Rob Lester, director of food and nutrition services at HCA's two-hospital Ocala (FL) Health system, was looking over his cafeteria spreadsheets in early 2008 when he had an epiphany. "I saw where in 2007 we had used 400 cases of disposable plastic spoons that come in cases of 1,000. When you think about those in real pieces going to a landfill, it's disgusting," Lester says. "I stared at those notes for a couple of days. I felt like there had to be a way we could make an impact."
So Lester looked into switching the utensils and to-go containers in the cafeterias at 200-bed Ocala Regional Medical Center and nearby 70-bed West Marion Community Hospital away from plastic and Styrofoam and toward recyclable and biodegradable alternatives. To gauge staff support for the idea, Lester sent out a notice to the hospital's 1,500 employees about a special Earth Day event on April 22, 2008, telling them about the plans to go green. He asked vendors to provide a one-day supply of biodegradable and recycled food service containers and utensils. Staff tasted food served in containers made of bamboo, a biodegradable material that resembles Styrofoam, and shredded paper, using utensils made from a biodegradable polymer and sipping drinks from cups made of corn starch.
The overwhelming response he got from employees surprised him. "People were crazy about it," he says. "I felt like we had to do something with this. I met with the administration and asked if I could try to put together a green program. They said fine as long as I kept the costs in line."
That's when he looked at the high cost of biodegradable food containers and had a second epiphany. It turns out being earth-friendly isn't always budget-friendly. The lidded white Styrofoam to-go boxes that sell for 7 cents apiece were a bargain compared with the biodegradable to-go boxes that cost between 15 cents and 20 cents each. A 12-ounce Styrofoam cup costs 3 cents, while a biodegradable corn starch cup costs 20 cents. "When you think about how many thousands of those we hand out each month, it really adds up," Lester says.
With earth-friendly products costing about three times as much as the standard disposable containers and utensils, Lester knew the switch to green wasn't doable. That's when he had a third epiphany. "We use real plates and bowls and silverware on our patient tray line. I got to thinking, what if we go back in time and see if we can bring china plates and stainless utensils back to the cafeteria." Lester says. "They aren't that expensive and you can use them over and over again. We put it all together and crunched the numbers and figured out that if we could get staff and cafeteria customers motivated to use the real china and stainless when dining in, we might be able to pull this thing off."
When some staff asked if the plates and silverware were sanitary, Lester invited them to inspect the hospital's dishwasher. "I've got a serious dishwasher," he says. "Our machine hits it with steam and kills everything. That helped."
Lester couldn't find a reasonably priced biodegradable cup. So, he bought 500 reusable 20-ounce insulated travel mugs, each carrying the Ocala Health logo. He sold them to employees at cost, along with a 25% discount on drinks. The travel mugs quickly sold out. He ordered 500 more. They sold out. He's awaiting a third shipment. "The mugs were made with recycled materials. I didn't plan that, but it helped to sell them a little bit more," he says.
So far the program has been cost neutral, but the reduction in nonrecyclable waste has been impressive. In January 2008, before the green initiative, Ocala Regional used 243 cases of disposable products representing 206,530 pieces at a cost of $6,338. In January 2009, Ocala Regional used 127,000 pieces at a cost of approximately $6,500. About 55% of those 127,000 pieces were recyclable or biodegradable.
To-go containers remain a big expense. In January 2008 Ocala Regional used 7,600 Styrofoam to-go containers at a cost of $636. In January 2009 the hospital used 8,400 biodegradable to-go containers at a cost of $1,943. "The cost is just crazy," Lester says. "That just shows how expensive that biodegradable stuff is. But we did reduce the non-recyclables by almost 100,000 pieces so we feel pretty good about that."
Ocala's emphasis on earth-friendly practices has not gone unnoticed. Last month, the Ocala Chamber of Commerce awarded Ocala Health its Environmentalist of the Year award. Lester says the only reason the program works is because the staff is committed to the idea. "You have to sell it to your staff. If they aren't committed it's not going to work," he says.
John Commins is the human resources and community and rural hospitals editor withHealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.
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Everybody's talking about social media, but it's hard to find examples of how, exactly, hospitals can use it to build their brand, create buzz, connect with physicians, and educate patients. One hospital that's getting it right: Henry Ford Health System in Detroit. Most recently, the hospital gained national attention when it performed a surgery and posted 140-character updates live on the micro-blogging site Twitter.
I asked William Ferris, Web manager at Henry Ford Health System (he also twitters about the Detroit Tigers), about the organization's social media efforts.
Gienna Shaw: So, why did your organization decide to describe the surgery live on Twitter?
William Ferris: We did the first one (the robotic cystectomy) in conjunction with the IRUS conference [the International Robotic Urological Symposium]. It was an opportunity to both try a new way to interact with patients and other physicians, and promote the IRUS conference. The feedback we received was generally favorable, so it became another way to share an innovative surgery with people, and it can be done in an interactive way.
GS: What were the benefits of this event—both for the audience and for Henry Ford?
WF: It gives patients and other physicians access into an OR to ask questions (even if it is only 140 characters at a time). We also were able to highlight a treatment option that isn't widely known, and in this case it saved the patient's kidney.
GS: What other social mediums does Henry Ford employ? In what ways do you use them?
Primarily these media are currently being used as distribution channels, but my goal is for them to be additional patient touchpoints.
GS: Are people paying attention? What kind of response do you get from patients and physicians?
WF: The response has generally been favorable. In the case of the surgeries we've been aided by the fact that Dr. Rajesh Laungani has turned out to be an excellent Twitterer, in my opinion. [Look for posts on Henry Ford's Twitter feed] He's a chief resident urologist and does a nice job balancing complex medical information physicians can use while answering questions in a way that non-clinical people can understand.
GS: How would you describe the state of social media in healthcare?
WF: Emerging. Many institutions (including Henry Ford) are trying to find out how to best leverage these tools. It provides another mechanism to interact with patients and outside physicians while also another channel to communicate your message. And it can be done at a relatively low cost. But understanding the right balance points for transparency and privacy are important considerations that we're still exploring.
So what can healthcare marketers learn from Henry Ford?
First, participate in multiple social media sites to strengthen your online presence. Remember that many of your customers are still just dipping their toes into social media, too. You have to reach them where they are, and that means cross-promotion on multiple platforms.
Second, don't just use Twitter or other sites as glorified press release feeds. You might not be ready to take as dramatic a step as twittering surgery live, but you can focus on your own strengths and tell your unique story.
Third, make sure the conversation is two-way. During the surgery (and for some time afterward) viewers posted questions about the event, engaging with the surgeons who were in the OR (and no, the surgeons did not twitter while they were performing the surgery—another doc was there to monitor the computer screen, post updates, and answer questions).
What can you offer to online audiences that other hospitals cannot? What can you do that is different, that will help your organization stand out? Henry Ford wanted to promote its surgeons and its technology. Decide what you want to be known for before launching an online persona. And then ask yourself how you can communicate that in new and buzz-worthy ways.
The process of creating your brand is the engine that will ultimately drive your ability to deliver and sustain it. Often marketers focus first on developing a campaign to define and communicate the brand without developing the relationships that bring the brand to life. Here are 10 steps to take.
While your organization may have more than enough traffic on your Web site to achieve your business goals, it still may be "leaky." That is, patients and physicians are visiting your Web site, but very few are taking the next step. This article discusses how to diagnose the problem and, more importantly, how to fix the leaks.
The good news for healthcare providers is that the $787 billion stimulus bill that President Barack Obama signed into law yesterday includes an additional $87 billion for state Medicaid programs. Given Medicaid's dismal reimbursements, however, that's also the bad news.
"It's mostly short-term good news for the hospitals, health systems, and physicians because it does hold the promise of broadening coverage, at least temporarily, in a broad environment," says Steve Jenkins, a vice president at Chicago-based healthcare consultants Sg2. "We do need some caution about the primary method of expansion being Medicaid. That has some risks. Payment levels are the poorest of any payer and don't cover costs. And because Medicaid is so tied to state budgets, it's very susceptible to the swings of state budget fortunes. It expands when state budgets are flush, and it contracts when state budgets are in crises, as many are today."
In fact, the Medicaid supplemental funding does have one very large string attached. States can only use the supplemental money if they do not cut their Medicaid programs. The National Conference of State Legislatures reports that 43 states face budget shortfalls this year, and AARP reports that several states have considered cutting their Medicaid expenditures this year to account for budget shortfalls.
Expanding healthcare coverage is clearly the largest priority of the stimulus plan's approximately $150 billion in dedicated healthcare expenditures. The Medicaid supplemental funding and $19 billion earmarked to pay up to 65% of COBRA premiums for laid-off workers are the top two biggest expenditures and comprise more than two-thirds of targeted healthcare spending. "Today, 15% or fewer of people who have the COBRA option elect it because it's not affordable to a lot of people who've lost their jobs," Jenkins says. "Now they are going to have a better opportunity to sustain their coverage. And it's a good thing for healthcare providers because it's going to maintain them at a group-based policy that is more likely to have reasonable reimbursement rates."
The third-largest healthcare-related expenditure in the stimulus is the $19 billion dedicated to provider healthcare information technology upgrades, of which $17 billion will be awarded through Medicare/Medicaid and $2 billion through grants and loans. Stephen Page, an attorney and analyst with Nashville-based Waller Lansden, says that amounts to a base of about $2 million for each hospital that qualifies as a "meaningful EHR user," under a rather dry and detailed federal definition.
Physicians have long lagged behind hospitals in the adoption of information technology; Page says that less than 5% of doctors use EHR. However, doctors could receive as much as $18,000 in incentives for the first year that they become a "meaningful EHR user," under a timetable that encourages quick adoption of the technology and financial penalties for those who lag behind. The incentive payments do not apply to hospital-based physicians who have access to the technology through their health system.
Page says the Obama administration's EHR incentives may be the carrot that eventually leads to a big stick: mandatory EHR for physicians seeking Medicare/Medicaid reimbursements. "If in five years you don't have EHR you could probably be seeing this kind of thing," he says.
One of the smaller expenditures in the massive healthcare stimulus package may prove to be the most contentious. The Obama administration has earmarked $1.1 billion—which is pocket change relative to the overall size of the stimulus—to compile data on evidence-based medicine.
The government wants to know which surgical procedures, drugs, medical devices and treatments work and which don't. Peter Orszag, director of the federal Office of Management and Budget, suggested recently that the government could adopt a system of financial rewards and disincentives for physicians and hospitals that use proven treatments. "More research on what works and what doesn't, tied to financial incentives to provide the higher-value care, could help to reduce costs without harming quality," Orszag said on National Public Radio. "We currently have a set of financial incentives just for more care. And we need a set of financial incentives for better care. And part of that requires knowing what better care is."
Evidence-based medicine is also aggressively supported by the health insurance industry. "The investment in comparative effectiveness will yield vital information on the safety and effectiveness of medical treatments and technologies, empowering patients and doctors to make better-informed healthcare decisions," says Karen Ignagni, president and CEO of America's Health Insurance Plans.
That enthusiasm from the government and the health insurance industry has doctors uneasy. Many doctors see evidence-based medicine as the government's and private carriers' first big step toward dictating treatment. Drug and medical device companies don't like it either. They're afraid that their more profitable products might be either exposed as ineffective or too costly.
"At some point I would imagine the government is going to try to figure out what is the best treatment," Page says. "Then the question is, are they going to tell doctors you treat this way or that way and you only reimburse them if they follow certain protocols. That is down the road, but if you read between the lines, is this where it's going?"
Obama administration officials have made it clear that the stimulus plan is the first major step in the president's plan to overhaul healthcare delivery. "This represents the beginning steps of the president's health reform vision," Jenny Backus, a spokeswoman for the Health and Human Services Department, told the Associated Press. "It's designed to get relief to people who need it most and to do everything we can to bring down the cost of healthcare, and improve access and quality."
Although it may be tempting to take every last nickel the feds are offering, Jenkins warns anyone taking stimulus money to read the fine print. "There are a lot of devils in the details about how the money is spent and how the different measures get implemented," he says. "Anyone doing business with the federal government needs to watch their Ps and Qs and exert all due diligence. If you can get passed that, my general advice is look for how this stimulus bill can work for you, and look for where there are initiatives you are pursuing where this new fund can support what you are doing."
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
Under an agreement between Cleveland Clinic and the Lou Ruvo Brain Institute, the Cleveland Clinic will staff and operate a brain center in Las Vegas. The brain center, dubbed the Cleveland Clinic Lou Ruvo Center for Brain Health, will be housed inside the Lou Ruvo Brain Institute. The center's clinical practice might begin seeing patients by midsummer, officials said.