallet didn’t feel quite so tight,
He whizzed in his Benz passing through a red light
And he brought back the copies of the bill for reform!
And he…

…HE HIMSELF…!
The Payor calmed the whole storm!

‘Twas the night before reform when all in the House…

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‘Twas the night before reform when all in the House

Were Tweeting and blogging and squawking like grouse

Their bill filled with zeroes and commas and flair

In hopes that the Senate would soon be there

The voters were restless, and in need of good care,

And they whined and they pleaded and they yelled ‘don’t you dare’

“Don’t sidestep this issue, don’t do it for votes”

“Don’t kowtow to payors or we’ll be at your throats.”

With Pelosi and her Botox and while Reid took his nap

Didn’t care if the people put up with their (you rhyme it, I’m pretending to be neutral)

The docs sat on the sidelines, bemoaning their fate,

While payors dressed like succubi caroled “ain’t this great?”

On the lawn of the White House there arose such disdain

As the public fought reform from ‘Frisco to Maine.

MSNBC, neigh now Comcast, buttressed their base,

And Fox, aka Rupert, said it was all a disgrace.

The words on the pages of the newly printed bill,

Hid nuance, erudition, obfuscation, and skill,

Do not read the details, adjectives and signs,

Do not worry how it impacts your bottom line.

We are here to pretend we did that of import,

To Hell with Medicare, Medicaid and the sort

It’s voters we want, It’s our doxology, our mantra,

And this year silly people, this year WE are Santa

On Boxer, on Biden on Fienstein they came,

And we chortled, berated, and chided by name.

“What about seniors, and sick people” we cried?

“What about uninsured, don’t you care if they died”

“This is about people you meet on the street.

People who must choose between their meds and to eat

It’s about Lipitor, Xanax, Prozac and Viagra,

It’s about doing what’s right, do what’s right or we’ll bag ‘ya”

And then in a twinkling I heard in my head,

The gnawing and chiding of Congress, who said,

We cavorted and sucked up, the best we knew how,

We spent bucks, made payoffs, and said the time is now.

Festooned all in new regs from NHS to VA

There were those who suggested, this is not going to play,

HITECH and ARRA are not making it fun,

RHIOs and RECs will soon come undone,

We’re paying the hospitals to do EHR

We know it seems silly, like we lowered the bar

If that doesn’t work we will tax them instead,

Make them spend gobs of money, make their budgets bleed red.

Spend it, refund it, and print new money now,

Buying Canada would be cheaper and easier but wow

They want to sign something, sign it soon, sign it fast,

But don’t assume that they’ve read it from first page to last,

We could’a been more like France, like the Swiss or the British

Make us more European, make our rich people skittish,

The tall socialist exclaimed as the dems shifted right,

Will Obamacare fail, have I lost all my might?

Can you name your Chief Patient Officer?

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(This column is not outsourced to Mexico.)

How many chiefs can you name? C-Levels, not Indians. I found these–COO, CIO, CTO, CMO, CMIO, CEO, CAO, CFO, Chief Purchasing Officer, Chief Network Officer, Chief Engineering Officer, Chief Benefits Officer, Chief Development Officer, Chief Brand Officer, Chief Staff Officer, Chief Health Officer, Chief Legal Officer, Chief Quality Officer.

Besides who gets the corner office, these titles demonstrate a firm’s commitment to those areas of their business, and these positions provide that business sector visibility all the way to the top of the firm. There’s a certain cachet that comes from having your sector of the business headed by a C-Level. Those are the ‘in’ jobs, the jobs to which or to whit one is supposed to aspire. You never see anyone clambering for a B-Level position. B-Level is the repository for all non C-Level jobs.

Remember Thanksgiving dinner when you were a child—apologies to those of who aren’t from the colonies. Anyway, if yours was anything like mine, there were two tables, the nice dining room table for the adults, and the smaller card table for the children, the B-Level guests.

So what does this have to do with patient care? You tell me. Let’s go from the premise that the C-Level positions are an accurate reflection of you firm’s focus. Why are we in business? If you go from the premise it must be because of finance, marketing, IT, Purchasing, or any of a dozen other things. The only thing missing in this view of the firm is the patient. The only entity without a seat at the grownup’s table is the person in the firm responsible for the patient. It seems to me a firm’s very existence, it’s raison d’être, is the patient. If that’s true, when do they get to eat with the grownups?