Traditionally, hospital CEOs are thought of as decision-makers—men and women who can digest a complex array of data and analysis, come up with an action plan, delegate the appropriate responsibilities and then take responsibility for the results when the board comes calling. And having a CEO with the ability to drive change by sheer force of personality is usually seen as a sign of institutional strength—I can't tell you how many stories I've written on successful hospital initiatives where a nurse, doctor or mid-level administrator told me, "This wouldn't have happened if not for the CEO," or, after a change in management, "This wouldn't have happened before, but now we've got the right person in charge."

Recently, though, I've come across an unmistakable trend in my reporting; the notion that thriving as a hospital CEO in an increasingly integrated, more patient-focused world, is less about leading from the top and more about building strong relationships with physicians and other community providers.

When I recently chatted with IHI CEO Maureen Bisognano, the subject of today's H&HN Daily podcast, she observed that back when she ran a hospital, her job was primarily focused on running the business of the institution: hiring staff, overseeing the physical plant and managing the financial operation. Gradually, the job of CEO evolved to more responsibility for clinical care. Now, Bisognano says, the job of hospital CEO is in the middle of another evolution—to deftly managing an increasingly broad set of relationships with physicians, patients and the wider community.

"Now it requires new negotiation and integration skills, and it requires seeing the patient across the entire continuum, so it requires collaboration and planning with entities that there's no legal connection to," Bisognano told me.

In his column for H&HN Daily yesterday, Dan Beckham, president of the health care consulting firm The Beckham Company, wrote that hospital boards, which "have seen the number of physicians on the payroll swell into the hundreds," want CEOs who have the people skills to manage all those new relationships.

"Relating productively with physicians is the core of a CEO's responsibilities," Beckham wrote.

As the old media saw goes, three makes a trend, and as I was putting the finishing touches on this piece, I happened to glance at the March cover article for the print edition of H&HN: "Simple Steps to Improve Relations with Physicians," which outlines informal steps hospital leaders can take to build better relationships with docs—including things as simple as asking personal questions and inviting troublesome employees out for coffee.

But I'm interested in hearing from you, the reader. Is running a hospital evolving from a strong leader who can drive change from the top to a more people-friendly relationship builder who can negotiate with physicians and lead with a more collaborative approach? E-mail your thoughts to hbush@healthforum.com.

Jamie's mother was well into her 70s when she was first diagnosed with a serious heart condition that sent her to the hospital. Prior to that, both mother and daughter had enjoyed amazingly robust health that required little more than routine doctor visits over the years.

"We were novices when it came to hospitals," Jamie recalls. "I was nearly 50, but I really knew nothing at all. I mean, I knew what doctors and nurses were, but that was about it." When a woman in a flowered smock introduced herself as an "R.N.," Jamie had to ask what that meant.

"They took it for granted that we knew the lingo," she says. "Here I was already a nervous wreck over my mother, and every time anybody said anything to me it seemed to be in code, with initials and abbreviations and acronyms." Information about things like her mother's heart rate or blood pressure was delivered strictly by the numbers, with little context. "I didn't know what X over X meant, whether that was high, low or normal."

Unlike many patients and their family members, Jamie was not meek. When she didn't understand what she was being told, she made the clinician stop and explain it in a way she could grasp. The hospital staff was patient, allowing her to ask all the questions she needed to. But really, she says, they all came down to the same question: What does that mean?

"I know they were in a hurry. Wouldn't it have saved time if they'd just said it in plain English from the beginning?"

After Jamie reluctantly left her mother in the hospital and went home, communication with the clinicians remained frustrating. Whenever her cell phone rang and caller ID showed it was the hospital, she'd start to panic. "But the person calling would begin haltingly by asking, 'Is this, um …?'," Jamie says. "I could hear her shuffling papers to try to find the right form. She'd finally say my name, I'd confirm it was me, and she'd continue, 'I'm calling about, um …' and I could hear the papers being shuffled again while she tried to find my mother's name."

"The whole time, all I wanted to know was: Is Mom still alive?"

Jamie assured me that overall the hospital staff did a wonderful job of treating her mother and that she has nothing but gratitude for their skill, hard work and obvious commitment to care. I told her that a number of health care groups and individual hospitals are encouraging clinicians to adopt a more patient-centered approach to communication by, among other things, being better prepared before meetings and phone calls with patients or family members and by jettisoning the jargon.

"Well, good," she replied, pleased if a little skeptical. "Because you really shouldn't need a medical degree to have a reasonable conversation with people who work in the hospital."

Every Tuesday in this column, I address issues that touch, sometimes peripherally, on generational shifts in the American population and the effect on health care from both a patient and hospital perspective. I welcome feedback and ideas. E-mail me at bsantamour@healthforum.com.

Later this week, I hear, CMS may finally release its rules for accountable care organizations. Pardon my skepticism, since the rules were originally expected out last fall, then in January. But sometime soon—and it better be, since the program is slated to launch next New Year's Day—the tough work of turning ACOs, often dubbed unicorns for their mysterious nature, into a tangible being will commence.

Despite the confusion about the finished product, ACOs have been seemingly everywhere since their inclusion in the Affordable Care Act a year ago. In nearly every interview I've done this year—from hospital CEOs to health IT gurus to industry thought leaders—and in nearly every health care article I've read, ACOs have crept into the conversation, often dominating it. Hospitals want to join them, the IT folks want to build systems to support them and everyone wants them to bend the cost curve.

Any new innovation with that much buzz was bound to invite a backlash, which is now in full swing. Lately, the conversations I've had about ACOs have swung from measured enthusiasm to skepticism. Some folks are worried that ACOs are too focused on the structural work of linking providers together, at the expense of the equally, if not more important work of redesigning clinical care. Others think many would-be ACO players, including hospitals, haven't fundamentally prepared for the seismic changes in payment and care delivery poised to shake things up in the next decade. Still others think that the age-old challenges of working with physicians—whether they are employed, as is increasingly the case, or in affiliated medical groups—will bedevil many a would-be ACO.

But no matter how well your average ACO ends up functioning, Medicare and private payers are moving to new models designed to increase accountability. Whether ACOs are around in 10 years remains to be seen. But it's unquestionable that hospitals will be held much more accountable for their work in the very near future, whether as part of a formal partnership or not. Valinda Rutledge, CEO of CaroMont Health in North Carolina, sums up this new reality in today's H&HN Daily podcast.

"We will have to assume some responsibility and accountability for health outcomes in which we will have some type of risk," Rutledge told me. "… We have to move from hospital-centric to community-centric in terms of our delivery of care."

A few days ago, while Apple CEO Steve Jobs introduced the iPad2—the latest device that will instantly transform all of our lives—he made a point to specifically talk up the flashy new device's formidable collection of health care applications designed for physicians and other health care providers. And in an accompanying video, John Halamka, CIO of Beth Israel Deaconess Medical Center in Massachusetts, was featured extolling the virtues of the iPad in the clinical setting.

"What we've tried to do on the iPad is give doctors at the point of care the tools they need at the exact moment a doctor can make a difference," Halamka said.

In general, I'm hearing more and more buzz lately from the field about the potential for tablets, smartphones and accompanying applications to change how hospitals and physicians think about and use health IT. When I interviewed Steve Lieber, CEO of HIMSS, last month, he offered his opinion that mobile technologies are poised dramatically alter the delivery of care—as the technologies enable doctors and other providers to extend out of hospital IT departments and into patients' homes and other settings. Ultimately, Lieber said, hospitals will have to change their IT departments from in-house systems to those that work collaboratively with a variety of devices out in the field.

Still, there are skeptics about whether the technology is quite there yet to support meaningful clinical change will. A friend of mine who's a business consultant is wary of how much capacity the current generation of tablets has for applications he uses to manage his projects—an issue to keep in mind for physicians, too. Then there's that pesky 10-hour battery life—which could be an issue for busy clinicians.

Overall, though, looking at the online reaction to Tuesday's announcement, the general consensus from health care observers appears to be measured enthusiasm. And in the long run, it's more a question of when, than if, a more mobile delivery system emerges where nurses and docs deliver care and share data on a diverse array of devices, both in the hospital and out in the field.

I'm working on a feature for the April issue of H&HN profiling a rural health system that has taken a zero-defect approach to medical errors. From top to bottom, eliminating preventable errors has become part of the organization's DNA. It is ingrained in everyone from admission clerks and back-office staff, to nurses, doctors and top administrators. Executive compensation is even tied to error rates. I've been reporting the article for a couple of months and have interviewed a number of people at the health system, as well as several outside experts, and they all reinforce the same theme, which Helen Darling, president and CEO of the National Business Group on Health, summed up pretty well during an interview we did on Tuesday: "Patient safety is fundamental. It isn't just something that is nice to do, it is fundamental to the care process."

Now, that's not really "news." No one goes to work at a hospital wanting to harm a patient, but preventable errors happen. We are all familiar with the groundbreaking work done by the IOM in this arena, which spawned any number of safety initiatives over the past couple of decades. The good news is that some gains are being made. Just this week, the CDC released data showing a 58 percent drop in central line bloodstream infections for ICU patients between 2001 and 2009. Up to 27,000 lives were saved as a result. An estimated 3,000 to 6,000 lives were saved in 2009 alone.

Obviously, the most important fact is that lives were saved, but it's also worth noting that the effort to cut infections resulted in huge cost savings—$1.8 billion in excess medical costs since 2001. Talk about bending the cost curve. Previous work from the CDC shows that health care-associated infections add between $28.4 billion and $33.8 billion to the system annually. In the assessment released this week, the CDC lists a host of steps that can be taken to make further improvements in curbing bloodstream infections. It recommends that the government develop and promote additional guidelines and tools for adopting best practices. It also suggests that providers join On the Cusp: Stop BSI, which is a joint effort between HRET, AHRQ, Johns Hopkins and the Keystone Center in Michigan.

If anything, the CDC data and programs like On the CUSP are evidence that strides can be made, especially when targets are set. That's something the rural health system I'm profiling in April has learned. For instance, one of the system's hospitals set a goal of 100 percent compliance with hand hygiene protocols. Right now, compliance hovers around 95-98 percent. Will they hit 100 percent? No one really knows, but that is the goal everyone is striving to meet. Efforts like these or those taken to reduce CLABSI are certain to become more important in the coming years as payment becomes linked directly to patient care, rather than patient volume. Regardless of what happens in the courts or Congress, the Affordable Care Act makes it clear that providers will be held more accountable for the care they provide. The law institutes payment penalties for hospital-acquired conditions, for instance. And as you've likely heard, CMS any day now will unveil a new national patient safety initiative. Details have been slow to trickle out, but a confidential draft dated Jan. 11 did, of course, find its way to the Internet. It shouldn't come as a surprise that CMS, under Donald Berwick's leadership, would pursue an ambitious patient safety agenda.

For hospital leaders, the issue is making sure that safety becomes part of your institution's DNA. "We find it over and over again," Darling says, "if you look at patient safety or anything that requires significant redesign and reengineering, there is strong executive leadership and insistence that this happens in a very comprehensive way."

We all have a hypochondriac relative for whom the Information Age is really the Age of Worry. Case in point: those regular calls from my sister informing me that according to her latest midnight Google search, that harmless bump on her arm is really a symptom of a life-threatening malady.

A new study by the Pew Internet Project confirms the widespread use of the Internet for people like my sister; a whopping 80 percent of Internet users look online for health information, making it the third most popular online activity among those tracked by the study, trailing only e-mail and using search engines. Roughly 44 percent of Internet users look online for information about doctors and other health professionals; 36 percent look up information on hospitals and other medical facilities.

There are still economic barriers to online use, though; according to the survey, roughly 95 percent of adults in a household with $75,000 or more annual income are online, compared with only 57 percent of adults in households with $30,000 or less in income.

And many of the folks who may need access to information about health care the most may not have it; only 64 percent of adults living with at least one chronic condition have regular access to the Internet, compared with 81 percent of adults reporting no chronic conditions. Once online, though, adults with chronic conditions reported higher rates of searches for health information than those without.

The big-picture lesson for hospitals is that patients are increasingly comfortable with self-educating themselves on their care journeys, and may finally be ready to play a more active role in their care. And this convergence couldn't happen at a better time; a recent report from PriceWaterhouseCooper's Health Research Institute cautions hospitals that Stage 2 of the federal meaningful use initiative calls for greater communication with patients via electronic communication and personal health records.

And while the PwC survey found that only 14 percent of Americans currently access their medical records electronically, the upward trends in online health engagement suggest those numbers will climb dramatically in the next few years. At the very least, I look forward to fewer worried calls from my sister, who can transition from WebMD searches to constantly updating her PHR. One can only hope.

As a general policy, I refuse to sew, arrange flowers or cook anything that requires more than three steps and four ingredients.

So you might think invoking Martha Stewart's name is nothing more than a transparent attempt to draw more eyeballs to this column, which most Tuesdays will be light on decorating and entertaining tips and heavy on generational issues that are profoundly impacting our nation's hospitals and health networks.

Turns out Stewart has become something of a crusader for "healthy aging," and whatever you might think of her multimedia dynasty or of the woman personally, her work on this particular issue is worth applauding. On a recent ABC News roundtable discussion called "Families on the Brink," she pointed out that even as baby boomers plunge headlong into senior citizenship, many are being called upon to care for their own elderly parents. Both old child and older parent need all the support they can get to maintain optimal physical, mental and emotional fitness.

Hospitals are finding themselves deeply involved—not only as acute care providers, but also as conveners of clinicians, support services and other resources in their communities. Mount Sinai Medical Center in New York City might be the shiniest example of that.

A few years ago, the medical center teamed up with the DIY diva to create the Martha Stewart Center for Living, which takes an impressively comprehensive approach to helping older adults and caregivers. In addition to medical care, it provides diet and exercise advice and activities that stimulate creativity, intellect and fellowship.

Mount Sinai has a long history when it comes to geriatrics. The term itself was coined in 1909 by I.L. Nascher, a Mount Sinai physician who is considered the father of geriatrics in this country. These days, in recognition of the severe shortage of geriatricians and of other physicians with even a modest understanding of the unique issues involved in caring for elderly patients, the Mount Sinai School of Medicine requires all students to do a monthlong rotation in geriatrics. It's Seniors as Mentors program matches every incoming student with an older Mount Sinai patient. And it offers "mini-fellowships" in geriatrics to non-geriatricians who teach in residency programs or medical schools. Mount Sinai faculty members continue to mentor participants after they return home.

Hospitals throughout the country are doing admirable things to meet the needs of their local aging populations. Many don't have the head start or resources—not to mention celebrity connections—to go as far as Mount Sinai has. But they can take giant steps by encouraging their own clinical staff to acquire at least a basic understanding of geriatrics, by keeping up with new technologies that allow patients to remain in their own homes, by offering advice and moral support to family caregivers, and by implementing best practices when it comes to discharge and follow-up care.

On most Tuesdays in this space, I'll pass on good ideas from the field. I invite you to share what you're doing in this area by e-mailing me at bsantamour@healthforum.com. But whatever you do, please, don't ask me how to bake a souffle.