RWL Newsletter #137 - ratings, doughnuts, and an unexpected career
Greetings from the University of New Hampshire! The freshmen move in today, and classes start on Monday. It’s hard to believe the summer is essentially over. I finished revising my management syllabus and loading the LMS (learning management system for you non-academics) yesterday, which means I am officially ready for class. This will be my tenth year teaching. That’s hard to believe - at least for me. I decided I wanted to be a teacher when I was 16. It took me 24 years to get there. Hopefully I’ve got another 20 years in me.
Picture above is of the closed Champion paper mill in Bucksport, Maine. We stopped in Bucksport on the way home from Bar Harbor last weekend. If you’ve seen the movie Hunt For Red October, at the end they sail up the Penobscot River. That’s the Penobscot you’re looking at. I lived on the other side of the river in the small town of Prospect for a few years in the early 80’s. My parents both worked in Bucksport, and my sister and I went to school there. Most of the boys I went to school with assumed they would someday get jobs at the mill like their fathers. I hadn’t been back to Bucksport since 1989. I had heard about the mill closing, of course, and wondered what the town would look like. The town is showing a fair amount of resilience as it moves into it’s post-industrial era. The world constantly changes no matter how much we would like it to stay the same. A salmon farm will be moving into the old mill property, and a maritime academy is also setting up there. Those organizations won’t provide the same number of high-paying jobs as the mill did, but they will provide a new economic engine and a different way of life for the town.
Like what’s happening in Bucksport, much of life is spontaneous and unpredictable. Even when you look closely, it’s hard to wrap your head around it. And that’s the theme this week for these three links. Rating systems that may not rate what you think they rate, a lesson about spontaneous order and doughnuts, and an unexpected career.
Read
What: NEJM Catalyst, Rating the Raters: An Evaluation of Publicly Reported Hospital Quality Rating Systems
https://catalyst.nejm.org/evaluation-hospital-quality-rating-systems/
Why: The article is a study looking at the most popular hospital quality rating systems including CMS Hospital Compare, Leapfrog, US News, and Healthgrades. There’s probably no surprise - the study finds the systems all have issues and gives none of them a particularly high rating.
Developing a fair evaluation system is incredibly hard, even in a micro environment where you get to sit face to face with an employee. Developing a rating system for something as complex and multifaceted as a hospital is exponentially harder, so I have some sympathy for the rating systems. That said, it’s important to try. Consumers need information, and these rating services provide information to consumers that consumers could not get on their own. The systems also provide an incentive to hospital leaders to be responsive.
I think the fact that we have multiple systems is a good thing. It is a bit concerning that so many of them basically use CMS data. I like the fact that US News uses a survey of physicians as part of their overall rating in order to capture subtle differences in quality (of course, it also captures the self-interest of the physicians, which isn’t necessarily 100% aligned with the interest of patients).
I’d recommend skimming this article to think about rating schemes in general, and of course hospital rating schemes in particular.
Watch
What: Institute for Humane Studies, Order without intent: How spontaneous order built our world.
Why: Kennedy’s famous line, “Ich Bin Berliner” was supposed to mean, “I am a Berliner” to show solidarity with the Berliners who were held captive behind Soviet lines. But it can also mean, “I am a doughnut”, which doesn’t carry the same gravitas.
Have you heard of Esperanto? Don’t admit it - people will know you’re a nerd. It’s a great example of an expert system that no one wanted. Instead we have thousands of languages around the world, most of which have inefficiencies if you step back and look at them as a predictable system. But languages in the wild grow and change constantly, appropriating words from other cultures or creating words whole cloth to express new meanings as the world changes. Think about all the texting speech that came about with the advent of the cell phone (LOL, ROTFL, SMH, etc.). Languages evolve as a result of a process called spontaneous order. It comes about people, seeking to meet their needs, test new ways of communicating. New words don’t come from experts, they come from random places in society, and they are imbued with meaning as they get used in different situations.
Most of our lived experience is the result of spontaneous order. It’s a beautiful thing.
Listen
What: Health Leader Forge, Sean Stevenson, SVP of Operations, Genesis HealthCare
https://healthleaderforge.blogspot.com/2019/08/sean-stevenson-svp-of-operations.html
Why: My latest interview is with Sean Stevenson, a Senior Vice President for Operations with Genesis HealthCare, and responsible for Genesis’s 110 skilled nursing facilities in New England. Sean is an alumnus of my department’s undergraduate program and does a lot for our current students. I knew very little about long term care before I joined the faculty at UNH, but in the time I have been here, I have been impressed by the opportunities the sector has for people who are interested in leadership and being close to patients. I now recommend all of my students at least consider the field.
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
Have a great weekend and do amazing things!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
"I know of no more encouraging fact than the unquestionable ability of man to elevate his life by a conscious endeavor." - Henry David Thoreau