Thursday, January 4, 2018

Don’t Legislate Through the Constitution



As you may know from my blog posts last spring, I spent significant time and energy during the first half of 2017 working with other health care professionals and legislators across the state to ensure that the Certificate of Need (CON) program was not repealed here in Florida.

Certificate of Need is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services here in Florida. In my opinion, repealing CON remains bad news for the consumer because it has the potential to not only increase costs, but could also lead to a decrease in the accessibility and quality of health care in our state. Thankfully, last spring the Florida Legislature failed to pass a bill that would have eliminated CON. This means hospitals like Tampa General Hospital can continue to offer the highest quality and most accessible care at an affordable price.

As I predicted last June, the debate on CON is far from over. This time, however, those that are set on repealing CON and have been previously unsuccessful have decided to take a new approach. They are now looking to revise the state constitution in order to eliminate CON and in order to do so, have filed a constitutional amendment with the Constitution RevisionCommission that would repeal CON. This would prohibit the State of Florida from limiting the number of hospitals, nursing homes, hospitals or care facilities for individuals.

The Commission’s General Provisions Committee voted inDecember to approve the proposed constitutional amendment, sending it to the full Commission for a vote. If the Commission gives the amendment the thumbs up, the fate of CON will be in the hands of Florida voters come election time in November.

And so, while I am passionate about maintaining CON here in Florida, I am equally passionate about keeping it off the ballot. And here’s why:
  1. CON is a legislative issue and not a constitutional one. Lawmakers need to do their jobs. Regulation should be administered via the legislature.
  2. A ballot initiative campaign will be incredibly expensive as millions of dollars will be spent on television ads trying to persuade voters to one side of the issue or the other. This is money that could be better spent on helping to provide accessible and affordable health care to millions of Floridians.
  3. And most importantly, CON is a highly complex and nuanced issue that would be difficult to explain and be understood by voters in a thirty second sound bite. For a complicated issue that really affects people’s everyday lives, it would be irresponsible of the lawmakers to casually bury this into the ballot.
Everyone in our community deserves access to the best, most affordable health care. The repeal of CON has the potential to dramatically increase health care costs, as well as lead to a significant decrease in quality of health care across Florida. It also has the potential to dramatically decrease access to quality health care that members of my community currently enjoy.

I will continue to do all I can do to make sure that CON remains in place, including working to keep it off the ballot in November. I ask you to join me by making your voice heard.

Specifically, I encourage you attend one of the Constitution Revision Commission’s public hearings being held across Florida during February and March. There, you can let members of the Commission know your desire to have access to high quality and affordable health care and keep CON off the November ballot. 


For a full schedule of the Commission’s statewide tour, visit here.

Thursday, December 28, 2017

A Million Deadheads Can’t Be Wrong




While I am an avid reader and try to keep up with the latest writing in my field, there are books I return to time and time again for inspiration and ideas, whether it be on how to increase my own performance or that of my organization. As I have recently taken on the leadership of Tampa General Hospital, I was inspired to return to one of my favorites, Everything IKnow About Business I Learned from the Grateful Dead: The Ten Most InnovativeLessons from a Long, Strange Trip by Barry Barnes.

You might think it strange for a health care guy like me to be inspired by the philosophy of the Grateful Dead. But, what you may not realize is that the band were innovators when it came to engaging their fans (aka consumers). In fact - they were true pioneers of consumerism.

Much of the band’s success came from doing things in unconventional ways and always putting their fans first and at the center of everything. For example, they capped ticket prices so their fans had greater access to their music and rejected corporate sponsorships that had become all too common in live concert tours. In addition, the Dead distributed their content through multiple channels—again to increase access—and for a reasonable price, if not for free. They also let their fans record their shows—creating a network (in a pre-social media era) of fans sharing and trading music. Their philosophy was that their product was not the music, or the band, it was the audience. The Dead was about building a community of audience and band.

But again, what can the Dead’s relationship to their fans teach us about health care and business? As I said, the Dead were at the forefront of consumerism. Their approach to access and putting their fans first is at the heart of everything we do in the health care arena.  For me, the tactics deployed by the Dead and discussed in the book are directly applicable to our approach to consumerism. Specifically, here’s how the Dead’s approach can be leveraged:

  • Consumer Insights: Get to know your customers—who are they, what speaks to them, what do they want and need? Knowing who your customers are will help you make the right business decisions later on.
  • Access: Provide multiple access points and platforms for them (brick and mortar as well as online) to obtain services. We should be available no matter where they are in their consumer journey.
  • Convenience: Make services easy and accessible. This has become the norm in other
  • Transparency: Be transparent about prices, quality, outcomes, etc. This will allow for consumers to not only shop services, but to feel more comfortable entrusting their care in your organization’s hands.
  • Patient Satisfaction/Experience: Focus on providing a positive experience not just at the time of the service but before, during and after.
  • Loyalty: Build followers and create a “tribe” of consumers. Remember, it is more expensive to acquire a new customer than it is to retain a current one.


While these tactics, when deployed properly, can result in deeper engagement and consumer loyalty, there is one more tactic of the Dead’s that is critical in achieving success—strategic improvisation. Strategic improvisation is the ability to adapt to changing times or forces affecting your business. The Dead were constantly changing and adapting as their work and brand evolved. As health care leaders, our true ability to succeed will be a result of our willingness to embrace change and not only adjust, but to capitalize on the new realities of our business.


To some, the Dead were simply musicians and to others, they were a way of life. Regardless of where you fall, you cannot deny the Dead’s ability to build a brand and cultivate a massive legion of followers. If we could achieve half that level of loyalty and engagement, we would be well on our way. A million dead heads are proof of that.

Thursday, December 21, 2017

It Takes a Village


If, as the saying goes, “all politics are local,” the same can be said of health care. As health care consumers continue to have greater agency in their health care decision-making and as the ACA requires nonprofit hospitals to focus on the long-term wellness and health of patients, the medical services available should now - more than ever - reflect the specific needs of the community in which they are offered.

In order to meet the needs of the community it serves, health care providers such as Tampa General Hospital (TGH) are looking to strategically collaborate with community partners like never before. For example, at TGH we work closely with a handful of partners throughout the community on programs that focus on preventative care and a wellness mentality that keeps people living healthier lives.  As such a high percentage of chronic diseases are linked to behavior, the more we can partner on community health initiatives, the less intensive and expensive health care costs will be down the road.

Collaborating and developing community partnerships should not be done in vacuum. By that I mean, hospitals and providers should consider a host of factors specific to the community it serves. Specifically, they should think about answers to the following questions when designing and developing these partnerships and programs:

  • What does the community need? Results of community needs assessments should be at the foundation of community partnerships. This will allow you to use objective data when developing new programs and ones that speak to the documented needs of your community. For example, in some communities, assessment results will lead you to develop obesity prevention programs, while in others, it might be diabetes education or infant mortality protection programs. 

  • What do the people want? Listen to your friends and neighbors to figure out what services they are asking for. While assessments will help define priorities and programs, it is equally important to directly listen to the population you serve. One way to do this is to hold conversations at different locations throughout the community in order to hear from a broad cross-section of the population. 

  • What are active access points for the community? In some, churches are a significant spot for activity and engagement, in others it is schools or community centers. Think about where neighbors go, and work with those institutions, when possible, to offer services. A great deal of providing community services is breaking down barriers to access.

  • Are you taking the long view? Partnerships and programs should be seen as providing a continuum of care for the community. Community partnership services should reflect an emphasis on preventative care, prevention and wellness enhancement as well as direct services.

  • Are you engaging neighbors and advocates to promote health and wellness? Empowering folks to take an active role in their health as well as that of their neighbors can be an effective and powerful thing. Think about developing partnerships that work to promote education about the health care policies that affect their community as well as providing opportunities for them to serve as ambassadors in their neighborhoods. This will allow you to develop a new set of stakeholders in the programs and services you offer, while continuing to develop more expansive ways to promote healthy living.



As the health care landscape continues to change and as consumers and neighbors rely on providers for more than just their direct services, leaders and organizations must continue to reimagine what it means to provide care. Today, we in the industry are charged with taking care of the health and wellness of our whole community and not just the patients that walk through our door. With this mindset, it takes our whole community strategically working together to make this happen. The more we can partner, the stronger our community will be.