As a part of my interview series with leaders in healthcare, I had the pleasure to interview Phil La Duke is the author of Lone Gunman: Rewriting the Handbook on Workplace Violence Prevention and I Know My Shoes Are Untied. Mind Your Own Business! He is a global business consultant and expert in workplace safety. Mr. La Duke has a background in Healthcare and sits on three biomedical research safety committees.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
After working many years in worker safety I was burnt out. The Great Recession knocked me out of my rut, and at the urging of a longtime friend he and I started a consulting firm together. As we built the business I worked in Healthcare.
Can you share the most interesting story that happened to you since you began leading your company?
Our company name, Rockford Greene International, was the product of the two of us brainstorming names for our company. My business partner is an Environmental Consultant so he wanted the name to contain the word “green” I insisted that it contain the name “International” and that “green” be spelled “Greene”. We sat in my living room brainstorming literally scores of potential names when he saw that I had a DVD of the entire Rockford Files and he joked that we should call ourselves Rockford Greene International. We laughed and continue brainstorming, and after about 40 minutes we decided that not only did we like the name but couldn’t think of anything better. It sounds as if we’ve been around forever.
Can you tell our readers a bit about why you are an authority in the healthcare field?
My job was manager of talent development for the Unified Revenue Organization for one of the largest Healthcare Systems in the US.
What makes your company stand out? Can you share a story?
We require our customers to complete an application to receive our services. It sounds backwards but we wanted to ensure that the customers we served aligned with our values, both of us had a strong aversion to working with customers who treated us badly or tried to get us to compromise our values.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Common sense and lean manufacturing applied to healthcare. There is a lot of non-value added activities in healthcare, things that the patients never see and certainly wouldn’t miss. And these activities are costing time and money.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
1. When you try to change manufacturing you are fighting 120 years of tradition but when you try to bring change to healthcare you are fighting 600 years of tradition. Just something as absurd as having patients with infectious diseases sitting waiting in the same room with people with traumatic injuries doesn’t make sense. This is a practice that has been around since before germs, bacteria, and viruses were discovered and yet it persists in many, if not most, medical establishments today. I am half surprised that they aren’t still using leaches to treat the flu, or bleeding patients to cure a fever.
2. Healthcare spreads accountability across the widest possible spectrum and that means that you have to meet with multiple department heads and have the same conversations multiple times. In many healthcare environments consensus is valued over knowledge and group think has no place in medicine.
3. Doctors don’t work for the hospital, and this means that hospital has little to no power to require them to complete mandatory training, follow basic protocols, or even be civil to patients, and you have to keep them happy; the hospital is essentially forced to keep the doctors happy and you have to keep the patients happy. The patients might dislike the behaviors of a doctor and that reflects on the hospital however unfairly. The healthcare facility is caught in the middle. And when you add insurance to the mix it is pandemonium. Someone could miscode your diagnosis and you would get a bill for $10,000, it will take months to straighten out and you aren’t likely to get so much as an apology.
4. While the technology at the hospital is quite often state-of-the-art but the systems of administering and operating a hospital can be quite antiquated. When coders went from International Coding For Diseases (ICD) 9 to ICD-10 the change was so significant that many coders simply left the position. The number of codes increased tenfold, and many coders were required to take courses in anatomy, software, and relearn their jobs. Many of them went from having an index card with the codes they used written on an index card and taped on their cube wall to a book the size of the Bronx phone book. This technology was necessary for us to share information with the rest of the world but it befuddled and discouraged the coders.
5.The biggest source of bad debt are people who can AFFORD to pay for it but simply choose not to. These aren’t the poor, these aren’t middle class worker struggling to make ends meet, the biggest source of bad debt are multi-millionaire deadbeats who don’t need credit and have lawyers to fight the ensuing litigation. There is something criminal in a guy who owns a tractor dealership who is worth over $10 million who runs up close to a $1 million in debt after quadruple bypass and doesn’t pay because he was too arrogant to get health insurance.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
1.Lack of preparedness. Recently I had an abscess that required emergency surgery. My family doctor called the hospital and was assured that a surgeon was waiting for me and would make a determination as to whether or not the abscess could be drained or if surgery was required. My family doctor worried that if we waited even as much as an hour it could burst and (since I am deathly allergic to the most effective antibiotic) I would be dead in about 30 minutes. When I got to the hospital there was no surgeon (I found out later that he had called in sick). I was told to take a seat. I called my family doctor who called again. This process was repeated until they finally stuck me in a triage room and left me there for several hours until I finally left and used a home remedy to draw the infection out. I returned to my doctor on Monday and he told me that they had scheduled me for surgery the following evening. The hospital’s excuse? They were too busy because “it was flu season”.
2.Lack of an emergency response plan. Some months later my family doctor told me that the same hospital had called him and asked him to release his patients early because they were 700 beds short! The Detroit area has more beds in its hospitals than the population can sustain, but a hospital that might provide excellent care under normal circumstances is still easily overwhelmed when there is a flu epidemic.
3. Lack of organization. The average factory floor has less trip hazards and equipment blocking emergency evacuation routes than the average hospital and yet they refuse to recognize the absolute need for a clear evacuation route. When questioned the staff will invariably say that they need that equipment, but stand dumb when asked why it could not be placed on one side or the hall or the other instead of the shalom course that currently exists.
4. A culture of blame exists. Hospitals remain fairly directive organizations and rules often trump common sense. I am a certified Just Culture practitioner and am horrified at the many instances where people died because the hospital staff refused to disobey a rule or protocol not for fear of litigation, but for fear that they would be punished for violating the rules.
5. A culture that protects its own. If you are planning a medical procedure ask a nurse’s assistant or an orderly which doctors are “good” and which are “bad”. They will tell you, because they know which doctors are prone to mistakes or are just plain bad at their jobs. There has been a lot of misinformation spread about how the high cost of healthcare is attributable to litigation and yet according to a paper, Malpractice Risk According to Physician Specialty by Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D. only “78% of all claims did not result in payments to claimants”. The cost of malpractice insurance is proportionate to the performance of the physician just as the cost of auto insurance is proportionate to the driving record of the insured. In fact, it is very difficult to get a doctor to go on record and accusing another physician of malpractice.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?
1.End credential inflation. There are literally Harvard MBAs working in low level project management positions. Jobs like front-line supervisors require Masters’ Degrees. Department heads and even middle managers are PhDs and Lawyers, and the salaries are commensurate with the people’s education not the value they provide to the hospital. It is almost criminal how much a person can make in healthcare and never once see a patient, particularly the salaries of healthcare executives. Good people are forced out of healthcare because they don’t want to earn a PhD. and that is a real shame.
2. Flatten the organization. In some departments there are two front-line employees to one supervisor, and three supervisors to a director, and so on up the org chart. Again, these are not people who are clinicians, they are accountants, and HR managers, program managers, and coders; it’s insane.
3. Insist on greater accountability. Nothing happens fast in healthcare. Why? Because nobody expects or demands something be done quickly. I have seen projects take years that could and should have been done in months or even weeks. Since it is nonclinical there really isn’t a rush, and since it is a support function nobody really cares when things get done.
4.Have fewer meetings. I have never seen organizations waste time in meetings like they do in healthcare. I personally have been in meetings that lasted three hours and involved 30 people, many of whom were paid six-figure salaries. What came out of that meeting? Nothing that we would have considered paying the price it would take to have an outside firm do it?
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
Demand more transparency. Instead of accepting that the CEO of a not-for-profit Healthcare System deserves over a million dollars a year in compensation demand that he or she demonstrates the value that he or she brings to the healthcare system for that amount of money. I personally would be in favor of having complete disclosure of the salaries paid to top leadership of hospitals. If these people are making a fortune and you find that excessive, don’t donate money to them. People shouldn’t have to choose between bankruptcy and saving the life of their child while the COO of the hospital is making a seven figure salary.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Good to Great. I like this book because there is a lot of practical, low cost solutions that healthcare could adopt to immediately lower healthcare costs without jeopardizing patient care.
How can our readers follow you on social media?
@philladuke on Twitter
Thank you so much for these insights! This was so inspiring!