Jeff Francis

Opening Day

2011-03-08T23:35:00.004-05:00

This past week, I have talked to you several times about the joys of spring. With the official first day of spring just two short weeks away, I thought I would keep the theme going and talk about the greatest part of spring: Baseball.

Baseball is one of the great past times of our country. Since the 19th century, people have turned out to watch their local nine do battle on open green fields. And for just as long, people have been thinking about the food they want to eat when they watch a game.

Everyone knows about the hot dogs, peanuts and Crackerjacks. But today, going to the ballpark also means Italian sausages, pizza, clam chowder, steak sandwiches and any other food a team can get in a stand and onto a plate--and some stuff that maybe shouldn't be put on a plate. In fact, the new Yankee Stadium has it's own butcher shop!

For my money though, nothing beats a warm, soft pretzel. Put on a little spicy mustard and the snack is complete. A homemade pretzel is a fantastic snack, and you don't have to go to the ballpark to get one.

Baking up golden pretzels is relatively easy too. Even tying the trademark pretzel shape is easier than you think. With a little practice, and you will have a regular cottage industry. If you don't want to make whole pretzels, pretzel bites are good alternative. They're cute and delicious. They are not only great when watching games at home, but they are perfect for taking a snack to Little League games too.

But don't take my word for it, head on over to Betty Crocker to try out our special Ham-Twisted Pretzels with Beer Dip. It is a guaranteed hit the next time the crowd comes over to check out the game.

And as always, we invite you to send in your favorite game time decisions. We look forward to hearing from you!

Betty

To Add or Not to Add

2011-03-07T23:49:00.005-05:00

A common question I get, even from kitchen veterans, is how much spice and herb should I use in my cooking?

The general, unhelpful answer is, it depends. It does, in part, come down to personal taste and the dish you are cooking. However, there are some general guidelines to follow when spicing up that dish.

First, remember that herbs and spices are meant to bring out the flavor of food, not overpower it. This is often ignored, especially when using meat that was frozen. Sometimes people fall in love with an herb and load up their dish so that the rosemary chicken becomes chicken rosemary. There is always room for personal taste, but if you aren't just cooking for yourself, it is best not to get loose with that shaker.

If you are trying a recipe for the first time or inventing your own, it is best to be modest with your use of spices. Another general rule when measuring spices is fresh herbs are not as potent as dried herbs. In general, one teaspoon of dry is equal to one tablespoon of fresh.

Secondly, it matters when you add the herbs and spices. If you are using whole herbs, put them in at the start since whole spices take longer to release their flavors. These are commonly used in soups and stews. Be advised though, it is best to use a tea ball or some other device to contain the herbs in order to more easily remove them when you are done cooking. I have yet to meet someone who enjoyed biting into a bay leaf with his or her soup.

If you are using chopped or ground herbs, these can typically be added in the last 15 minutes or so of cooking. Unlike whole herbs, it does not take as long for the flavor to come out of chopped herbs. If you are serving a cold dish, add the herbs about an hour beore serving so the flavor can seep in. Steaks and other BBQ meats should have a couple hours with the spices to get to know one another before cooking.

Those are the main rules. Otherwise, have fun and experiment. And just to have some fun, and confuse everyone, here is a great recipe for tuna where you add cilantro at the beginning, the middle, and the end!

Enjoy!
Betty

Pan-seared Tuna with Avocado, Soy, Ginger and Lime*

2 big handfuls fresh cilantro leaves, finely chopped
1/2 jalapeno, sliced
1 teaspoon grated fresh ginger
1 garlic clove, grated
2 limes, juiced
2 tablespoons soy sauce
Pinch sugar
Sea salt and freshly ground black pepper
1/4 cup extra-virgin olive oil
1 (6-ounce) block sushi-quality tuna
1 ripe avocado, halved, peeled, pitted, and sliced

In a mixing bowl, combine the cilantro, jalapeno, ginger, garlic, lime juice, soy sauce, sugar, salt, pepper, and two tablespoons of olive oil.

Stir the ingredients together until well incorporated.

Place a skillet over medium-high heat and coat with the remaining two tablespoons of olive oil.

Season the tuna generously with salt and pepper.

Lay the tuna in the hot oil and sear for 1 minute on each side to form a slight crust.

Pour 1/2 of the cilantro mixture into the pan to coat the fish.

Serve the seared tuna with the sliced avocado and the remaining cilantro sauce drizzled over the whole plate.

*Recipe courtesy of the Food Network's Tyler Florence.

Food Grows on You

2011-03-06T23:50:00.000-05:00

Hi, everyone. What a beautiful Sunday we had today. A little rainy, but you can't complain about weather in the 60s after the winter we had.

Who knew that by talking about the warm weather coming, it would just show up. It must be in anticipation of all your summer time recipes.

Today, I actually saw people out raking the lawn. Two weeks ago, lawns were completely covered in snow. Now, just barely in March, and people are out in their gardens getting ready for the spring. I have to admit, I took a walk by my garden to see if the tulips I planted last fall had started to poke out. I know, it is a little early, but the warm weather gets your hopes up.

Speaking of gardens, depending on your growing zone, it is almost the perfect time to start planting those hardy cold-weather vegetables. Up here in Minnesota, we still have a ways to go, but most of the country is either in-season or just a few weeks away.

Now is the time to start planning the leafy greens you will want for the fresh spring salads. Some vegetables to start thinking about are kale, lettuce, collards, snow peas, beets, carrots, cabbage and broccoli.

Vegetables from your own garden are a great way to save money--not to mention the satisfaction you get from being self-sufficient.

Of course, I know a lot of us don't have gardens to get down and dirty in. No worry, even a small apartment can sustain an herb garden. There are plenty of herb garden kits that can survive indoors. Maybe you can't grow your own tomatoes, but the fresh sprig of parsley from your herb garden will spice up any dish.

I have been keeping gardens for most of my life. It is a great way to relax, as well as added motivation to come up with great dishes for your hard work.

I'd love to see the fruits of your labor. Send me pictures of your gardens, and we will feature you on our website.

Here's to all the green thumbs out there.

Betty

Warm Weather Around the Corner

2011-03-05T23:22:00.000-05:00

Now that it is March, spring is right around the corner. That means warm weather and barbecueing; and who doesn't love a good BBQ?

Here at Betty Crocker, we look forward to getting outside and cooking on an open flame. We also love potato salad, pasta salad, corn on the cobb, and a good old fashioned New England clambake.

Anyway, with all the snow we have had this year, I thought it would be nice to think about the summer cooking that we have just ahead of us. In order to help everyone achieve this warmer state of mind, we are having a cookout contest! We invite you to send in your favorite cookout recipes. We will choose 50 finalists, and post the recipes on our website. Then you all can vote on your favorites, with the top ten recipes winning a Weber grill!

This contest is open to every kind of recipe. Have a great marinade or rub for your ribs? Send it in. How about a great summer time beverage? Every cookout needs good drinks, so send those in too.

The only requirement is that you get your entries in by March 31. And of course, it must taste delicious. Send in as many entries as you can. Voting will continue the entire of month of April. Please send all entries to contest@notbetty.com.

In line with the summer theme, I am posting a favorite summer treat of mine: Clam Cakes. This is a simple, but delicious deep-fried treat. The best part is, most people will have all the ingredients they need already.

2 cups Gold Medal Flour
2 eggs
1 tsp. paprika
1 tsp. fresh chives or parsley, chopped
1/2 tsp. onion powder
1 tsp. salt
1/8 tsp. pepper
1 tbsp. sugar
1/2 cup milk
2 small cans minced clams
1/2 cup clam broth or liquid
2 tsp. baking powder

One of the great things about this recipe is its simplicity. First step, mix everything in a mixing bowl. Be sure to drain the clams, but save the juice. Depending on the clams, you should be able to get half a cup of juice out of one can of clams. Once everything is mixed, drop the batter, a tablespoon at a time, into a deep fryer or a pan of hot oil. Try to keep the oil around 375 degrees. The cakes should float, so make sure to flip them so both sides get golden brown. They should take about 3-5 minutes to cook. Dry them on a paper towel before serving. Then, enjoy!

Hopefully, this inspires all of you.

Good luck, and get cooking.

Betty

Cooking to the Music

2011-03-04T19:31:00.003-05:00

It's Friday, and a lot of our friends are getting ready to kick back and relax. So, I decided to answer a particularly fun question that came to me the other day.

Hi Betty,

I love cooking. There is something envigorating about making a home cooked meal. But, so much of the prep work can make me nuts. Peeling potatoes and chopping vegetables is just so boring. Usually, I try to put on some music to make it go by quicker. I was wondering, do you like cooking with music? And if so, what are your favorite songs?

Sincerely,
Rockin' Around the Kitchen.

This is a great question. I do enjoy music to liven up the work. It certainly makes waiting for the water to boil more tenable, as well as cleaning up after the meal. The radio is almost always playing as I dance around the dishes.

As for my favorite songs, I guess that depends on what kind of mood I am in and what I am cooking. If I am cooking delicious desserts, like a bundt cake or cheesecake, I prefer something upbeat that helps you move around the kitchen. Nothing gets you up and moving like a good R&B mix. I enjoy Marlena Shaw's "California Soul" or Carol King's "I Feel the Earth Move." But anything that gets you moving and dancing is great for mixing up some batter and strutting out your desserts. Great desserts take confidence and bravado, anything that can inspire that only adds to the dish.

Of course, if I am making a dinner for two, I want to be inspired in a different way. Maybe it is a Valentine's Day meal. A little love mood music is in order. "The Best Is Yet to Come" by either Frank or Tony is probably echoing off the linoleum. Another standard of the Crocker kitchen is "Cause I Love You" by Lenny Williams. If that song doesn't inspire love in your food, nothing will.

Music is great for helping you get in touch with your inner chef. The best cooking comes from the soul. Whether it reminds you of your grandmother's kitchen or makes you think of how special the people you are cooking for are, music can really help that dish strike the right chord.

That's all for this week. Have a great weekend.

Betty

Active People Can Still Eat Well

2011-03-03T23:22:00.006-05:00

These days, people lead busier and busier lives. The result too often is we take shortcuts when it comes to eating. Even if you are busy, you still need to refuel, and a protein shake is no substitue for a dinner. We need to take care of ourselves, both inside and out.

Now be honest with me, how many times this week was your supper rice cakes and peanut butter?

Here at Betty Crocker kitchens, we know how difficult it is to find the energy to cook a good meal. Still, good food is the best fuel. I know what you are thinking, but it doesn't have to mean boring salads or stale tasting food.

Yesterday, we mentioned a real life saver: the slow cooker. They are great kitchen tools for busy people who want to eat healthy. Just drop in all your ingredients and flip a switch. Then, head off to work, the gym, pick up the kids, and come home to an aroma filled house and a ready to eat meal. Coming home to a ready, home-cooked meal is not only delicious, but refreshing. There are so many great options for the slow cooker, it's not just soups.

One of my favorite foods is sweet potato. Using your slow-cooker, you can make a delicious chicken and potato dish for a great healthy dinner option.

Here is the simple sensation:

8 boneless, skinless chicken thighs
1 teaspoon salt
1/8 teaspoon cayenne pepper
1 teaspoon paprika
1 teaspoon curry powder
1/2 teaspoon ground ginger
3 sweet potatoes, peeled and cubed
1 onion, chopped
1 cup peach preserves OR apricot preserves
3 tablespoons apple cider vinegar
1 tablespoon low-sodium soy sauce
1/2 cup chicken broth or water
2 tablespoons cornstarch

The key to this recipe is properly seasoning the chicken. You can season it to your personal taste. It is best to put the seasoning right on the chicken, don't just drop it into the pot. Use the salt, cayenne pepper, paprika, curry powder, and ginger on the chicken. Line the bottom of the slow cooker with the sweet potatoes and onions. Then place the chicken on top. Finally, top everything with the peach preserves, vinegar, and soy sauce.

That's it. Just cover and let it cook for about six to eight hours. Then go get your busy on.

When you come home, mix the chicken broth and cornstarch. Pour it into the slow cooker to thicken up the sauce(about 10 minutes).

That's it. Dinner is ready to eat 15 minutes after you get home. Maybe steam some fresh green beans on the side, and you have a dinner that blows away those whey powder drinks.

Enjoy!
Betty

I can't get my kids to eat healthy...what the Crock(er)!

2011-03-02T23:34:00.005-05:00

Do you have picky eaters at home? Creating fun, healthy meals can be frustrating when kids refuse to eat certain foods.

Given how busy we all are these days, it's easier sometimes to just give in to the inhibited gourmets. Even big kids fuss over their food. I was recently out for dinner with some friends, and one of the girls ordered some pad thai--minus the eggs and peanuts. Trying to convince her that pad thai isn't pad thai without those ingredients just didn't work. I suppose if she's made it this far in life without eggs and peanuts, there's no use in trying to convince her otherwise.

In the case of the pad thai, my friend's only missing out on the exquisite flavor. But with vegetables and kids, there's much more at stake than a deficient dish.

So, how do you get those fruits and vegetables into a kid's stomach?

I put this question out to my Facebook friends to see how they do it. And boy, do parents have all kinds of tricks of the trade.

A lot of people said they try covering up vegetables with butter and cheese, but they admit this defeats the purpose somewhat. Even then, some kids will see through the ruse and not bite, literally. Like many of our friends, I've always been a fan of ants on a log. However, I've also seen enough spit out raisins and licked celery stalks to appreciate the efforts children will take to avoid healthy snacks.

Other parents say they lie to the kids about what they are eating. One mother commented that she convinced her son to eat peas by telling him that they were just green corn. Apparently, the concept of off-color corn is more appetizing than fresh peas, because she said it worked. At least, she clarified, for a little while. Now that he's older, though, he eats all his vegetables...except peas! I guess they were martyred for a good cause.

Another common response is to make soups loaded with vegetables, especially minestrone. Another great thing about soups is a good slow cooker can do most of the work for you, and there are always leftovers to take for lunch the next day. Still, parents lamented that this strategy isn't infallible either. Many soon discover that their tikes are little Jacques Cousteaus, deep sea exploring in their bowls to avoid anything that looks healthy. It's "Where's Waldo?" soup edition.

The suggestion that was by far the favorite took the cat-and-mouse game one step further: Create dishes where the vegetable isn't just hidden but disguised.

This note came from one of our Facebook friend's Internet test kitchen:

"I am a fan of taking muffin and pancake mixes and adding pureed fruits and veggies to them, as a way to sneak healthy foods into my picky two-year old. So try a recipe of adding 1/2 cup pureed beets to pancake mix (tastes like fruit; not my idea, it belongs to Jessica Seinfeld); or adding 1/2 to 1 whole cup of sweet potato to any muffin mix. Doesn't really change the consistency; you just add a few extra minutes to the baking time."

I love this idea. Beets are great too because they can be used to add a rich color to foods. (It's the traditional food coloring in velvet cakes.)

Once this was out there, everyone started coming up with all kinds of foods where puree fruits and vegetables could hide. We will be posting a lot of your recipe suggestions on our website, including the beet pancakes and sweet potato muffin recipes.

Keep them coming.

Betty

Enfin

2010-11-15T19:03:00.003-05:00

After a week of analyzing the Running a Hospital blog, I still don't understand how people have time to work a full-time job and blog. Paul Levy manages to provide at least one blog entry every day. I am a grad student, and I find forcing myself to blog daily to be too time consuming.

One of the things I do appreciate about the blog format is its simplicity. Every time you open up the blog, there is blank slate available for creation on any topic. On Levy's blog, blog posts regularly turn into a conversation on health care issues. Rather than someone dictating how it should be, it is a bunch of people discussing positive solutions, or at least attempting to do so.

Levy's blog is pretty plain in design, but it feels right for him. A busy hospital CEO shouldn't be overly concerned about fancy design. In this case, he chose a standard template without adding on any extra features or details. If this were the CEO of a marketing firm (Todd Defren or AJ Gerritson) or some other creative position, one might expect a little more flair with the blog. But in this case, I think simplicity sends the right message.

I actually do enjoy blogging, but I would never force myself to keep up a daily routine. At least, I wouldn't if it was intended as an after hours hobby. The creation of a blog post shouldn't be forced. The blog itself is very much a cool medium, as media critic Marshall McLuhan would say. It is a pastiche, to borrow a term from the post-modern movement, of styles and genres that coalesce into a fuzzy picture of references and meanings--created not only by the author, but anyone who chooses to join the discussion.

In a sense, there is never a finished product. So much of the blog world is deriving and understanding meaning, and then applying your own meaning to what you have read. A post is always evolving through comments, updates and changing realities. Every new interpretation builds up or can cancel out previous meanings.

The great thing about blogs is it is a place where people can be brutally honest and discuss anything they want. In the case of the most recent posts on Running a Hospital, it can shed light on important topics, like health care rankings, or it can just be a fun diversion into the inane, like discussions about water. It is a place for media to dance in the moonlight, shimmering in the reflective glow of our own personal sun.

As for me, there is probably a blog in my future. Just don't ask me to review blogs for a living.

The Penultimate Post

2010-11-14T19:56:00.005-05:00

My week of blogging is almost over, and not a moment too soon. Don't get me wrong, I actually enjoy blogging. I enjoy writing. I don't enjoy writing about the same topic. Rather, being forced to write about a specific blogger every day is a bit tedious.

Today, Paul Levy has two short stories. The first one is more or less a promotional piece about some of the good work doctors at BIDMC are doing in the Cape Verde Islands.

The second one is an open discussion about quality and cost. It starts with a quote from another Massachusetts hospital administrator who said, "There is lots of evidence that Massachusetts health care is the best in the country."

According to Levy, the comment was in response to someone pointing out how much health care costs in the Bay State. The persuasion point was that better health care was worth more. Levy throws this out to his audience to find evidence to prove or disprove the premise that Massachusetts provides the best health care.

One interesting note on this point is that evidence does exist, which suggest an inverse relationship between quality of care and money spent on health care.

Several of the readers chimed into the comment section to fill in the holes on the administrator's claim. It would seem the consensus is that Massachusetts is at best fifth and possibly seventh in the country, depending on the measures used.

Jim Conway said...
Paul, nothing I’d like more but the data hasn’t yet proven it out. It is within our horizon.

The MA Health Care Quality and Cost Council has a 2012 goal that we would be first among the 50 states.

Hope this data below helps.
Jim Conway QCC and IHI

Commonwealth Fund State Scorecard has MA seventh in the nation

Fourth in the Commonwealth Fund Child Health Score Card

AHRQ has MA on the edge of average to strong

C in palliative care

This is one of those slow blog days. Tune in tomorrow for the final wrap on "Running a Hospital."

Update: More information about the Massachusetts health care ratings.

The Boss's Human Touch

2010-11-13T22:26:00.006-05:00

So yesterday, I jokingly compared Paul Levy to Peter King. Today, I found out it might have been an apt comparison.

For those of you who don't follow Peter King's Monday Morning Quarterback column for Sports Illustrated, he is known for several peccadilloes. One, as mentioned yesterday, is his off-topic discussions of coffee. Another is his regular updates of his daughter's high school field hockey team.

In his most recent post, Levy updated his readers on the happenings of youth soccer in Newton. The Newton Thunder rolled to the championship. No specific explanation was given as to the affiliation.

This post, along with yesterday's post about hotel water, brings me to an interesting point. For the most part, Levy's blog is a serious take on many of the issues that face a hospital CEO. At the same time, he provides stories like these, which provide insight into the boss's personality.

I know several people who work or worked at BIDMC. They all seem to have the same opinion of Levy: He is a hard-working CEO and a nice guy. Some of this, no doubt, comes from his blog persona. It makes you wonder how much this helps him when something bad happens.

We did find out last spring how people would react to his malfeasance. As would be expected, there were people calling for him to be fired. Some threw "transparency" in his face. In the end, Levy apologized and most people moved on. In my opinion, the issue does not affect medical care. It is a board issue that really shouldn't concern the public at large. And for the most part, people who knew Levy and weren't just naturally cynical of his approach felt the same way.

I bring this up because on his blog, Levy tries to make himself as human as possible. He isn't egotistically. He isn't judgmental. You may not agree with his opinions entirely, but he usually gives every issue a fair shake. This last point is something that was lost on all the people crying for his head when the news broke about his mistress/employee.

I am reminded of the interesting phenomena within the medical malpractice world. It turns out doctors don't necessarily get sued if they are bad doctors. Doctors get sued based on how well they are liked by their patients. Basically, if you make a mistake, but your patient likes you, he or she is less likely to sue you. Some people just don't like him and were waiting for a reason to "sue" him. Others really do like him and were more able to let it go.

That is the whole point of a CEO blogger. Make yourself and the company likable and establish both as experts in the field. If he does it right, he is making himself into a person. This is seemingly the whole premise behind CBS's "Undercover Boss." As I said then, I don't know if that show does a meaningful job of this. Blogging, on the other hand, is a persistent effort, a commitment to a philosophy, which requires sincerity and hard work.

I know salacious stories sell papers. And I also know it is human nature to tear down anyone who dares to be different, especially if they are successful at it. But years of honesty and openness can help insulate a CEO and a company when something goes wrong...without the lawyers, guns or money.

To Forgive Is Divine

2010-11-12T17:51:00.003-05:00

In 1999, the Institute of Medicine released a report on hospital errors titled "To Err is Human: Building a Safer Health System." In this report, IOM discovered that as many as 98,000 people die every year in U.S. hospitals due to medical errors (i.e., Human mistakes).

Since the release of this report, the medical industry has instituted many changes to combat human error. Despite these measures, mistakes still happen. How we handle those mistakes is what makes the difference.

Paul Levy highlights a story on MSNBC about a doctor who recently published a paper in the New England Journal of Medicine about a surgical error at Mass General Hospital--an error he made.

It is an interesting concept to publicize your own mistake. It is also a positive way to deal with errors--even ones as embarrassing as performing the wrong surgery. As Levy points out, if we aren't open about our mistakes, we can't prevent them from happening in the future. Levy would know, his hospital had a similar situation a couple of years ago.

On the lighter side, Levy found time to discuss the merits of water in hotel conference rooms. He is the hotel water equivalent to Peter King's coffee nerdness, I suppose. A year ago, he did his best Freakonomics impression on a Boston hotel's choice of water. In this case, it was $2 bottle of water from Norway. Then there is the blueberry water, seen on the left, which created this off-topic line of inquiry:

In our group, the first question was, "Do you think they washed them?" The second question was, "Do you think they are real?" Then, "Can you taste them at all?" Answer: No.

He later asks: "Is there something they teach in hotel school that suggests that having unusual water in conference rooms is good for business?"

It is an interesting economics discussion, well-suited for a CEO. It is also a refreshing break from some of the more serious topics on the blog. In case you are wondering, BIDMC has ditched the bottles in favor of tap water. They discovered what most people know, even if they still pay for it, once out of the bottle, water tastes, well, like water.

And now for the weekend...

The Trouble With Trillions

2010-11-11T21:28:00.008-05:00

Health care is a tough industry. It is built on the idea of helping people, but it is still a business. Providing treatment can be expensive. Hospitals need to make money to survive. Physicians need to make money to keep their practices alive. At the same time, the people most in need of medical treatment are often the least able to afford it.

For the decades, the government has helped with programs like Medicare, Medicaid and CHIP. But the government through Medicare has overpaid hundreds of billions of dollars since 2002, according to an article Paul Levy cites in his recent post.

I am not going to get into all the details of sustainable growth rate, because I am not expert enough to discuss it intelligently. What I do find interesting is that any time the government tries to adjust payment rates, there is significant push back from physicians. It is always followed by physicians threatening, "We will be forced to stop accepting Medicare patients."

Levy doesn't really give an opinion on the matter. (He does respond with a "No." in the comments section when asked if BIDMC would drop Medicare patients.) Instead, he puts the matter out there, and he tacitly endorses reform while taking a wait-and-see approach.

The problem is there is considerable waste in the medical system. “Waste” according to the payer (government, insurance companies and patients), however, is profit in the eyes of the hospital.

Levy, despite not really voicing an opinion on the matter, does link to an article by Austin Frakt, an assistant professor at Boston University's School of Public Health. In his article, Frakt proposes some measures that could help stop waste. He points to a topic I discussed in an earlier post, which has to do with reimbursing based on quality not quantity.

The fact is, until they feel it in their wallets, hospitals usually don't make changes, and there is a precedent for reforming payment structures leading to positive change. For instance, when Medicare changed its policy on reimbursement for treatment of hospital-acquired conditions, hospitals began implementing more rigorous standards to ensure patients didn't get sicker at the hospital. This isn’t to say hospitals ignored this before, but they were now motivated financially to prevent these conditions.

Frakt also points to the problem of too many specialists in the industry. He references a recent Newsweek article, which claims specialists are responsible for hundreds of billions of dollars of waste. The current system is setup to financially reward specialists. As a result, primary-care physicians have decreased over time as med students with crushing med-school debt choose the more lucrative specialties over being a PCP. Most projections figure that the U.S. will have a shortage of PCPs when the new health care reform measures take effect. One would think fewer specialists would equal less waste, but incentives have to change for this to happen.

While most of the comments on Levy’s post support the need to reform, one commenter chose the ideological approach.

Anonymous said...
Paul - A little history here.... this was a deal cut by Obama and the American Medical Association. The AMA would support Obamacare and he would reverse scheduled Medicare cuts. The kicker, of course, was he couldn't include the fix in his Obamacare bill because it would have added billions in cost to his bill and made it way too expensive. So they said they would do the fix in a seperate bill so they can still get on their soapbox and pretend Obamacare doesn't add to our trillions in debt. This is just a perfect example of everything wrong with politics and why this country is heading quickly towards bankruptcy. No transparency on cost and dealing straight with the American public.

This is an interesting theory, despite the fact that the SGR was put into place in 1997 and has been a problem ever since the U.S. started accruing huge national debt in 2002. In fairness to the commenter, he is pointing to the AMA’s refusal to support health care reform if it meant less money for physicians. (I guess by history lesson, he meant recent history that supports “Obamacare” being evil.)

Politicizing the problem and stamping Obamacare all over it just pushes us farther from a solution. This shouldn’t be a political issue. This isn't about punishing doctors or business, it is about eliminating the waste physicians freely admit exists (most estimates say about 33 percent of health care spending is unnecessary). Both hospitals and physicians need to get serious about limiting waste, or they will have to accept the consequences of their greed.

What would be interesting, and is noticeably absent from Mr. Levy's post, is what his hospital does to eliminate waste. At the very least, he should point out some solutions. But, I guess the first step to healing is admitting you have a problem.

Not included in this discussion, but a guilty party in all this waste is the patient. Possibly in a future post, we could tackle how the American patient contributes to medical waste and how better chronic disease management could save us.

Everyone Contributes

2010-11-10T21:33:00.010-05:00

One of the benefits of a CEO blogger is he or she has the opportunity to highlight the work of individual employees in a public forum. When it comes to a hospital, sometimes those employees are being commended for heroic behavior. Such is the case will Paul Levy's most recent post, which highlights the extraordinary effort of a couple of security guards at Beth Israel Deaconess.

The post is a letter from a nurse who wanted to acknowledge the guards who helped save a man in cardiac arrest. Thanks to their efforts, they were able to resuscitate the man by quickly starting CPR. This is a great way to not only highlight individual employee efforts (everyone wants to work somewhere they feel appreciated), but also publicize how great the hospital is, from top to bottom. Granted, most people don't get to choose their hospital, but it is encouraging to know you are covered from the ER to the parking lot at BIDMC.

Another interesting post on the blog is the discussion about scheduling at a hospital. It is pretty common for people to be frustrated waiting to see a doctor or surgeon. In certain situations, like the ER, there is a triage system where the most serious cases get in first. Most people understand that, even if they don't appreciate it at the time. However, sometimes the wait is needless, as it was in the situation covered by Levy yesterday evening.

Again, we have a situation where Levy values customer service over secrecy. In this case, the issue could have been left between the two hospital departments and the patient. Instead, Levy chose to put the response to the problem in full on his blog. Obviously, this can make some employees nervous. It might be somewhat uncomfortable thinking that every email you have with your boss could end up on his blog. That is, of course, if your main goal is to cover yourself.

Most of the posts on Levy's blog elicit great conversation about hospital procedures, both from patients and professionals. Not surprisingly, there isn't always consensus. We regularly find out that doctors are sensitive (they rarely "accept" criticism as constructive) and patients sometimes have unrealistic expectations—not to mention your typical cynicism native to comment sections. The good news is that the conversations are usually civil, and Levy responds to the comments, especially if someone asks for more information.

For example:

Anonymous said...
But - aren't you the CEO? And haven't you been at BIDMC for quite a few years? If you thought that it was important for your hospital to collaborate with other local hospitals in quality improvement, why haven't you made it happen?

In response:

Paul Levy said...
I was hoping someone would ask that question!

Collaboration does not get driven from the top in academic medical centers. You cannot order it to happen from the C-suite.

The collaboration that occurs happens because individual faculty members, nurses, or their leadership make the connection with people at other places. It is based on those relationships.

The fastest way to failure in these kinds of hospitals is to order people to do things.

(And besides that, look at the way you have framed the question. Even assuming your premise might have been correct, it takes two to tango. You cannot assert that it is the sole responsibility of one institution to make collaboration happen. There have to be two willing partners.)

Again, this is the type of honest discussion that never would have happened between a hospital and patients years ago. In fact, most patients probably never thought about the hospital experience until they were in the hospital. After the fact, they just hoped they never had to go back. Given the complexities involved with delivering health care, it is nice to have a place to discuss these topics and help guide positive change.

At this point, I am going to to end this post. I am running on a mix of flu medication, which really makes crafting coherent sentences difficult. And now, for something completely different:

Running a Hospital - Day 1

2010-11-09T16:20:00.001-05:00

For a class assignment related to blogging, I am following and writing about a blog for seven straight days. I am focusing on Running a Hospital, a blog by Paul Levy, president and CEO of Beth Israel Deaconess Medical Center (BIDMC).

I chose this blog because I believe it is a great example of how an executive can create a meaningful dialog between customers (in this case patients), staff and the industry. While there are other hospital executives who've embraced blogging and Twitter (Jimmy Weeks of Greenwich Hospital and Dr. Harry Greenspun who is currently a CMO for Perot Systems), Levy's stands out in its ability to address hospital issues in a way that is in-depth without being too "inside baseball."

One thing I really appreciate about his approach is he isn't afraid to address sensitive issues publicly. In particular, he gained attention by releasing BIDMC's infection rates even though Massachusetts law does not yet require hospitals to disclose this information. Since I have experience working on the informatics side of health care, I find his view of transparency and his genuine efforts to make medical care better very interesting.

His most recent post is a perfect example of what I like about his blog. He discusses one of the elephant-in-the-room topics in the health care industry: Cost of Procedures.

In this post, Levy addresses the issues related to the trend of hospitals purchasing proton beam machines. As Levy explains, these machines are used to treat specific forms of cancer. Mass General Hospital has one of these machines, which helps to serve the region. However, a recent study showed that these machines are starting to proliferate beyond their need.

Levy does a great job explaining how this affects everyone from the hospitals to the patients to the taxpayers. These machines are expensive (as much as $150 million). If a hospital purchases one, they need to use it. However, the actual number of cases that would be appropriate for this machine does not necessitate having them on anything more than a regional level. What is the result? In an effort to make a profit on the machines, hospitals have begun using it to treat other forms of cancer (most notably prostate cancer), which could be treated just as effectively and for less money with other methods.

This is not new to the medical industry. This has happened with CT Scans and MRI machines as well. As Marshall McCluhan observed, technology creates its own demand. When hospitals spend money on technology, they need to use it or risk losing money. But the misuse of this technology creates waste--part of the problem at the core of our health care industry.

According to an article on Forbes.com, cited by Levy:

Most of the $1.5 billion that has been sunk into or committed to building proton centers has come from investors hoping to make a profit. Even the proton center at the august M.D. Anderson Cancer Center in Houston is mostly owned by various investors...Medicare pays twice as much for a round of protons as for X-rays: $34,000 for eight weeks of therapy versus $16,000.

Levy points out that when profit becomes involved in medical care, hospitals start making decisions based on business factors instead of clinical factors. To combat this, people haves started to advocate for pay-for-performance standards, which reimburse hospitals based on outcomes rather than for the particular services performed. For instance, instead of paying for every X-ray or MRI, hospitals are paid for successful patient outcomes, based on agreed upon standards. This system certainly has flaws, particularly with regard to the standards, but it is a move in the right direction.

While there is some room for discussion (the National Association for Proton Therapy popped up in the comments to protest his view on the machines), Levy's larger point is dead on. As much as people protest the figment of Sarah Palin's imagination (Death Panels), hospitals need to evaluate cost and benefit of procedures related to expected outcomes. It is a necessary part of any honest discussion about health care reform.

The Globe Reporters Learn Nothing About Baseball

2010-10-01T10:00:00.000-04:00

It is almost baseball season. Following the marketing ploy that is "Truck Day," the players are filing into Fort Myers for Spring Training. It also means the return of amateurish Red Sox coverage by The Boston Globe.

First, we have this gem:

Caption: Red Sox prospect Lars Anderson (left) headed out on to the field for some batting practice with another teammate.

Now, how much effort would it take to find out who that other teammate is? Not much. If I had to guess, I would say that is newly acquired infielder Bill Hall. Even if the reporter didn't recognize him, I am sure someone in the Red Sox office would be happy to clear that up. It would take two seconds. Honestly, they give the name for Kevin Youkilis' trainer and the "amiable bulldog," but can't be bothered to find out the names of actual players.

Then, there is the caption along with this photo:

Caption: Red Sox shortstop prospect Jose Iglesias showed off his quick hands in the field during Tuesday's workout, snagging several sharply hit ground balls.

Oooh, he even caught the "sharply hit" ones!?!? EVERY professional infielder should be able to field "sharply hit ground balls." Now, if he did this without a glove, it might be worth mentioning. Also, fielding ground balls would most likely not be where he showed his "quick hands." It is possibly where he showed his soft hands. Maybe if he were turning double plays with "another teammate," then he would be showing quick hands.

It just goes back to the hack job The Globe does covering the Red Sox. They hire young, inexperienced reporters to cover the team. People like Amalie Benjamin, who is both ignorant of the game and writing for journalism, attack your baseball senses with rambling, nonsensical recaps that resemble fan-fiction stories rather than the game you watched the previous night.

They kill journalism and cry when it's dead.

Protesting Is Not for the Faint of Heart

2010-02-16T17:15:00.014-05:00

Caption: For this protester, shit just got unexpectedly "real."

Undercover Boss: A Public Relations Headache

2010-02-08T00:46:00.004-05:00

As is customary for the Super Bowl network, CBS premiered one of its "exciting" new shows following the big game. Undercover Boss, an internal exposé of sorts, features top executives disguised as first time employees to learn what it's really like to work for a living. It is gives everything one might expect from a reality program. It also raises a number of public image issues and human resources liabilities. I am still not sure what these companies hope to gain from this experience.

In the premiere episode, Larry O'Donnell, president and COO of Waste Management, is on the front line of his trash business in an attempt to better understand how his company operates. He works with five employees in the company doing jobs from sorting recycling to cleaning portable toilets. Predictably, he isn't very good at any of the jobs he attempts and must confront some of the frustration created by his decisions on the corporate level. Apparently, eight hours on the job provides many epiphany moments.

The first problem is employee selection. In the show, they never explain how the five locations and employees were selected. I would imagine the company had that responsibility, so I would assume these employees were heavily vetted. It all appeared too perfect, as though Waste Management found five issues they could highlight and easily fix. For me, it wasn't just the five employees who were selected, but the thousands who weren't. Are we to believe these five are exceptions in the company or a microcosm of the company's employees? I am sure the answer is somewhere in between. Still, I am certain there are many other employees working as hard as the ones featured on the program who don't get anything out of Undercover Boss – unless you count the "task forces" created to improve employee conditions. I wonder how many letters corporate will receive from other workers who are also performing the jobs of three or four people, are underpaid and about to lose their homes.

This brings up another issue: Is it ever smart to handle human relations/personnel issues on national TV? Take, for example, the manager who gets publicly reprimanded for his implementation of corporate's policy about clocking in late. He barely gets to say a word, but has to sit there while the president of the company self-righteously paints him as some awful tyrant enforcing rules from behind a desk. Moreover, in the preview for an episode involving Hooters, a manager puts his waitresses through bizarre eating contests before they are allowed to go home – certainly not good for the manager or the company's image.

Another considerable problem is just how clueless Mr. O'Donnell appears to be. He is constantly amazed by how his corporate directives don't always work in practice the way they did in theory. Honestly, if you have to go undercover in your company to gauge how your policies are working, you are seriously failing. In the end, he promises his employees that he will change the way he manages, but never really gets into the how. Also, how would you feel as an employee knowing that CEOs come down, essentially, to spy on your work? Is that type of suspicion good for the company?

I would really like to know the internal review process weighing the pros and cons of going on this show. Much like Gordon Ramsay's Kitchen Nightmares, this is very much a double-edged sword. At least in the case of restaurants on Kitchen Nightmares, those businesses are desperate to avoid going bankrupt. Why would a successful company expose its sores? Without any data to back this up, the negative images of the company most likely outweigh any positive publicity received on this show. This is especially true during the saccharine finish to the show where employees are given raises and new roles in the company, which feels extremely hollow and self-serving.

Since Waste Management doesn't really deal with consumers (I don't choose my garbage men), their risk is probably low. However, I could see legitimate consumer relations issues for future episodes dealing with Hooters and 7-eleven. (As an aside, I worked at a 7-eleven while in college. I can tell you firsthand, it isn't a hard job. I am really interested to see how that one plays out.) Then again, Wal-Mart has a horrible reputation for mistreating employees, and its business seems OK.

Can anyone think of a reason why this might be a good idea? Would anyone out there ever advise a client to go on the show?

Pretzel Logic

2010-01-21T09:33:00.003-05:00

According to Ron Regan's blog, a poll of Massachusetts Democrats who voted for Scott Brown found that 37 percent believed Democrats were not doing enough to challenge Republican policies. Interesting. But how exactly does voting for Brown accomplish the goal of challenging Republican policies?

I think more telling is the low voter turnout in areas where Martha Coakley won compared to much higher turnout in areas where Brown won. Seems the biggest issue is Martha either inspired apathy or anger in voters -- neither being a recipe for electoral success.

Wave of the Future

2009-11-09T16:47:00.004-05:00

This weekend the best and worst thing happened to me. The best thing was that I received an invite from Google to play around with Google Wave. Of course, this was also the worst thing since I had three papers and a midterm due on Monday.

Early returns though show a lot of promise for Wave. It is buggy and slow now, but it has plenty of potential for collaborating on projects. In fact, I think it will be the way students work on group projects in the future, especially for Internet classes. It is great because then you can do your group work without ever having to see the people in your class. I can't wait to be able to make derisive comments in real time. No more waiting until you get home to try to remember the dumb thing someone said.

But seriously, the collaboration ability for Google Wave is exciting. I can't wait to start using it for project coordination. It might actually make me procrastinate less. Well, at least until the shine wears off.

The Final Push

2009-11-02T17:30:00.003-05:00

The finish line is in sight. It is hard to believe it is November already. It feels like the semester just started. A few more weeks and I will have finished my first semester back. Of course, this also means I can feel the pressure as exams and final projects loom.

Due dates that were months away are suddenly pressing down. The worst part about projects is coming up with ideas. Right now, I am in the what-is-the-perfect-idea phase. Undoubtedly, that will be replaced by what-can-I-reasonably-do phase. Finally, it will be the just-do-anything phase. I am hopeful I can avoid this predicament. I am kicking around a few thoughts. Now I just need to snap them into place.

The great motivator is looking forward to a Sunday of relaxation without assignments due in 24 hours.

(What's So Funny 'Bout) Peace, Love, and Editorial Standards?

2009-10-26T10:23:00.000-04:00

Sometimes I feel like a schmuck. Every time I read a newspaper, I see absolutely terrible writing. It never fails. (And I say "never" without any fear of absolutes.) Whether it is The Globe and its atrocious collection of Red Sox beat writers or The Herald and its lack of any attempt to practice legitimate, unbiased journalism, it appears that newspapers have stopped trying.

So why am I spending my time trying become a better writer?

Obviously, I know why I do it, and it is not to be a journalist. Still, it is annoying to see other people who purport to be writers not have any respect for the craft. Whether it is lack of editing or just poor writing, it is sad to see such low standards.

Bill Donohue's editorial on The Washington Post's "On Faith" blog is the latest affront to writing quality. Aside from the questionable opinions and spurious claims in the piece, the writing is sloppy, lazy, and just bad. I know it is a guest editorial on a blog, but it is still attached to The Post and Newsweek. We are a long way from the reporting of Watergate.

Balloon Boy: Or How I Learned to Defy Gravity

2009-10-19T09:30:00.007-04:00

This past week, while the world was captivated by an empty balloon, I was trying to gather enough steam to take off with some of my school projects. Over the next few weeks, my time management skills, along with my ability to be two places at once, will be put to the test. Fortunately, the Red Sox helped me out by being swept out of the playoffs. Thanks, guys!

Aside from my school work, I am also entering the unofficial busy season at work. Whether it is everyone being back from vacation or the year end budget having extra, unexpected capital, September through December usually sees a significant increase in hospitals wanting new software. I guess holiday shopping takes many forms.

The current state of my apartment only adds to the depressing to-do list. A month and a half after moving 4 blocks, my place is still about 70 percent unpacked. It is fairly pathetic when I still cannot find things because it is still packed away in a box somewhere. Right now, the dining room is more of a makeshift storage area than anything else. The problem is that every time I feel motivated to unpack, I am overwhelmed by the desire to do something else, like sleep -- or dance!

A Neverending Story...Literally

2009-10-12T19:18:00.004-04:00

Last class, my writing professor regaled us with the tale of a narcoleptic interviewee. Aside from being a funny story, it brought back some fond memories of my high school years. I too had a narcoleptic make a lasting impression on my life.

Junior year of high school, Mr. Newton, a paranoid narcoleptic, was my English teacher. He was the first teacher to ever enforce grammar requirements on all assignments. He introduced me to sentence diagrams and sight corrections. (Incidentally, he also introduced me to snide remarks from a teacher.) He was a brilliant teacher, and I learned more in his class than most any other while at Somerset High.

After class last Monday, I went back to my old blog and reread an entry I wrote about him and the English language. A couple of things hit me about that post.

It is ill-advised to reread anything written over a year ago. Writing never ages well, especially when it is one's own work.
It is amazing how learning and perfecting grammar in one's writing never ends.

While Mr. Newton taught me a lot, he could only teach so much in one year. I learned a tremendous amount about grammar and writing from him, but it was only the foundation. Over the years, I have continued to learn, and I know there is still more to learn.

He may have only started me on my way, but he did impart the most important lesson of all: grammar matters. As a media writer, poor grammar can ruin the best arguments. Perfect grammar may not always enhance the argument. It does, however, allow the point to be made without distraction. Like a meal in a restaurant, a nice steak on a dirty plate ruins the dinner. My old boss used to tell me that my job was to be the guy in back washing dishes. People should only notice me if I am not doing my job.

The more I think about writing and reread my old work, the more I realize that writing is always a work in progress. It is a grueling and humbling endeavor, but it is nice to know that I will be better tomorrow than I am today.

Waiting for the Bye Week

2009-10-04T22:56:00.000-04:00

It is week four of the school year. The leaves are changing colors, the temperature is dropping, and Boston College already has four wins. (There is still no word on when the first Boston University football game is.) Columbus Day is right around the corner, which means a day off, right? Not a chance. Monday-only students received a bye the first week of the year. Instead of a week to regroup, I have to reload on Tuesday. I guess a 24-hour reprieve is all discovering a country where people were already living is worth.

Lack of respect for Italian explorers aside, I am satisfied with my decision to return to school. I did not realize how much I missed academic discussion. The workplace lacks spirited conversations about grammar and sentence structure. Although, people at work are asking me a lot of questions about school. I keep telling them that it is a lot of work, but it is worth the effort.

The major downside right now is the travel. On Monday, I have to head out to Framingham at 7 a.m. Then, I have to race back to the city at noon. After I drop the car off, I patiently wait for the 57 bus to Kenmore Square. Three hours of class later, I am back on the 57 heading home. I usually get home with enough time to eat lunch, grab a change of clothes, and then drive back to Kenmore in search of an open meter. I finish up the last class of the day around 9 p.m. No worries though, I do keep my brain working long enough to drive back to Brighton.

I have heard whiskey is the drink of choice for great writers. Right now, I would settle for an extra cup of coffee.

Welcome to the Machine

2009-09-28T17:10:00.000-04:00

After a seven-year hiatus, I am back in a world of double-spaced type and conceptual theories: I have finally reentered the world of academia. Though I planned my return for years, the transition has not been seamless. The first few weeks have taught me a lot – especially outside the classroom.

The main lesson is working full time and juggling class work is more difficult than expected. Unlike working as an undergraduate, it is not as easy to split full-time employment with school. The biggest obstacle is most days I have “homework” for my employer. Moreover, most of the work required for classes is similar to the work I do for my job. I am suffering from a recurring problem in my life: finding the will to write at home after spending eight hours writing at work. I hope to find a healthy rhythm soon, but for now, my typical procrastination habits are winning.

Fortunately, I only have classes once a week this semester, on Mondays. This makes for long Mondays, which is great because Monday, of course, was already my favorite day. It does get me out of work by noon on class day, so there are benefits. However, I am starting to believe that only having class once a week enables my procrastination. I do have good reasons for it. For starters, I just need to relax on Tuesday after a long Monday. Wednesday is usually a tough work day. Thursday is “Must See TV” night. Who does work on a Friday night? Saturday is usually so nice outside that I need to get out after working so hard all week. There are so many good NFL games on Sunday, and managing a fantasy football team is a full-time job. But as soon as everything else is out of the way, I can finally do my schoolwork without any distractions.

The other major drawback to my current schedule is I am unable to take any of the classes related to my degree, Applied Communication Research. In essence, this means I will not start my program until September of 2010. While this means my stay at Boston University will be longer than originally planned, it could also help me long term. I need to relearn how to be a student before delving into new material. Sometimes it feels as though I am running in place during my first year. At the very least, I am consistent with putting things off.

I once had a professor tell me procrastination was a trait of perfectionists. She had some reasoning related to built-in excuses for failure. I cannot quite remember. I would look it up, but I just do not have any time.