Straight Talk - "Cumulative Advantage"

August 1, 2013

Dear Friends and Colleagues,

Let’s talk about the economic term “cumulative advantage,” which has Biblical origins and roughly translates into these ideas: The best get better, the rich get richer, success begets more success, and quality encourages even better quality.

Cumulative advantage is what we have been practicing at NCH over this past decade as our healthcare center, fueled by a staff of caregivers who are second to none, has risen to greater and greater heights. Sadly, more than a few hospitals in Florida have had just the opposite experience; many are also undergoing the shift in status from not-for-profit responsibility to the community to one of for-profit focus on quarterly returns for shareholders. Some systems are considering changing ownership. All healthcare systems today must be prudent with limited resources.

One significant reason for the success of NCH, while others have struggled, is our creative and supportive 17-member NCH’s Board of Trustees ( At our bi-monthly board meeting last week, cumulative advantage was very much on display as the board focused on continuing to help everyone live longer, happier, and healthier lives.

  • At last week’s meeting, Dr. Hermes Koop, former president of the Medical Staff for four years, started with the customary Quality and Patient Safety Report, reviewing Leapfrog’s designation of a “B” for NCH Healthcare (the highest hospital score in Southwest Florida) and our aspiration of an “A” rating next year, when we will have only Board Certified Critical Care physicians in the ICU (

  • North Naples ER Director Betsy Novakavich and Microsystem Director Jon Kling then shared spectacular results on improved patient and staff satisfaction, door-to-doctor time, decreased risk, and overall better outcomes by employing efficient, operation management principles (lean/six sigma) to change the way we care for ¬50,000 ER patients without adding people or space.

  • The overall challenges and goals for the 2014 Health Plan were then reviewed with the decision to seek feedback from all our colleagues. Focus groups are now underway. NCH will be following best practices from around the country as we encourage better health for everyone.

  • The remainder of the meeting was devoted to progress on our five tactical goals: (1) Growing primary care; (2) Integration of in and out-patient care; (3) Information Technology; (4) Population Health; and (5) growing our Mayo affiliation (

  • Among highlights, we discussed the addition of almost 20 physicians to the NCH Physician Group; an upcoming thorough review of our hospitalist service; an update on our paperless Computerized Provider Order Entry (“SIMON”) system, now at the 90% computerized provider order entry level; our Health Information Exchange enrolling physicians; population health initiatives to improve health habits and results; and our Mayo network affiliation adding consults.

  • In a related sense, we reviewed an upcoming program led by Mayo experts on communication between physicians and their patients, and a cardiology trial led locally by Dr. Adam Frank working with five other Mayo affiliates.
All in all, a Board exercise in quality encouraging better quality, and success begetting more success. And that’s what we mean by cumulative advantage at NCH.


Allen S. Weiss, M.D., President and CEO

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