Characteristics of a Successful Leader in a Health Care Setting

I want you to think about the term Leadership for a moment. If I asked several of you to give your definitions I bet there would be many different points of view, some similar, perhaps, but most quite different. Do you envision someone who is strong and demanding with rigid concepts about getting things done? Do you envision someone who is a good listener, who leads by example? I think there are many valid ideas about leadership, and each probably has its place depending on the situation. I want to focus on what kind of leadership is necessary for changing an organization into a Lean organization or maintaining a Lean organization. The reason I choose to do so is that I am a member of a committee that is charged with developing a program to assist local physicians and physician organizations incorporate Lean healthcare with the Wagner Chronic Care Model. One of the milestones is to develop leadership locally; leadership in quality also came up as the primary identified need in a survey of the local physician organizations.

When changing an organization into a Lean one, the first thing I consider is the person at the top and his characteristics. Without firm support from this person the transformation will not be successful and will not endure. In a hospital this would be the CEO and in a primary care setting, the person making the major management decisions, whether the office manager of a physician. One characteristic of this leader should be persistence. Why? Changing the way an organization approaches quality requires a cultural change. Such change will encounter resistance; people tend to resist change because maintaining the status quo is comfortable. A leader at a hospital, for instance, might after much staff training in Lean tools succeed in getting the front line workers-the nurses, the aides and the doctors–to change only to have middle management sabotage the efforts. Only with persistence can this roadblock be overcome. Persistence mixed with patience and high standards will be necessary because the changes will take a considerable amount of time too. One year for a primary care office to embrace continuous quality improvement would not be unusual, whether the leader starts small by changing one part of the office at a time or whether the staff as a whole is trained and asked to change. By the way, in a November 19, 2007 article in the Wall Street Journal persistence along with attention to detail, efficiency, and analytical skills were named as the most important skills of successful CEOs.

Attention to detail means recognizing and understanding how the parts work together.  In order to lead change successfully this would mean understanding how different members of a quality improvement team work together.  Do they complement each other?  Do they clash?  The leader is responsible for integrating such a team.  Besides understanding team dynamics, a leader must understand how the different parts of the healthcare site function.  Does the support staff or administration complement the clinical?  For instance, is billing efficient?  If not, this has negative consequences in providing clinical care.

Efficiency in quality improvement cycles means understanding where waste exits in an organization and also understanding how to utilize staff ideas to eliminate these wastes.  For example, in a primary care site a leader should have a clear picture of how to reduce the time spent looking for misplaced patient histories, if paper histories are still being used.  Of course, if electronic health records are being used, this problem would be largely obviated.

A fourth skill very necessary for strong quality improvement leadership is analytical skills.  A leader should be able to weigh the cost of a quality improvement effort versus the return on investment.  Rarely are the success or failure of a quality improvement effort tracked in terms of cost and savings.  Focusing only on patient health means that sustainability is ignored.  With the increase of competition in health care and the advent of bundling of payment for services in Medicare the financial factor cannot be ignored.

Besides these four characteristics the leader guiding the Lean transformation must also understand some of the basic tools of Lean-process mapping, kaizen events, 5S and voice of the customer, among others. I don’t think that the leader needs to be the master of these; rather she should be able to recognize their correct application and through her vision of a quality organization see that these tools are implemented and the results communicated throughout the organization. One situation, for instance, in which the leader makes sure the tools are implemented correctly is by appointing people with Lean skills to teams; this team might be defining new processes to handle diabetes patients in a primary care setting. She should be able to select an able leader for this team and see that the ideas generated are sorted and disseminated with the best ones implemented. Once the process is implemented the leader should have the impact measured and if the impact is positive have the process maintained in spite of common roadblocks such as resistance from those who want to maintain the status quo, as mentioned above.

In order for a leader to become familiar (not an expert though) with these tools several approaches are possible. There are many conferences and trainings for lean management available in healthcare. The American Society of Quality offers such. Another approach is to contract with a consultant who is familiar with both healthcare and Lean techniques. Whatever the approach-workshops, conferences, online training or hiring of a consultant–I think it a good idea to follow up these with a reference text such as A Lean Guide to Transforming Healthcare by Thomas Zidel.

Lest you think that I miss the mark with my characterization of a Lean leader, let me relate one last story. Jaimie Houghton was the CEO of Corning Glass and implemented Total Quality Management in the early 90’s to Corning. He spent a great deal of time traveling to Corning’s units worldwide to drive his vision of a quality organization. In 1995 one of Corning’s units received the Malcolm Baldrige National Quality Award. Mr. Houghton retired the next year after successfully imbedding TQM in Corning. His successor, however, did not have the passion for quality that Mr. Houghton had. The programs were not abandoned but other priorities and visions preempted Mr. Houghton’s legacy. The result was that sales dropped dramatically and the stock price fell from $113 to as low as $1.10. In 2002 Mr. Houghton was coaxed out of retirement to rescue this failing giant. This time, Mr. Houghton instituted quality using Lean and Six Sigma. He made sure that the programs would endure after he left again. Although the share price is considerably below the high of $113 of previous years, the company leads its competitors considerably in market value. Much of this is attributable to the persistence of Mr. Houghton in ingraining recognized quality approaches into the company.

Dog Owner’s Guide – How to Care For Dogs

High Quality Dog Food

Just like humans canines need to be fed on a high quality pet food. A combination of dry and wet dog food would be ideal. High quality food is very important for your canine friend as it will reflect on your pets overall performance, energy levels, motivation and mood.

Fresh Water

Must be available at all times.
Fresh water is essential for your four legged friend so it is advisable to make sure dogs have water available at all times and especially during hot weather dogs needs it.

Vet Visits

Since early puppy stages, advisable time would be to take your puppy to the vet at eight weeks old, and this is when your puppy will be fully vet checked and will receive ever so important and necessary dog vaccination which will help your dog to bust it’s immune system by fighting back any disease he / she can pick up outside from other animals.
Thereafter dogs should be taken for a vet check at least once per year. This can prevent any illnesses in the future and also dogs should be getting their booster from their vets too, which should boost their vaccination to stay effective.

Dog De-fleaing

Dogs should be defleaed every month to every three month, it depends which products you have decided to use. It is highly recommended to use products suggested by your vet. You can get either spray or you can get spot on formula. Especially in the summer it’s essential to take care of your dogs fleas on a monthly basis also to make sure you regularly clean your dogs room, bedding, the whole house should be cleaned and hoovered up as much as possible. By hoovering your house you are also reducing the amount of fleas in your house. Also combination of salt and soda bicarbonate mixed (equal amount of each ), should be sprinkled around the house on all the carpets and it should be left on for 24 hours. This will destroy any fleas in the house and their eggs.

Dog Toys

Dogs needs their toys to express themselves throughout the day. A variety of dog toys is recommended dog balls, dog Frisbee, any chew toys which are highly important especially at early stages of your dog’s life as it’s teeth are growing just like with us they need something to stimulate it’s teeth and help with their uncomfortable pain too.

Dog Exercise

Probably one of the most important things in your four legged friends life would be daily exercise. Exercise is essential to keep your dog healthy, fit, energized, in top form, it help with several health issues. Problem behaviours like barking, excessive barking, chewing, restlessness, unhappiness, problems with dog socialization, aggressive dogs, unfriendly dogs, depressed dogs, all this health issues often indicate the fact that dogs are simply not getting enough exercise. Sometimes dog owners automatically think that dog training will help to their dogs with their issues, but they don’t realise that their dogs needs fresh air, sun and exercise. It is also extremely important for their mental abilities, mood and mental and physical stimulation. Dogs should be taken out to the nearest parks and forests on a daily basis. It is highly recommended one hour in the morning and one hour in the evening. By doing this and making this your canine’s friend part of every day life you are making sure your precious four legged friend is getting all that important exercise and you are increasing chances to have a happy and healthy dog.

Professional Dog Walkers

Due to the fact most of the people are busy dog owners and often work 12 hour shifts it is impossible for them to take their dogs out for an hour in the morning and hour in the evening. This is where professional dog walkers come in very handy. Professional dog walkers can become the best friend for your dog and will always make sure your canine friend gets all the exercise they need in order to live a long, happy and healthy life.

5 Air Ambulance Characteristics Every Health Care Provider Should Research

Making an informed decision about your patient’s medical transportation is not an easy task. In fact, as a health care provider or social worker, it’s probably one of the more frustrating day-to-day tasks you have. For some reason most air ambulance websites are either geared toward individuals or insurance employees — even though it’s far more likely that case workers like yourself will be the ones arranging the flights. There are five air ambulance characteristics every health care provider should research before they hire a service, and you’ll know exactly what they are after reading this article.

Before we begin, let’s talk a little bit about the two most important concerns every health care provider has when it comes to air ambulances. The five things we’re about go over were specifically chosen for how they relate. The two concerns every health care provider has are:

  • Quality patient care
  • Time management

Quality patient care is often one of the biggest concerns for medical providers; and this is especially true when it comes to air ambulance services. There are a lot of patient transport services to choose from, but you cannot assume that patient care will be consistent among them. In fact, this is something that tends to vary greatly among providers.

The second biggest concern is time management. As a case manager or social worker, you’re expected to serve both as patient advocate and dispatcher. This can be very time consuming for you, but a well trained company can help by taking care of things on their end to make sure they are ready to fly at a moment’s notice.

Now, a good way to make smart choices about patient transport is to follow a check-list. This will also help by making the whole process a lot less overwhelming for you. Just because you’ve been tasked with the responsibility of hiring an air ambulance service, it doesn’t mean you need to start right from square one every time.

There are five areas to pay special attention to when arranging medical flights. They are:

  • Amenities
  • Safety
  • Risk
  • Customer service
  • Affordability

Hopefully, you can see how each of these areas will have an enormous impact on patient care and time management. Let’s briefly go through them and see what you should be looking for.

Amenities. Air transport has come a long way since the original army helicopter model. Learjets are not exactly commonplace in the industry, but are used by some of the superior air ambulance companies and can afford your patient more room and better access for loading and unloading.

Safety. Something that is not required of air ambulance services is the ability to fly at special altitudes that reduce the minimum vertical distance of aircraft. This unique type of certification can cut down on delays due to air space restrictions.

Risk. Risk to the patient can be reduced dramatically simply by ensuring constant care is administered from the time the patient enters the air ambulance until he or she is transferred to a bed at the receiving hospital. In the industry, this is referred to as bedside-to-bedside care.

Customer Service. Most companies provide at least some level of customer service. What you want to look for is consistency and quality. Every staff member you come into contact with should have the ability to answer your questions and solve problems.

Affordability. It should cost your patients a fortune to receive this higher level of patient care. When you’re doing your price comparisons, look for companies that offer middle of the road pricing without any major sacrifices to the other services mentioned here.

Lastly, you’ll want to give careful consideration to location. Don’t just overlook this aspect because it seems so obvious. Airplane or not, it will take your ambulance longer to reach you if they’re not centrally located.

It’s preferable to find a company that services a specific region. That way you’ll know they’re familiar with the area, and already have existing relationships with the nearest medical facilities.

If you are a case worker that’s committed to finding the best air ambulance service for your patients, you’re not alone. Amenities, safety, risk, customer service, and affordability are all factors that play a key role in patient care and time management — the two areas most important to you. You can use this guide as a template while you gather the information you need to make a responsible decision.

Mexico Health Care – A Guide For US Retirees

When planning on moving to Mexico a primary concern should be healthcare. People who have moved to Mexico are very lucky since Mexico health care is generally very good, in most places, it is positively exceptional.

Many health care practitioners in Mexico receive at least part of their training in the United States and many American doctors have trained in Mexico, notably in Guadalajara.

Every mid-sized to large city in Mexico has at least one first-rate hospital and a big plus about health care in Mexico is that the costs are generally half or less than one might expect to pay in the U.S.

The same thing also applies for prescription drugs. Those prescription drugs that are manufactured in Mexico are about fifty percent less on the average, compared with similar drugs manufactured in the United States.

There are two options to consider for healthcare in Mexico: IMSS (Social Security) and Private.


Thousands of U.S. retirees are moving to Mexico and taking advantage of IMSS – Mexican social security healthcare (Instituto Mexicano del Seguro Social).

Mexico has allowed retirees and people who wish to stay in the country for a longer period of time to contribute to this scheme, this is the closest to socialized medical coverage as it is possible to get.

There are some pre-existing conditions that would prevent you from coverage by way of IMSS. The typical cost of payment is calculated having a full time job on a minimum wage salary; the cost will increase marginally each year.

You can apply for IMSS on the official government web site by answering general health care, medical history and a questionnaire. The annual fee will give you access to resources like regular doctor and dental checkups, emergency surgeries, lab tests from your doctor, prescription medicine and even eyeglasses.

In a recent article about IMSS from USA Today, the paper said “The system has flaws, the facilities aren’t cutting-edge, and the deal may not last long because the Mexican government said in a recent report that it is notorious for losing money. But for now, (American) retirees say they’re getting a bargain.”

Many retirees move to Mexico from the US as they cannot afford the healthcare and the IMSS system is the best there is.

It is not altogether clear how many Americans use this IMSS system, however with between 50 and 80,000 retired Americans living in Mexico the numbers are probably in the thousands.

The Mexican social security is cautious that this plan may need reviewing and may not be sustainable if thousands more American re locate to Mexico.

You may not get the luxury treatment of a private room with TV, and phone, and if things do go wrong the Mexican court system is not on a par with the US and does not provide much recourse. However it is an affordable way of protecting yourself against medical emergencies while living in Mexico.

Private Healthcare

Private health care in Mexico is far less expensive than in America. Paying by cash for an appointment could always be an option. A general medical consultation may cost around $30 USD, but be warned costs are more expensive in major tourist destinations and big cities.

Very few Mexicans have private health insurance, but this sector is growing. There are also very good medical centers in towns and smaller cities often frequented by tourists.

Private clinics or hospitals in more rural locations have a tendency to be owned by groups of local doctors or physicians varying in levels of training. Their facilities and technology are not as sophisticated and cutting edge, but are adequate to treat minor illnesses.

Most private hospitals do not accept foreign health insurance, and will require a credit card or cash payment before any treatment. However, if you are critically injured or in grave health a private hospital will do everything they can to stabilize your condition then you would be transferred to an IMSS or Government hospital.

There is also talk of Americans being able to use Medicare or Medicaid insurance in Mexico health care facilities by the end of 2010. So really, whatever option you go for, you can be sure of accessible, high quality, well priced health care should you decide to retire to your own home in the Mexican sun.

Universal Primary Health Care

Primary Health Care is the Foundation of all Health Care Systems. A strong PHC will build strong healthy populations. Compared to Secondary and Tertiary Health, it only costs Governments a small fraction of the Gross Domestic Product. However, because it is not Glamorous, most Governments, especially Developing Countries neglect it at great cost to their suffering populations. and would rather waste huge amounts in building Fancy Hospitals for the 10 % who are mostly there because of the failure of the PHC System due to inadequate funding and lack of population health education.

However the World Health Organisation has pleaded with all Governments to ensure “Health for All” and PHC can bring solace and comfort to 90% of the Population of the World and instituted 21st Century Millenium Development Goals to guide each country’s shortcomings. Essentially PHC covers 5 Strategies, 1st is to provide Preventative Health Programs like Compulsory Vaccinations Schedules for young and old, Screening programs like Pap’s Smears and Mammography for Women to detect Cancer early and Blood and Urine Screening to detect Chronic Non-communicable Diseases like Diabetes, Hypertension, Heart Problems and Respiratory difficulties and of course School Health as well as well -grounded Ante-Natal and Post -natal Programs for the growing populations, especially for the poor and needy.

The 2nd Strategy is to use the various Public Media to Promote Healthy Life Styles against Alcohol, Smoking, Narcotic and other Habit forming Drugs, Educate on Proper Diets and Appropriate Exercise programs to keep People Fit and Healthy. 3rd Strategy is to have adequate PHC Clinics to look after Acute Disease presentations which appear suddenly and have the potential to kill rapidly. 4th Strategy is to manage Chronic N-C Diseases which have increased dramatically and produced so much morbidity and reduced quality of lives. ( upto 50 to 70 % of people bove 30 years of age, Finally 5th Strategy is to Rehabilitate those who have contracted Disabilities due to motor vehicle accidents, strokes and heart attacks to live comfortably as their Human rights and be able to perform their Activities of Daily Living with dignity and privacy.

Primary Health Care is NOT an option BUT a basic human right for every citizen. It therefore becomes a political agenda which every responsible person should value and push for when considering their future Governments. Every country which has invested in a well-organised and developed Primary Health Care System has harvested rich rewards in producing productive populations who in turn have raised the standards of living and equity and justice among all their fellow citizens.