The business equation for Value is (Quality x Effectiveness) divided by Cost (QE/C). A real problem in managing tight budgets is that Cost (e.g salary and benefits) is much easier to measure when compared to Quality or Effectiveness. For example, how could we objectively value compassion and empathy, team-work, collegiality, work ethic, vicarious leadership, attitude, interpersonal skills, flexibility, and happiness? A happy pediatrician makes children and families happier, makes learners more content and confident, makes scholarships more productive. As we work toward updating our compensation methodology to better align salary with meaningful contributions and accomplished goals, I am confident that we will have more flexibility to reward superior clinical work effort (and results) as well as outstanding performance in mentoring, research, scholarship, teaching, and leadership. I am equally committed to a balanced budget as I am to ensuring that our faculty are rewarded for their high performance.
Last week, I and Surgeon-in-Chief, Dr. Charlie Howell, had the pleasure of meeting with our new President, Dr. Ricardo Azziz, to welcome him to the Medical College of Georgia, and to share key information about our strengths and challenges. This was a very productive and encouraging meeting. Yesterday, I was delighted to read in an Augusta Chroniclearticle that the Children’s Medical Center was viewed by President Azziz as a “Jewel” serving children and families. Last year we achieved a #1 ranking in the country in quality and safety (out of 104 children’s hospitals linked to medical schools) for one of the quarters, and for the first quarter of 2010 (January through March) we ranked #3 (out of 110) nationally. For the last four quarters running we rank in the top 10 percent of all children’s hospitals…a fantastic bit of news for Georgia’s families. In teaching, we rank #1 among clinical departments in the School of Medicine, and in research, we rank in the top 25 percent nationally. All of this started 100 years ago and it is good to remind families in the region of the exceptional and compassionate care we provide every day. The excellence in research and education is preparing a new generation of doctors to care for our children…our future. Please spread the word with friends in our community as the Exceptional Care campaign unfolds through November www.mcghealth.org/exceptionalcare. I would like Augustans, and Georgians more broadly, to be reminded that we represent THE destination place for children. With pride and
Since moving to the Medical College of Georgia, I have been moved and inspired by Dr. Lois Ellison, our Historian Emeritus. Dr. Ellison has educated me intensely about the wonders of our history, and about its importance when planning for the future. As we remember the journeys of the children and families served by our pediatric community during the last 100 years, let us not forget that the community that made The Wilhenford Children’s Hospital a reality is still here! We are privileged to be living at this turning point for our children’s hospital and I am so grateful for all that Dr. Ellison has helped me within my first year at the Medical College of Georgia. Now, I have to work on calling Professor Emeritus Dr. Lois Ellison, “Lois” as she insists to be called. Thank you Lois…you are a treasure to those who serve children and their families with “Exceptional Care” every day, and for me one of the most unexpected and pleasant surprises of becoming a citizen of this great state.
My son grew up in a family environment that constantly put safety first. This may explain why none of us could open secured doors under the sink in our home!
This morning, I learned that MCGHealth Children’s Medical Center finished the last fiscal year (FY10) with a total of 670 media exposures compared to 465 at the end of FY09 (44% increase). If one purchased this exposure, the total advertisement equivalency would approach $650,000! Rene Hopkins, coordinator for Safe Kids East Central, was extremely active and effective in getting the word out about car seat safety, Cribs for Kids, water safety, and bicycle helmet use. It is highly likely that Rene has had a direct impact in keeping many of the children and families from life experiences that threaten survival and quality of life. Thank you for your service Rene, and for your unmatched passion for protecting children from injury and helping them lead better lives.
Getting an “A” feels great as a grade, doesn’t it? It makes you and your family smile…life is good! It is the best one can do…or is it? When more than 50% of the class gets an A, does it have the same meaning? If my son gets a B, should I not still be very proud of him?
I think the reason an A is so valuable is because people put so much emphasis on the grade which is much easier in judging than probing an individual’s talents, motivations and purpose in life. The world is full of folks who were not A students and yet they made marvelous contributions. Few teachers took time to understand Albert Einstein or Bill Gates and yet they are both notable for their ingenuity, drive and poor grades. I have yet to see a single publication showing that A medical students make A physicians or that B and C students are any less capable and caring than A students.
When I evaluate a student, I first look for motivation. Sometimes I am drawn-in to people who have struggled to succeed because they have humility and drive to make it, and a more mature and constructive fear of failure. I believe that our strongest leaders are people who have tasted failure to succeed. As the saying goes, it is how you get up after falling that matters. If grades were critically important in medical school and strong predictors of how a physician turns out, would we not post our transcript instead of our diplomas in our offices? What I find disturbing is that some students select a field of medicine that is higher paying because they have the grades (rather than the deep-routed passion for the field) to enter that super-competitive field. There is no question that financial debt-load of students is influencing career choices and this should concern us all. I am reminded of what my mentor John Freeman once said, “Bernie, you will make more money but you’ll never have more! You will spend more.” To our students I say, find your calling and do your best so that you have no regrets, whether the grade is A, B or C. For students with D’s or worse, find another training program than ours. .
As Independence Day approaches, I’d like to ask everyone to take a moment when entering the MCGHealth Children’s Medical Center and notice the beautiful bronze statue of two children playing. It was donated by beloved and honored pediatrician Dr. Charles Linder in memory of his wife Marion who worked diligently for years in leading the Children’s Miracle Network Telethon on behalf of children in need. This beautiful depiction of children at play represents the singular goal of our work – to return children to independent play. It is a celebration of volunteers and a reminder about the pleasures of giving. Happy Independence Day!
Last week, the Georgia Chapter meeting of the American Academy of Pediatrics (AAP) was held at Amelia Island. The Chapter was awarded the top ranking nationally because of the exceptional leadership of director Rick Ward and president Dr. Avril Beckford. It was my honor to chair this year’s summer meeting and we set a record for attendance and multi-state representation (19 states). For the first time, we held skills workshops that were extremely well received. We can all be very proud to belong to the country’s leading pediatric organization!
We really appreciate being paid for clinical services because we value the highly skilled professionals and personnel that work together to make a difference every day for children, and who must be paid. I was recently reviewing a standard audit of clinical billing for pediatric services rendered by our department. This is what is called “compliance work” in clinical circles. The documentation from the clinical encounter must match the level of the physician’s billing to be in compliance. However, it occurs to me that probably few people outside of healthcare know about the incredible array of codes and rules that must be mastered before submitting a bill for payment or often enough, denial of payment by insurance companies or agencies. It seems as if the first response of insurance companies is “no” and that collecting for services depends on a counter-denial operation that rivals Mission Impossible. Sadly, collecting 25 cents on the dollar billed (this is now typical for care provided for children from impoverished families) depends on rooms filled with good folks who must massage clinical bills through the gigantic bureaucratic insurance mill. I learned that our “special” system will soon be getting much worse, so much so that a billing sheet could be as long as 30 pages (screens on the computer) when the current billing sheets are one to two pages. We’ll have to be specific about which toe is sore because “sore toe” alone will be refused payment. Who will stop this craziness? At some perverse level, it is at least somewhat comforting to know that not every one of my patients must have a disease (sick) code; our current billing system allows for V65.5, Worried-Well: Person with feared complaint in whom no diagnosis was made. I look forward to seeing if the new system has a diagnostic code for Worried-Mad.
Having just returned from Kyoto, Japan where I attended the 8th International Meeting on Hyaluronan (HA), I wanted to share some insights. Japan is a beautiful country that exemplifies respect for history, for nature, and for others. It is truly a remarkable place to visit and experience. In terms of science, our bodies contain about 15 grams of HA, a large sugar called a glycosaminglycan. One third of our HA is turned over by hyaluronidases each day. One half of HA is in our skin where it hydrates which is why it is doing a lot of GOOD for the bottom lines of large cosmetic companies. HA forms nets around neurons in our brains and spinal cords and the more nets we have, the lower our ability to recover from BAD things like spinal cord injury and stroke. Under mysterious conditions, HA becomes activated in tumor cells where it makes them more malignant and UGLY, however, there is absolutely no evidence that applying HA to our skin or having it injected into our joints causes cancer. I have returned from Japan more convinced than ever that our lab’s focus on interfering with HA effects is a key to future cancer therapies and to improving neural plasticity. I have returned from Asia with a new level of respect for the Japanese culture, as well as their traditions and admirable values.
Thank you for the opportunity to report as Pediatrician-in-Chief to the CMC Annual Meeting. I am truly delighted by what we have accomplished together in the last year and I am sorry that I had to be away at the time of the meeting.
First, our internal centennial campaign has subscribed nearly 2,000 “100 Year Old Kids.” The Georgia Kids First monthly newsletter and weekly Bernie’s Blog have improved communication and transparency. The external marketing campaign will begin in July with outdoor, print, broadcast (TV) and radio media.
Second, First Contact, First Visit Child Neurology, and PIRATE programs have enhanced quality clinical care, effectiveness, and responsiveness that families and referring docs treasure. Building our hospitalist system of care in the new academic year will enhance First Contact, and First Visit is planned for endocrinology, pulmonary/sleep medicine, and rheumatology.
Third, we recruited 16 outstanding, new faculty members (including four FY10/FY11 chief residents) in addition to a superb and larger-than-ever (14) class of centennial interns. We hope to maintain this momentum in the coming year because the quality of care at the CMC is directly dependent upon the quality of physician-led teams.
Fourth, we gained a deeper understanding of our individual and divisional contributions to the Department and the CMC. For the first time, each faculty member has an individualized charter and set of focused goals.
Fifth, we completed a comprehensive and integrated (Department-CMC) strategic plan in a highly inclusive fashion (all faculty, all divisions, community pediatricians, CMC nursing leadership), and set 16 departmental goals that will be revisited annually at our fall retreats.
Sixth, as a department we achieved > $1MM turn around from a projected end-of-academic year $800K deficit to a modest $277K surplus. We endowed two new chairs, the Strong and Linder Chairs to recruit outstanding senior physician scientists in cardiology and general pediatrics. We soon hope to fill the Tedesco Distinguished Chair with a senior pediatric hematologist/oncologist.
We have a great deal to be proud of as the medical staff of the CMC, and I am very pleased with my partnership with Dr. Howell and newest partners Jim Mumford and Kim Basso.
Let us not forget in the year ahead that we are ultimately measured by what we do for others, and in our case what we do for children, their families, and our community. In all of the challenges ahead, we will do just fine as long as we keep children as our central motivation and as Osler said, “care more for the individual patient than for the special features of the disease.”
.
As Independence Day approaches, I’d like to ask everyone to take a moment when entering the