Some more photos from the SNMA session mentioned above. These were taken by Dr. Rafael Campo.
Saturday, September 26, 2009
Signature collection grows
I have previously written about the email signatures used by some of the girls on the soccer team I coach. Here is another one, from a player with musical talent as well as excellent foot skills.
--
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3$$~~~~$$~~~~$$~~~~$$$ from jillian...
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3$$~~~~$$~~~~$$~~~~$$$ from jillian...
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Basic Eating
Jeremy Warner MD, a Hematology & Oncology Fellow at BIDMC, writes a neat blog called Basic Eating: Food Defined, Not Refined. The theme: Basic eating means increased awareness, increased health, and reduced impact on the environment. Check it out.
Friday, September 25, 2009
Twitter apps
Bill Ives posts 25 Creative Twitter Applications. He embeds this link.
Examples go from really useful -- but dangerous if you text while driving:
CommuterFeed aggregates tweets about traffic from people stuck in jams. By following your city’s feed, you can get updates about ongoing traffic tangles. New Jersey Transit riders have created a similar service.
To just plain goofy:
When Tyler Aaron Menscher (@kickbee) was born in January, he already had hundreds of followers. That’s because his dad, Corey Menscher, created a device that recorded and tweeted his son’s kicks from the womb as they happened.
Examples go from really useful -- but dangerous if you text while driving:
CommuterFeed aggregates tweets about traffic from people stuck in jams. By following your city’s feed, you can get updates about ongoing traffic tangles. New Jersey Transit riders have created a similar service.
To just plain goofy:
When Tyler Aaron Menscher (@kickbee) was born in January, he already had hundreds of followers. That’s because his dad, Corey Menscher, created a device that recorded and tweeted his son’s kicks from the womb as they happened.
Thursday, September 24, 2009
A surgeon's view of Thoreau's neighborhood
Many of you were engaged by the story by Jim Hurst, our chief of surgery, in which he outlined his experience as a patient in our hospital. Well, Jim's doing fine and is out and about. He is an excellent photographer and was kind to send me these recent photos of Walden Pond, since he knows I often swim there. I hope you like them. (You can see more of Jim's work here.)
Fenway Fantasy
Several dozen BIDMC staffers took part in the annual Fenway Fantasy softball game yesterday. Here's one group of smiling players from our OB department holding up the Green Monster.
Wednesday, September 23, 2009
The rich and famous get sick, too
Here's a neat blog called Celebrity Diagnosis. Here's the statement of purpose: "One of our main goals at Celebrity Diagnosis is to increase health awareness and medical knowledge using examples of common diseases affecting uncommon people."
I think this is an engaging way to get people informed. See what you think. Does it make you feel like one of the paparazzi?
I think this is an engaging way to get people informed. See what you think. Does it make you feel like one of the paparazzi?
ACHI brunch on October 3
A colleague at the Harvard School of Public Health asks me to spread the word about an event sponsored by African Community Health Initiatives. ACHI connects African in Massachusetts to health and social service. It not only helps many people overcome barriers and receive care, but it also facilitates the delivery of services by providers to African immigrants.The event is a brunch on October 3, from 11am to 2pm at the Hyatt Regency Hotel in Boston. Featured speakers are Amadou Diagne, Associate Director of Medical Sciences at Gilead Sciences, Inc., and Frederica Williams, President and CEO of Whittier Street Health Center. Admission to this fund-raising event is $75, which you can send to PO Box 120094, Boston, MA 02112. More information is available at achi_org (at) yahoo (dot) com.
Things are cooking at Codman Square!
Bill Walczak, CEO of Codman Square Health Center, sends the following note:
Dear Friends,
I'd appreciate if you would consider coming to our event -- Men of Boston Cook for Women's Health -- this Thursday, September 24 from 6-9. If you haven't had a chance to come to one, you're in for a treat. Food from 30 restaurants served by prominent men of Boston in a gala atmosphere under a big tent in Codman Square. It is our only fundraising event, and all funds raised support the many services we offer to women in Dorchester and surrounding communities, including OB/GYN, Family Planning, Mammography, public health, fitness and adult education programs. And it's tax deductible.
Hope to see you.
Bill
Dear Friends,
I'd appreciate if you would consider coming to our event -- Men of Boston Cook for Women's Health -- this Thursday, September 24 from 6-9. If you haven't had a chance to come to one, you're in for a treat. Food from 30 restaurants served by prominent men of Boston in a gala atmosphere under a big tent in Codman Square. It is our only fundraising event, and all funds raised support the many services we offer to women in Dorchester and surrounding communities, including OB/GYN, Family Planning, Mammography, public health, fitness and adult education programs. And it's tax deductible.
Hope to see you.
Bill
Tuesday, September 22, 2009
Moral high ground?
Oh, I forgot to mention below another example of the SEIU's moral high ground. Here's the latest comment:
In another controversial affront to consumers, BIDMC CEO Paul Levy has recently called for new taxes to be imposed on employer-provided healthcare. Such a tax has been unpopular in most corners of the health care debate, since it is widely believed any such charges would simply be passed on to consumers, and would particularly hurt seniors who pay more for health insurance if they are not yet on Medicare. The CEO of BIDMC has aggressively attacked national healthcare reform efforts . . . .
Regular readers here know what I actually said, looking for a progressive way to pay for health reform, while pointing out the importance of expanding health care access in the US.
But, as below, what on earth does this have to do with union organizing? Answer: Attempt to isolate someone politically based on a mischaracterization of his views, all part of trying to denigrate the reputation of the target you are attacking. Perhaps this worked in other cities, but it just doesn't sell in Boston.
In another controversial affront to consumers, BIDMC CEO Paul Levy has recently called for new taxes to be imposed on employer-provided healthcare. Such a tax has been unpopular in most corners of the health care debate, since it is widely believed any such charges would simply be passed on to consumers, and would particularly hurt seniors who pay more for health insurance if they are not yet on Medicare. The CEO of BIDMC has aggressively attacked national healthcare reform efforts . . . .
Regular readers here know what I actually said, looking for a progressive way to pay for health reform, while pointing out the importance of expanding health care access in the US.
But, as below, what on earth does this have to do with union organizing? Answer: Attempt to isolate someone politically based on a mischaracterization of his views, all part of trying to denigrate the reputation of the target you are attacking. Perhaps this worked in other cities, but it just doesn't sell in Boston.
How to be persuasive?
It is striking to me that the SEIU continues to think it is persuasive to hire a billboard truck that adds to the pollution and congestion of Boston streets to spread its message. It is also curious that it thinks that parking the vehicle in front of the hotel in which our volunteer community leaders are holding their annual meeting will be useful. And then, too, there is the trash barrel overflowing onto the street with its leaflets.What's even more curious is the idea that the union apparently views criticism of ER doctors' billing practices as an effective way to gain support.* Especially since they were mighty silent about some controversial CEO compensation at a hospital in which they already have organized the workforce: "Representatives of SEIU 1199, the union that represents many of Boston Medical Center’s workers, declined to comment."
Oh, I forgot. This is not about organizing workers. It is about conducting a corporate campaign.
What's next? Demonstrating at the grand opening of the newly improved hospital in Needham, the one where it opposed the bond issue to pay for a project that has widespread community support? What a moving case that would make.
*Note: The physicians are not employees of the BIDMC or the other hospitals cited in the story.
The best care we can offer
Sometimes the best care we can offer consists in getting a patient home as quickly as possible, particularly in end-of-life situations. Here is a letter of appreciation, reprinted with permission, from the daughter and other relatives of an elderly patient. As noted by our chief palliative care nurse, "Everyone worked very hard to get this woman home in an extremely short time so she could die with her family around her in her own home."
We members of AB's Family want to thank you all for your amazing support and guidance. Because of your compassionate guidance, our Mom was able to die in peace at home by the fireplace with her dog and children and Grandchildren around her.
The Grandchildren picked wild flowers for her and brought her chocolate bars.
My youngest son, age 9, helped take care of her. He and his cousin gave my Mom the gift of their presence when she passed. She gave them the gift of seeing how peaceful and beautiful death can be.
We are so grateful for your help and have spoken with all our friends and family about the amazing support that you all gave us.
We held my Mom's wake in our small chapel that was built in memory of my brother, her oldest son, who died when he was 11 years old.
With the candles and fireplace going, we and hundreds of friends and extended family sat with her, reminiscing and celebrating an amazing woman.
The funeral service was simple elegant and deeply religious, just as she would have wished. No eulogy, just poems, written and read by the grandchildren.
How fortunate we all are, including my Mother, that we ended up in your care.
We will remain eternally grateful.
We members of AB's Family want to thank you all for your amazing support and guidance. Because of your compassionate guidance, our Mom was able to die in peace at home by the fireplace with her dog and children and Grandchildren around her.
The Grandchildren picked wild flowers for her and brought her chocolate bars.
My youngest son, age 9, helped take care of her. He and his cousin gave my Mom the gift of their presence when she passed. She gave them the gift of seeing how peaceful and beautiful death can be.
We are so grateful for your help and have spoken with all our friends and family about the amazing support that you all gave us.
We held my Mom's wake in our small chapel that was built in memory of my brother, her oldest son, who died when he was 11 years old.
With the candles and fireplace going, we and hundreds of friends and extended family sat with her, reminiscing and celebrating an amazing woman.
The funeral service was simple elegant and deeply religious, just as she would have wished. No eulogy, just poems, written and read by the grandchildren.
How fortunate we all are, including my Mother, that we ended up in your care.
We will remain eternally grateful.
Monday, September 21, 2009
SafetyNurse names 25; Gratton aggregates them
I am humbled by patient safety nurse Barbara Olson's inclusion in her list of "top 25 tweeps for patient safety". She has assembled a list of 25 of us whose Twitter feeds he has "identified as valuable patient safety resources, visionaries, or exemplars; their approach is consistent with the science of patient safety and they're currently active in the Titterverse."
And then, faster than you can say "social media", Fabio Gratton, at Ignite Health, aggregated the tweet feeds of the 25 of us here.
I like Barbara's summary of the issue:
The systems used to deliver care and the culture of the organization where care is provided influence how often inadvertent harm occurs. Transparency, disclosure, error reporting, and an urge to prevent errors by learning from others are hallmarks of patient safety. People who champion the science of patient safety borrow from cognitive psychology, systems engineering, and human factors, recognizing the inherent fallibility of humans. They use proven strategies that mitigate the consequences of human error. Like other worthy endeavors, this one is realized with high-end metrics, and, like others, patient safety relies on IT solutions.
And then, faster than you can say "social media", Fabio Gratton, at Ignite Health, aggregated the tweet feeds of the 25 of us here.
I like Barbara's summary of the issue:
The systems used to deliver care and the culture of the organization where care is provided influence how often inadvertent harm occurs. Transparency, disclosure, error reporting, and an urge to prevent errors by learning from others are hallmarks of patient safety. People who champion the science of patient safety borrow from cognitive psychology, systems engineering, and human factors, recognizing the inherent fallibility of humans. They use proven strategies that mitigate the consequences of human error. Like other worthy endeavors, this one is realized with high-end metrics, and, like others, patient safety relies on IT solutions.
At the New Hampshire Hospital Association
Just heading back from Bretton Woods, where I was honored to be invited to address the annual meeting of the New Hampshire Hospital Association. Here are Peter Davis, chairman; Steve Ahnen, president; and the panel who responded to my talk -- Nancy Formella from Dartmouth-Hitchcock Medical Center; Mike Green from Concord Hospital; and Stephanie Wolf-Rosenblum from Southern New Hampshire Medical Center. The topic was transparency and its role in quality and safety improvement. There were lots of good questions during the program and continued interchanges afterward.
Policy unravels, regional strife begins
In a post below, I raised questions about the application of a new tax on relatively expensive insurance policies, pointing out the potential inequities depending how it was designed. Well, thanks to Senator Baucus, we now have confirmation that I was correct to be concerned.
As noted in this Boston Globe story by Lisa Wangsness, the tax has a broader reach than so-called "Cadillac" plans. It disproportionately affects states whose health care premiums are above the national average, or plans within states that are more expensive for actuarial reasons.
We are finding out, again, that President Obama's formulation of health care reform as offering more access, lower costs, and consumer choice is flawed and misleading. As long as Congress tries to pass a bill based on this fiction, it will be forced to make political -- not policy -- choices that try to hide the real costs.
But the derivative of doing so is that the battle between the states will begin in earnest: Now, it's just about money. There is a minuscule chance of holding together 51 votes for the Baucus plan when 17 states -- including many represented by Democrats -- are affected disproportionately. Especially because their labor partners oppose it. (By the way, on that front, keep an eye out for union-friendly amendments that would exempt collectively bargained insurance plans from the tax.)
But, here's the rub. If you diminish or roll back this tax, you have to come up with other money to keep the program deficit-neutral, a commitment made by President Obama. If you can't find new dollars, you have to cut back on subsidies for low-income people and undermine the goal of universal access. I think access is the most important goal, but it requires a broad-based, progressive tax plan. We should accept the fact that we have to pay for a national priority.
As noted in this Boston Globe story by Lisa Wangsness, the tax has a broader reach than so-called "Cadillac" plans. It disproportionately affects states whose health care premiums are above the national average, or plans within states that are more expensive for actuarial reasons.
We are finding out, again, that President Obama's formulation of health care reform as offering more access, lower costs, and consumer choice is flawed and misleading. As long as Congress tries to pass a bill based on this fiction, it will be forced to make political -- not policy -- choices that try to hide the real costs.
But the derivative of doing so is that the battle between the states will begin in earnest: Now, it's just about money. There is a minuscule chance of holding together 51 votes for the Baucus plan when 17 states -- including many represented by Democrats -- are affected disproportionately. Especially because their labor partners oppose it. (By the way, on that front, keep an eye out for union-friendly amendments that would exempt collectively bargained insurance plans from the tax.)
But, here's the rub. If you diminish or roll back this tax, you have to come up with other money to keep the program deficit-neutral, a commitment made by President Obama. If you can't find new dollars, you have to cut back on subsidies for low-income people and undermine the goal of universal access. I think access is the most important goal, but it requires a broad-based, progressive tax plan. We should accept the fact that we have to pay for a national priority.
Sunday, September 20, 2009
She didn't quite get the message
I have a rule for the 13-year old girls for whom I am a soccer coach: If they are going to have to miss a game, they are supposed to notify me personally in a timely fashion. This is not their parents' job. The girls are now old enough to take personal responsibility for their actions.
Here's the entire transcript of a voicemail I received late this morning, just before two matches scheduled for 1 and 4pm. The playing time for the games was sent to the entire team many days ago. Putting aside the tardiness of the call, do you think a couple of important items are missing from the message?
Hello, this is one of your soccer players, and I wanted to confirm what times the games were at, and if they are both in the afternoon, I can't make either of them, so can you call me back as soon as possible? Thank you.
Here's the entire transcript of a voicemail I received late this morning, just before two matches scheduled for 1 and 4pm. The playing time for the games was sent to the entire team many days ago. Putting aside the tardiness of the call, do you think a couple of important items are missing from the message?
Hello, this is one of your soccer players, and I wanted to confirm what times the games were at, and if they are both in the afternoon, I can't make either of them, so can you call me back as soon as possible? Thank you.
Saturday, September 19, 2009
Fall mushrooms in New England
Pictures taken on beautiful day at the MA Audubon Sanctuary in South Natick. Perhaps Doctor Halamka will identify them for us.
Friday, September 18, 2009
L'shana Tovah
Happy New Year to those of the Jewish faith.
Whether you are or not, you might appreciate this video.
And this one, too!
Whether you are or not, you might appreciate this video.
And this one, too!
Prostate on the BostonChannel
Please check out Heather Kahn's video and the links leading from it to learn more about prostate health issues.
Thursday, September 17, 2009
Recognizing talent
A story from a former BIDMC staffer:
I sent my niece, her husband and their 8 year old William (my great nephew and godson) to his first Sox game at Fenway today. A man a few rows in front of them got hit by a foul and the BIDMC medical team sprang into action. William (who I say is gifted) said, "Hey mama look, those guys have the same logo as Auntie Michelle has on stuff at her house...are they special, too?"
Yes, William, they are.
I sent my niece, her husband and their 8 year old William (my great nephew and godson) to his first Sox game at Fenway today. A man a few rows in front of them got hit by a foul and the BIDMC medical team sprang into action. William (who I say is gifted) said, "Hey mama look, those guys have the same logo as Auntie Michelle has on stuff at her house...are they special, too?"
Yes, William, they are.
First week in school
This young lady has a backpack big enough for all of her books through high school!
Helping the vets
Here's an announcement of a wonderful program between the Red Sox Foundation and Massachusetts General Hospital. Program director John Parrish also leads the 11-member multi-institutional research program called CIMIT, which has a division focused on PTSD that will be integrated into this new joint venture.
ED and House meet Sherlock Holmes
Dr. Jonathan Edlow of our Emergency Department offers fifteen engaging tales in The Deadly Dinner Party and Other Medical Detective Stories (Yale University Press). Here are some other chapters from this new book to whet your appetite:
The Baby and the Bathwater
The Forbidden Fruit
Two Ticks from Jersey
The Case of the Wide-Eyed Boy
A Study in Scarlet
The Case of the Overly Hot Honeymoon
The Baby and the Bathwater
The Forbidden Fruit
Two Ticks from Jersey
The Case of the Wide-Eyed Boy
A Study in Scarlet
The Case of the Overly Hot Honeymoon
Wednesday, September 16, 2009
Abracadavers are sure to reach the beach
Bilal sent me this note on Facebook:
Hi Paul,
I thought you might like to know that a group of ten residents and fellows from various years within the Department of Pathology are taking part in a 36 hour 200 mile relay race in NH this weekend. Ideally, we will be using the collaborative skills we have developed over time within the workplace to coordinate the massive effort to reach Hampton Beach. This is a refreshing change of pace for us and we thought you would certainly appreciate the mini-adventure we're about to embark on.
Regards,
Team Abracadavers...get it? :)
Hi Paul,
I thought you might like to know that a group of ten residents and fellows from various years within the Department of Pathology are taking part in a 36 hour 200 mile relay race in NH this weekend. Ideally, we will be using the collaborative skills we have developed over time within the workplace to coordinate the massive effort to reach Hampton Beach. This is a refreshing change of pace for us and we thought you would certainly appreciate the mini-adventure we're about to embark on.
Regards,
Team Abracadavers...get it? :)
Thanks to Lois
A large crowd gathered last night to express their gratitude to Lois Silverman upon the completion of her term as Chair of the BIDMC. Among the group gathered were many of the previous chairs of New England Deaconess Hospital, Beth Israel Hospital, and BIDMC. Here they are wearing their white coats, one of our traditions to honor past leaders. (Don't worry, they are not allowed to practice medicine. Actually, alone among the group, Lois, being an RN, could.)This remarkable collection of community leaders includes: John Hamill, Robert Melzer, Eliot Snider, Carl Sloane, Alan Rottenberg, Ed Linde, Ed Rudman, Lois, Norman Leventhal, and Steve Kay.
Too many VPs, or too few?
In the comment section of a post below, two doctors bemoaned the proliferation of vice presidents and other administrators in many hospitals. I replied that this was often the case, but that it was my impression, too, that very often the medical staff have little or no idea of the personnel needs of complicated places like hospitals. It is often easy to blame clinical or budgetary woes on "the overhead", especially when you have had no experience in administration.
I said, "I'll give you an example in a future post, and you can be the judge." Here it is. First, a thoughtful note from one of our most loyal, engaged, and best doctors, whom we'll call Sam, to our Chief Operating Officer:
Dear Eric,
In your August letter to the Board you wrote: "The key to making this operating margin for the year is expense control…" and yet immediately following you note that you are creating "a new senior leadership position to oversee all employee safety related issues and activities." You mention that you "...gathered all the leaders in various aspects of employee safety - from Occupational Health, Radiation Safety, Infection Control, Environmental Health and Safety, etc…" to discuss employee safety (I'm curious how many additional leaders there were in the etc category). There would appear to be plenty of existing senior leadership and expertise to oversee employee safety. Is it necessary and politically wise at this time when everyone else is being made to make personnel cuts (I understand more are coming) and not to replace open positions, to add this position?
Why can't this long list of leaders attend to issues of employee safety which I agree are important? Furthermore, why is a search consultant being employed which will cost an additional 20-30% of the individuals salary? Again, it seems like this is a luxury in this time of belt tightening that is hard to justify. I'm sure there are injuries to be prevented, money to be saved, and public relation points to score, but wouldn't it be better to hold this long list of present leaders in employee safety accountable for improving employee safety? I hope you will reconsider this decision or more adequately justify it to those who are questioning its need.
Sincerely,
Sam
To which Eric replied:
Hi Sam,
Thanks for your thoughts, but I can’t agree with you on this one.
Even in times of constraint, we still have the run the institution, and that means setting priorities and spending and investing where necessary. This is one such area, in my opinion.
We have distributed responsibility for different aspects of this problem but no overall coordination and no clear responsibility. More importantly, we don’t have enough detailed subject-area expertise in this area. The issue has been turfed out to folks already burdened with other significant clinical and administrative responsibility. Our organizational structure and resources devoted to safety compares very poorly to any medium-sized manufacturing or construction company, and we have much higher rates of injuries. There’s a connection, I think. While most of them are not of the death-and-dismemberment type, many are serious or potentially serious, and I can’t justify 800 or 900 employee injuries a year. Despite ongoing efforts to improve, we’re not getting anywhere. We need a different approach.
I’m in the process of pulling together a more comprehensive analysis of the financial impact of the current situation, in medical treatment and medications, workers compensation costs, short-term and long-term disability costs, admin costs associated with comp and disability claims, return to work and wellness programs, and the staffing expense in the Occupational Health department associated with responding to injuries. I don’t know what that number is yet but it is many multiples of the cost of better leadership, and I fully expect that once we get an effective safety program in place, the result will be significantly lower overall cost. That’s been the case in most private sector industries, which probably explains in part why they are so far ahead of healthcare with respect to safety. A good record in protecting employee safety will more than pay for itself.
I don’t know what you are hearing about personnel cuts, but the budget that we will send to the Finance Committee later this week includes increases in positions over the staffing levels at which we are currently running. There will be a few areas where VPs have decided to lay off a current employee to make room for a critically needed hire. I expect there will be about a dozen or so such moves, in the context of a budget that includes funding more than 6100 FTEs.
Sam, I have never been someone who has added overhead for its own sake to any organization for which I’ve had substantial responsibility. By my count, I am net –1 in senior administrators reporting to me since coming to the Medical Center two years ago. The people I have brought in from the outside – Walter Armstrong for construction & capital facilities, and very recently Bob Cherry for food service, housekeeping and other support services – have both immediately generated very significant savings for the hospital. In FY ‘10, we will fund every single one of the highest priority projects for capital investment, in large part due to a very good process that Walter structured that significantly improved physician involvement in setting priorities. And last week Bob Cherry submitted a operating budget for his areas that was almost $2 million less than ‘09, without reducing service. In both cases: strong management, deep subject area expertise, strong partnership with physician leadership. I’m confident we can do the same in employee safety.
Best regards,
Eric
I said, "I'll give you an example in a future post, and you can be the judge." Here it is. First, a thoughtful note from one of our most loyal, engaged, and best doctors, whom we'll call Sam, to our Chief Operating Officer:
Dear Eric,
In your August letter to the Board you wrote: "The key to making this operating margin for the year is expense control…" and yet immediately following you note that you are creating "a new senior leadership position to oversee all employee safety related issues and activities." You mention that you "...gathered all the leaders in various aspects of employee safety - from Occupational Health, Radiation Safety, Infection Control, Environmental Health and Safety, etc…" to discuss employee safety (I'm curious how many additional leaders there were in the etc category). There would appear to be plenty of existing senior leadership and expertise to oversee employee safety. Is it necessary and politically wise at this time when everyone else is being made to make personnel cuts (I understand more are coming) and not to replace open positions, to add this position?
Why can't this long list of leaders attend to issues of employee safety which I agree are important? Furthermore, why is a search consultant being employed which will cost an additional 20-30% of the individuals salary? Again, it seems like this is a luxury in this time of belt tightening that is hard to justify. I'm sure there are injuries to be prevented, money to be saved, and public relation points to score, but wouldn't it be better to hold this long list of present leaders in employee safety accountable for improving employee safety? I hope you will reconsider this decision or more adequately justify it to those who are questioning its need.
Sincerely,
Sam
To which Eric replied:
Hi Sam,
Thanks for your thoughts, but I can’t agree with you on this one.
Even in times of constraint, we still have the run the institution, and that means setting priorities and spending and investing where necessary. This is one such area, in my opinion.
We have distributed responsibility for different aspects of this problem but no overall coordination and no clear responsibility. More importantly, we don’t have enough detailed subject-area expertise in this area. The issue has been turfed out to folks already burdened with other significant clinical and administrative responsibility. Our organizational structure and resources devoted to safety compares very poorly to any medium-sized manufacturing or construction company, and we have much higher rates of injuries. There’s a connection, I think. While most of them are not of the death-and-dismemberment type, many are serious or potentially serious, and I can’t justify 800 or 900 employee injuries a year. Despite ongoing efforts to improve, we’re not getting anywhere. We need a different approach.
I’m in the process of pulling together a more comprehensive analysis of the financial impact of the current situation, in medical treatment and medications, workers compensation costs, short-term and long-term disability costs, admin costs associated with comp and disability claims, return to work and wellness programs, and the staffing expense in the Occupational Health department associated with responding to injuries. I don’t know what that number is yet but it is many multiples of the cost of better leadership, and I fully expect that once we get an effective safety program in place, the result will be significantly lower overall cost. That’s been the case in most private sector industries, which probably explains in part why they are so far ahead of healthcare with respect to safety. A good record in protecting employee safety will more than pay for itself.
I don’t know what you are hearing about personnel cuts, but the budget that we will send to the Finance Committee later this week includes increases in positions over the staffing levels at which we are currently running. There will be a few areas where VPs have decided to lay off a current employee to make room for a critically needed hire. I expect there will be about a dozen or so such moves, in the context of a budget that includes funding more than 6100 FTEs.
Sam, I have never been someone who has added overhead for its own sake to any organization for which I’ve had substantial responsibility. By my count, I am net –1 in senior administrators reporting to me since coming to the Medical Center two years ago. The people I have brought in from the outside – Walter Armstrong for construction & capital facilities, and very recently Bob Cherry for food service, housekeeping and other support services – have both immediately generated very significant savings for the hospital. In FY ‘10, we will fund every single one of the highest priority projects for capital investment, in large part due to a very good process that Walter structured that significantly improved physician involvement in setting priorities. And last week Bob Cherry submitted a operating budget for his areas that was almost $2 million less than ‘09, without reducing service. In both cases: strong management, deep subject area expertise, strong partnership with physician leadership. I’m confident we can do the same in employee safety.
Best regards,
Eric
Tuesday, September 15, 2009
QCC posts its Roadmap
A significant detail, as yet unironed out
As President Obama said in his speech last week, "there remain some significant details to be ironed out." Let's focus on one:
And this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money -- an idea which has the support of Democratic and Republican experts.
The manner in which this idea is implemented matters a lot. The first question is whether jurisdictional boundaries will be taken into account in this calculation. Let's say that Aetna or some other national insurer provides coverage in many states. We know that premiums vary significantly from state to state for lots of reasons, one of which is the degree to which each state requires certain types of medical services to be included. Beyond these underwriting rules, there are differences in health care costs, demographics, and consumer benefit preferences.
Given these differences, how do we decide what are "the most expensive policies?" There is a danger that the states that are the most progressive with regard to coverage requirements and other plan design features would find themselves in the "most expensive" category if the chosen jurisdictional boundary is a national one. By taxing insurance plans more in those states, we would create a regional imbalance in states' contributions to the national pool that will subsidize insurance access for the poor. Indeed, we might find that a high-premium state like Massachusetts, which already offers insurance to the vast majority of its population, would find itself subsidizing insurance access in low-premium states that have a high percentage of uninsured.
Along those same lines, will premiums be indexed by cost of living in the various states? Again, one reason Massachusetts premiums are high is because wage rates are higher here, and hospitals have to pay higher salaries to nurses and other health care professionals.
Or, will the tax be defined within each state, or within each insurance company? You can immediately see other types of problems of implementation if that happens.
Whatever method is used, the addition of a tax on higher premiums will make those premiums higher. The idea that businesses and others will then discontinue or redesign those plans ignores the significant friction in the employment market (not to mention the rules and regulations of state insurance commissioners). Will school teachers and other unionized public employees agree to a change in their collective bargaining agreements that lowers their health care benefits, or increases the monthly amount they must pay? Likewise, will auto, steel, petrochemical workers and other private sector unions be amenable to similar changes?
I'm sure there is more to be said on this topic, but thus far I have not seen a cogent explanation of how this portion of the plan would be implemented that does not create large flows of money from one region to another, or from one group of employees to another.
By the way, my proposal to remove the tax exemption for employer sponsored health insurance also has inter-regional impacts, essentially shifting money from those states with greater benefit packages and higher priced insurance to those with lower priced insurance. My only defense of this proposal is that it takes place within a progressive income tax system that at least deals with the issue of lower-income versus higher-income workers. But, it would clearly have a higher net cost to workers in states and industries with more generous health benefits.
And this reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money -- an idea which has the support of Democratic and Republican experts.
The manner in which this idea is implemented matters a lot. The first question is whether jurisdictional boundaries will be taken into account in this calculation. Let's say that Aetna or some other national insurer provides coverage in many states. We know that premiums vary significantly from state to state for lots of reasons, one of which is the degree to which each state requires certain types of medical services to be included. Beyond these underwriting rules, there are differences in health care costs, demographics, and consumer benefit preferences.
Given these differences, how do we decide what are "the most expensive policies?" There is a danger that the states that are the most progressive with regard to coverage requirements and other plan design features would find themselves in the "most expensive" category if the chosen jurisdictional boundary is a national one. By taxing insurance plans more in those states, we would create a regional imbalance in states' contributions to the national pool that will subsidize insurance access for the poor. Indeed, we might find that a high-premium state like Massachusetts, which already offers insurance to the vast majority of its population, would find itself subsidizing insurance access in low-premium states that have a high percentage of uninsured.
Along those same lines, will premiums be indexed by cost of living in the various states? Again, one reason Massachusetts premiums are high is because wage rates are higher here, and hospitals have to pay higher salaries to nurses and other health care professionals.
Or, will the tax be defined within each state, or within each insurance company? You can immediately see other types of problems of implementation if that happens.
Whatever method is used, the addition of a tax on higher premiums will make those premiums higher. The idea that businesses and others will then discontinue or redesign those plans ignores the significant friction in the employment market (not to mention the rules and regulations of state insurance commissioners). Will school teachers and other unionized public employees agree to a change in their collective bargaining agreements that lowers their health care benefits, or increases the monthly amount they must pay? Likewise, will auto, steel, petrochemical workers and other private sector unions be amenable to similar changes?
I'm sure there is more to be said on this topic, but thus far I have not seen a cogent explanation of how this portion of the plan would be implemented that does not create large flows of money from one region to another, or from one group of employees to another.
By the way, my proposal to remove the tax exemption for employer sponsored health insurance also has inter-regional impacts, essentially shifting money from those states with greater benefit packages and higher priced insurance to those with lower priced insurance. My only defense of this proposal is that it takes place within a progressive income tax system that at least deals with the issue of lower-income versus higher-income workers. But, it would clearly have a higher net cost to workers in states and industries with more generous health benefits.
Monday, September 14, 2009
Is SEIU writing itself into the health care bills?
I think the National Right to Work Committee can be a bit over the top sometimes, but this article by its president, Mark Mix, makes interesting assertions which, if correct, would be worth some public focus. He says, with regard to health care reform committee bills: "Tucked away in thousands of pages of complex new rules, regulations and mandates are special privileges and giveaways" for organized labor.
We know that Andy Stern, head of the SEIU, has had unprecedented access to the White House over the first several months of the Obama administration. "Stern estimates he visits the White House once a week. SEIU officials talk to senior Obama advisor Nancy-Ann DeParle about healthcare -- a top priority for Stern.... We get heard," Stern said." I wonder how this compares to the access that certain defense contractors and energy firms had during the Bush-Cheney administration, something that riled a lot of people and raised the hackles of good-government advocates.
Parenthetically, I note that the Obama administration has recently agreed to disclose the names of advocates visiting the White House, but we will not see those names until December 31, well after legislative action on health care is likely to be completed.
We know further than the President and many members of Congress feel indebted to the SEIU for its huge financial and logistical support during the last election. While SEIU has been unsuccessful in obtaining support for its proposal to eliminate elections as part of union organizing drives, it is quite conceivable that it would use that feeling of indebtedness to obtain provisions in the reform bills that would strengthen its ability to organize health care workers.
Perhaps Mr. Mix's article will stimulate reporters and editorial writers to do their own research on the matter.
We know that Andy Stern, head of the SEIU, has had unprecedented access to the White House over the first several months of the Obama administration. "Stern estimates he visits the White House once a week. SEIU officials talk to senior Obama advisor Nancy-Ann DeParle about healthcare -- a top priority for Stern.... We get heard," Stern said." I wonder how this compares to the access that certain defense contractors and energy firms had during the Bush-Cheney administration, something that riled a lot of people and raised the hackles of good-government advocates.
Parenthetically, I note that the Obama administration has recently agreed to disclose the names of advocates visiting the White House, but we will not see those names until December 31, well after legislative action on health care is likely to be completed.
We know further than the President and many members of Congress feel indebted to the SEIU for its huge financial and logistical support during the last election. While SEIU has been unsuccessful in obtaining support for its proposal to eliminate elections as part of union organizing drives, it is quite conceivable that it would use that feeling of indebtedness to obtain provisions in the reform bills that would strengthen its ability to organize health care workers.
Perhaps Mr. Mix's article will stimulate reporters and editorial writers to do their own research on the matter.
Sunday, September 13, 2009
Tom does it again
When cancer survivor Tom DesFosses puts his mind to something, it is a sight to behold. Today's second annual Reason to Ride attracted 185 bike riders devoted to raising money for cancer research at BIDMC. This was well over double the participation from last year.Here are some pictures:
Tom and his doctor, neuro-oncologist Eric Wong; Dave deBronkart (aka e-Patient Dave) and his orthopaedic surgeon, Megan Anderson; a friendly server from event sponsor Fuddruckers with BIDMC staffer Allison.
Finally, here's a video of The MERJ, a wonderful musical ensemble who donated their time and kept the place hopping, even after the ride. Here they are singing the Hank Williams favorite, "Jambalaya (On the Bayou)."
More scenes from Jessica
Make sure you keep up with Jessica Lipnack's scenes as she observes things during a friend's extended stay in a hospital. Best to bookmark that site or get the RSS feed, as you are sure to enjoy each chapter.
Tennis anyone?
We have many loyal and grateful patients and families who want to help out. Here's the next event, on Thursday, September 17.
Boston Realty Advisors invites you to participate in their annual Tennis Tournament on the grass courts at the Longwood Cricket Club to benefit the Center for Violence Prevention and Recovery at BIDMC.
There are still some slots left. Check our Grateful Nation website for the details.
Boston Realty Advisors invites you to participate in their annual Tennis Tournament on the grass courts at the Longwood Cricket Club to benefit the Center for Violence Prevention and Recovery at BIDMC.
There are still some slots left. Check our Grateful Nation website for the details.
Saturday, September 12, 2009
Can this be true?
A story by Liz Kowalcyzk in today's Boston Globe has to cause some raised eyebrows. It is about a plan by the state's Quality and Cost Council to reduce health care costs over the coming decade, a very significant public policy goal. Here's the quote in question:
The state removed the draft recommendations from its website after the Globe inquired about them.
I understand that this is a draft report that might change before it is formally issued. But what could it contain that is so sensitive that the Council would want to avoid public review and comment? When bills go through the legislature, we all get to see early drafts. When environmental impact statements are under preparation by state agencies, we get to see drafts.
Why, in a field in which transparency is becoming a watchword, would the Council not want to have the advantage of a final stage of public comments on its draft document? In contrast, see this earlier (12/10/08) press release by the same Council: "Members of the Massachusetts Health Care Quality and Cost Council (HCQCC) gathered with members of the Legislature, health care advocates and consumers today for the launch of an interactive website designed to promote transparency in the health care industry."
The state removed the draft recommendations from its website after the Globe inquired about them.
I understand that this is a draft report that might change before it is formally issued. But what could it contain that is so sensitive that the Council would want to avoid public review and comment? When bills go through the legislature, we all get to see early drafts. When environmental impact statements are under preparation by state agencies, we get to see drafts.
Why, in a field in which transparency is becoming a watchword, would the Council not want to have the advantage of a final stage of public comments on its draft document? In contrast, see this earlier (12/10/08) press release by the same Council: "Members of the Massachusetts Health Care Quality and Cost Council (HCQCC) gathered with members of the Legislature, health care advocates and consumers today for the launch of an interactive website designed to promote transparency in the health care industry."
Friday, September 11, 2009
A Reason to Ride
There is nothing like spending a fall morning on the North Shore bike riding along a beautiful rural route. And there is nothing like doing so while helping to raise money for cancer research.
Please join cancer survivor Tom DesFosses, his family, and lots of us for A Reason To Ride, a 10-, 20-, or 50-mile ride starting in Danvers, MA, on Sunday, September 13.
Tom says, "For me, this ride will be very emotional, but in another way it will give me incredible joy. It will give me time to reflect on how blessed I am to be a cancer survivor, and to think of others who are not able to join me on this quest. I hope other cyclists will join me on this ride to help raise greatly needed funds for life-saving cancer research."
Tom wanted this to be a very inexpensive fund-raiser to encourage many people to join in. It is just $50 per adult and $25 for a child, or $100 for a whole family. Get the full story here.
Please join cancer survivor Tom DesFosses, his family, and lots of us for A Reason To Ride, a 10-, 20-, or 50-mile ride starting in Danvers, MA, on Sunday, September 13.
Tom says, "For me, this ride will be very emotional, but in another way it will give me incredible joy. It will give me time to reflect on how blessed I am to be a cancer survivor, and to think of others who are not able to join me on this quest. I hope other cyclists will join me on this ride to help raise greatly needed funds for life-saving cancer research."
Tom wanted this to be a very inexpensive fund-raiser to encourage many people to join in. It is just $50 per adult and $25 for a child, or $100 for a whole family. Get the full story here.
Thursday, September 10, 2009
Groupon, Livingsocial, and digital norms
Regular readers have noticed that I am a bit of a social media junkie -- this blog, Facebook, Twitter -- but I am also intrigued by social media sites that are set up only for commercial purposes. It is fun and instructive to watch the evolution of these sites.
Along those lines, a few weeks ago, I wrote about Groupon. The concept: The retailer offers a discount deal in the city of your choice, but only if enough people sign up for it. The viral power is amazing, because after you sign up for something you want, you contact all your friends asking them to do the same so you can get the deal. Meanwhile, the retailer gets noticed by people with an affinity for his/her product or service, and gets a bundle of cash in prepayments. The folks at Groupon get some kind of fee. Everyone is happy
Now arises a new site, soon to go into business, called Livingsocial. Like Groupon, you can sign up for the deal of the day, and if enough people sign up, the deal is on; but unlike Groupon, if you get three other people to sign up for the deal, you get your coupon for free.
I'm not sure, but I do not think this last feature is going to catch on. I think people will be reluctant to try to get their friends to sign up for a coupon so that they can profit from the experience. I think friends, too, will be put off to think they are being "used" that way by their digital buddies.
One of the things I have learned about social media users might seem a bit paradoxical. People value their privacy. Huh? People who expose all on their blogs, Facebook pages, and Twitter feeds value privacy? Well, yes, in certain respects. They don't like receiving commercial spam, even from their real friends. I wonder if the Livingsocial model will feel like it violates that cultural norm.
Time will tell, but in the meantime, please offer your thoughts on the matter.
Along those lines, a few weeks ago, I wrote about Groupon. The concept: The retailer offers a discount deal in the city of your choice, but only if enough people sign up for it. The viral power is amazing, because after you sign up for something you want, you contact all your friends asking them to do the same so you can get the deal. Meanwhile, the retailer gets noticed by people with an affinity for his/her product or service, and gets a bundle of cash in prepayments. The folks at Groupon get some kind of fee. Everyone is happy
Now arises a new site, soon to go into business, called Livingsocial. Like Groupon, you can sign up for the deal of the day, and if enough people sign up, the deal is on; but unlike Groupon, if you get three other people to sign up for the deal, you get your coupon for free.
I'm not sure, but I do not think this last feature is going to catch on. I think people will be reluctant to try to get their friends to sign up for a coupon so that they can profit from the experience. I think friends, too, will be put off to think they are being "used" that way by their digital buddies.
One of the things I have learned about social media users might seem a bit paradoxical. People value their privacy. Huh? People who expose all on their blogs, Facebook pages, and Twitter feeds value privacy? Well, yes, in certain respects. They don't like receiving commercial spam, even from their real friends. I wonder if the Livingsocial model will feel like it violates that cultural norm.
Time will tell, but in the meantime, please offer your thoughts on the matter.
Transforming at the Joint Commission
Here's an announcement from Mark Chassin at the Joint Commission. I recall that Mark set forth some of these themes several months ago, and it is great to see that he and his folks are implementing them:
Today, I am excited to announce the launch of the Joint Commission Center for Transforming Healthcare, which was created to address the most pressing safety and quality problems in health care. The Joint Commission is using a new approach to systematically measure the magnitude of serious quality and safety problems, pinpoint their underlying causes, and develop and test targeted, long-lasting solutions. And, we aim to provide these proven effective solutions to you as an additional benefit of accreditation. The Center is well on its way to completing its first initiative - developing solutions to improve hand hygiene and reduce preventable health care-associated infections.
I know you are searching for - and are eager to implement - highly effective, sustainable solutions that are relevant to your most difficult quality and safety problems. This new approach is required to achieve the level of consistent excellence that is sought by you, by patients and their families, by physicians and other clinicians, and by other public and private stakeholders. I strongly believe that the Center for Transforming Healthcare will live up to its name - transforming the delivery of health care so that all people always experience the safest, highest quality and best-value health care.
The Center is developing solutions by using the same Robust Process Improvement(TM) (RPI) methods - including Lean Six Sigma and change management - that other industries have long relied on to improve quality, safety and efficiency. You may recall that the Joint Commission deployed RPI internally in 2008, and we are aggressively using these proven methodologies to improve our systems and processes for the benefit of customers. Likewise, the Center's participants - volunteer hospitals and health systems throughout the country - have substantial, real-life expertise using RPI in the health care environment. They are using a proven systematic approach to analyze specific breakdowns in care, discover their underlying causes, and develop targeted solutions that solve these complex problems. In addition, the Center is engaging industry to create new products that will amplify and sustain the impact of its solutions.
The Joint Commission has led the way nationally and internationally to identify the highest priority health care quality and safety problems and to address them. Our National Patient Safety Goals, core measures, and state-of-the-art accreditation standards have helped health care organizations focus their efforts to gain the greatest improvements in safety and quality. And you and your colleagues have focused your efforts and made great progress - often with scarce resources and limited help. Now, the Joint Commission Center for Transforming Healthcare aims to provide you with specific guidance on exactly how to improve and sustain quality and safety using Center-developed, proven effective solutions that will be customized for differences among health care organizations. Importantly, the Center's solutions are designed so that your organization will not require any expertise in RPI methods in order to use them.
Ultimately, the Center will provide knowledge and practices that will help transform health care into a high-reliability industry, with rates of adverse events and breakdowns in routine safety processes comparable to air travel or nuclear energy. To accomplish this goal, the solutions that are developed and tested by the Center must make their way into health care organizations across the nation. The Joint Commission is uniquely positioned to facilitate this process. As the Center's solutions are proven effective, the Joint Commission will speed their distribution to our accredited health care organizations and, in the future, we may consider them for possible inclusion in our standards or National Patient Safety Goals.
The Joint Commission is successfully obtaining outside funding for the Center's vital work, so we can deliver these solutions to accredited health care organizations to the extent feasible at no additional cost. In addition to the hand hygiene project, the Center is also developing solutions for hand-off communications and safeguards to prevent wrong site surgery and will work on additional projects for the range of health care settings we serve. To learn more about these projects, visit the Center's Web site and make it a regular resource for your organization.
The Center for Transforming Healthcare is already creating excitement about its new approach to solving problems that we all face every day. I know you will find value in these and other solutions emanating from the Center. Together, we can make a difference and transform health care for patients everywhere.
Sincerely,
Mark R. Chassin, M.D., M.P.P., M.P.H.
President
The Joint Commission
Today, I am excited to announce the launch of the Joint Commission Center for Transforming Healthcare, which was created to address the most pressing safety and quality problems in health care. The Joint Commission is using a new approach to systematically measure the magnitude of serious quality and safety problems, pinpoint their underlying causes, and develop and test targeted, long-lasting solutions. And, we aim to provide these proven effective solutions to you as an additional benefit of accreditation. The Center is well on its way to completing its first initiative - developing solutions to improve hand hygiene and reduce preventable health care-associated infections.
I know you are searching for - and are eager to implement - highly effective, sustainable solutions that are relevant to your most difficult quality and safety problems. This new approach is required to achieve the level of consistent excellence that is sought by you, by patients and their families, by physicians and other clinicians, and by other public and private stakeholders. I strongly believe that the Center for Transforming Healthcare will live up to its name - transforming the delivery of health care so that all people always experience the safest, highest quality and best-value health care.
The Center is developing solutions by using the same Robust Process Improvement(TM) (RPI) methods - including Lean Six Sigma and change management - that other industries have long relied on to improve quality, safety and efficiency. You may recall that the Joint Commission deployed RPI internally in 2008, and we are aggressively using these proven methodologies to improve our systems and processes for the benefit of customers. Likewise, the Center's participants - volunteer hospitals and health systems throughout the country - have substantial, real-life expertise using RPI in the health care environment. They are using a proven systematic approach to analyze specific breakdowns in care, discover their underlying causes, and develop targeted solutions that solve these complex problems. In addition, the Center is engaging industry to create new products that will amplify and sustain the impact of its solutions.
The Joint Commission has led the way nationally and internationally to identify the highest priority health care quality and safety problems and to address them. Our National Patient Safety Goals, core measures, and state-of-the-art accreditation standards have helped health care organizations focus their efforts to gain the greatest improvements in safety and quality. And you and your colleagues have focused your efforts and made great progress - often with scarce resources and limited help. Now, the Joint Commission Center for Transforming Healthcare aims to provide you with specific guidance on exactly how to improve and sustain quality and safety using Center-developed, proven effective solutions that will be customized for differences among health care organizations. Importantly, the Center's solutions are designed so that your organization will not require any expertise in RPI methods in order to use them.
Ultimately, the Center will provide knowledge and practices that will help transform health care into a high-reliability industry, with rates of adverse events and breakdowns in routine safety processes comparable to air travel or nuclear energy. To accomplish this goal, the solutions that are developed and tested by the Center must make their way into health care organizations across the nation. The Joint Commission is uniquely positioned to facilitate this process. As the Center's solutions are proven effective, the Joint Commission will speed their distribution to our accredited health care organizations and, in the future, we may consider them for possible inclusion in our standards or National Patient Safety Goals.
The Joint Commission is successfully obtaining outside funding for the Center's vital work, so we can deliver these solutions to accredited health care organizations to the extent feasible at no additional cost. In addition to the hand hygiene project, the Center is also developing solutions for hand-off communications and safeguards to prevent wrong site surgery and will work on additional projects for the range of health care settings we serve. To learn more about these projects, visit the Center's Web site and make it a regular resource for your organization.
The Center for Transforming Healthcare is already creating excitement about its new approach to solving problems that we all face every day. I know you will find value in these and other solutions emanating from the Center. Together, we can make a difference and transform health care for patients everywhere.
Sincerely,
Mark R. Chassin, M.D., M.P.P., M.P.H.
President
The Joint Commission
Wednesday, September 09, 2009
Quick reactions to Obama at the NYTimes blog
Several of us were invited to submit comments to a New York Times health care blog about President Obama's speech tonight. Here they are.
MICUs go Lean: Result = Happiness
Continuing our spread of Lean process improvements, a team recently assembled to use the 5S process to redesign the supply rooms in two of our medical intensive care unit ("MICU") supply rooms. The objective was to standardize the arrangement and display of supplies in the two rooms, which are on two separate floors. Beyond making each room more efficient, we wanted them to be identical because the same staff people work in the two units. It is better for them to see supplies in the same configuration in the two venues. The plan was to organize items to make the supply collection process more intuitive and also to require less motion. After all, these are intensive care units, and people can often be in a hurry when supplies are needed. Time matters.And beyond one quick fix, we were looking for sustainability, an organization and process that would keep the units well organized and neat well into the future.
As always, this Lean project was multidisciplinary, involving attending physicians, residents, nurses, respiratory therapists, patient care technicians, and our supply and distribution folks. Able assistance was provided by our Business Transformation unit (aka "Lean Team"), but also people from other units who had conducted similar improvement events on their floors.
The results:
-- 100 distinct, unnecessary items were removed from the supply rooms.
-- 86 frequently used items were converted to par items (i.e., restocked regularly, rather than being called for as needed.)
-- 100% identical supplies in the two supply rooms. See Venn diagram above for the before and after.
But, most impressive, the amount of time accumulating supplies for a given procedure was dramatically reduced. See these before and after videos of nurse Tim collecting arterial line supplies. And then view the third video for Tim's triumphal conclusion!
Why am I always in the slow line?
Here's an excerpt from a lovely little book by John D. Barrow called One Hundred Essential Things You Didn't Know You Didn't Know; Math Explains the World. This selection has a great lesson about statistical inference. The chapter is entitled, "Why does the other queue always move faster?"
You will have noticed that when you join a queue at the airport or the post office, the other queues always seem to move faster. When the traffic is heavy on the motorway, the other lanes always seem to move faster than the one you choose. Even if you change to one of the others, it still goes slower.... In fact, the reason you so often seem to be in the slow queue may not be an illusion. It is a consequence of the fact that on the average you are usually in the slow queue.
The reason is simple. On the average, the slow lines and lanes are the ones that have more people and vehicles in them. So, you are more likely to be in those, rather than in the faster moving ones where fewer people are.
The proviso "on the average" is important here.... You won't invariably be in the slowest line, but on the average, when you consider all the lines that you join, you will be more likely to be on the more crowded lines where most people are.
This type of self-selection is a type of bias that can have far-reaching consequences in science and for the analysis of data, especially if it is unnoticed. Suppose you want to determine if people who attend church regularly are healthier than those who do not. There is a pitfall that you have to avoid. The most unhealthy people will not be able to get to church and so just counting heads in the congregation and noting their state of health will give a spurious result.... [W]hen we do science or are confronted with data the most important question to ask about the results is always whether some bias is present that leads us preferentially to draw one conclusion rather than another from the evidence.
You will have noticed that when you join a queue at the airport or the post office, the other queues always seem to move faster. When the traffic is heavy on the motorway, the other lanes always seem to move faster than the one you choose. Even if you change to one of the others, it still goes slower.... In fact, the reason you so often seem to be in the slow queue may not be an illusion. It is a consequence of the fact that on the average you are usually in the slow queue.
The reason is simple. On the average, the slow lines and lanes are the ones that have more people and vehicles in them. So, you are more likely to be in those, rather than in the faster moving ones where fewer people are.
The proviso "on the average" is important here.... You won't invariably be in the slowest line, but on the average, when you consider all the lines that you join, you will be more likely to be on the more crowded lines where most people are.
This type of self-selection is a type of bias that can have far-reaching consequences in science and for the analysis of data, especially if it is unnoticed. Suppose you want to determine if people who attend church regularly are healthier than those who do not. There is a pitfall that you have to avoid. The most unhealthy people will not be able to get to church and so just counting heads in the congregation and noting their state of health will give a spurious result.... [W]hen we do science or are confronted with data the most important question to ask about the results is always whether some bias is present that leads us preferentially to draw one conclusion rather than another from the evidence.
Tuesday, September 08, 2009
BIDMC-style behavior and gratitude
Kristin sends me a note this morning on Facebook:
"Wanted to post a hospital wide thank-you to whomever found my wallet next to my car in the garage and put it in my door handle untouched....it is refreshing to know that there are good people out there and makes me proud to call them my coworkers. Thank you!!!!"
"Wanted to post a hospital wide thank-you to whomever found my wallet next to my car in the garage and put it in my door handle untouched....it is refreshing to know that there are good people out there and makes me proud to call them my coworkers. Thank you!!!!"
More than "a matter of convenience"
Back in July, the Lewiston, Maine Sun Journal published an editorial entitled "A matter of convenience," supporting a move to furlough state employees for 20 days spread out over the year but disagreeing with a plan to require those furlough days to be taken in such a way as to lengthen regular holiday weekends. "What isn't so good is the inability of that public to access government services during these furlough days, most of which are conveniently scheduled to extend already long weekends for government workers.... The shutdown days were scheduled to save salaries, not the costs of heating, cooling, insuring or otherwise of operating offices, so there was no real need to tie these days to existing holidays."
Well, it looks like those editorial writers had the right concerns. A colleague wrote me last night:
I was in Mid-Coast Hospital in Brunswick, Maine, all weekend with my father, who was suffering from a viral infection that was giving him some kind of dementia. It may have been H1N1, possibly Lyme disease. But here's the kicker. The Maine state lab employees were on furlough. No test result, which resulted in us staying the whole weekend and my father leaving without a result. Hospital officials said that Medicare and Medicaid patients also had to stay longer because there was no one to process their papers. Amazing. It was frugality over functionality, and blind bureaucracy trying to find savings that ended up costing probably millions in unnecessary health claims.
Well, it looks like those editorial writers had the right concerns. A colleague wrote me last night:
I was in Mid-Coast Hospital in Brunswick, Maine, all weekend with my father, who was suffering from a viral infection that was giving him some kind of dementia. It may have been H1N1, possibly Lyme disease. But here's the kicker. The Maine state lab employees were on furlough. No test result, which resulted in us staying the whole weekend and my father leaving without a result. Hospital officials said that Medicare and Medicaid patients also had to stay longer because there was no one to process their papers. Amazing. It was frugality over functionality, and blind bureaucracy trying to find savings that ended up costing probably millions in unnecessary health claims.
Monday, September 07, 2009
Facebook leaks data
For those Facebook users out there, here's something you will want to know. Facebook quiz technology lets developers (who are not screened by Facebook) see not only your data, but your friends'.
This article links to the American Civil Liberties Union's Facebook quiz, which demonstrates what developers can see when you agree to let an application get access your data. As noted: This is mostly due to the fact that Facebook's default privacy settings allow access to all your profile information whether or not your profile is set to "private."
This article links to the American Civil Liberties Union's Facebook quiz, which demonstrates what developers can see when you agree to let an application get access your data. As noted: This is mostly due to the fact that Facebook's default privacy settings allow access to all your profile information whether or not your profile is set to "private."
Thursday, September 03, 2009
Freecycling
Swap shops are spreading around the hospital! An email went out this week in one of our office buildings:Beginning today, Sept. 1, look for the new “Take It or Leave It” freecycle swap table in the second floor elevator lobby.
Items such as paper clips, pens, pencils, paper, envelopes, manila folders, tape dispensers, staplers, binders, toner cartridges, etc …, can all be dropped off at the table (please help keep things tidy). Anyone who needs the supplies can take whatever they want from the table — just use it!
Jane Matlaw is seen above, hawking.
Scenes from a hospital
Jessica Lipnack offers perceptive observations while visiting a patient in an out-of-town hospital.
Will this be in the President's speech to Congress?
In contrast to the you-can-have-it-all-without-sacrifice approach of the President, Jonathan Gruber states the case pretty clearly today in a Boston Globe op-ed:
"Fundamental cost control is simply incompatible with unrestricted consumer choice."
"The premiums that all employers and most employees pay are exempted from both income and payroll taxation, unlike wages. This shields firms and employees from reaping the financial benefits of lowering insurance costs."
"Health care reform can be financed by reforming the tax exclusion, and can also include stronger regulatory reforms on the supply side. Just capping the tax exclusion at the average cost of employer-sponsored insurance, so that individuals pay tax only if they have plans that cost above average, could raise as much as $500 billion over the next decade to finance reform."
"Fundamental cost control is simply incompatible with unrestricted consumer choice."
"The premiums that all employers and most employees pay are exempted from both income and payroll taxation, unlike wages. This shields firms and employees from reaping the financial benefits of lowering insurance costs."
"Health care reform can be financed by reforming the tax exclusion, and can also include stronger regulatory reforms on the supply side. Just capping the tax exclusion at the average cost of employer-sponsored insurance, so that individuals pay tax only if they have plans that cost above average, could raise as much as $500 billion over the next decade to finance reform."
Wednesday, September 02, 2009
Reprise: Compensation for directors of non-profits
Some time back, I raised the issue of compensation for members of non-profit boards, particularly those of insurance companies in Massachusetts, noting:
I do not write this to give any sense that I begrudge the insurance company board members their annual retainer and meeting fees, but I wonder how the custom evolved that they should be paid. Has it always been such, or is this a recent development? Is there is anything special expected of them in return for that payment that we do not expect of unpaid board members serving other non-profits?
Apparently, people with lots more statutory authority than I have had similar questions. Our Attorney General, Martha Coakley, has issued an announcement through her Division Chief David Spackman that she intends to have her Non-Profit Organizations/Public Charities Division investigate this practice, noting:
In the area of director compensation, we will address the unusual practice of compensating otherwise independent directors at four of our eight charitable health care insurers. The basis for compensation has not, to the Division's knowledge, ever been clearly articulated to the public and we are asking each of the current boards to take a fresh look at the practice. If the practice is to continue at any of them, it should do so only on the basis of a sound and well considered foundation, for which the benefits and risks have been fully explored and appropriately considered, and in a manner in which the independence of the board has been preserved.
The announcement also suggests a more thorough and contemporaneous review of insurance company and hospital executive compensation, also a welcome step. As I would expect, the Attorney General takes a measured and thoughtful approach to the issue, but she also reminds us of the overall context and the need to be especially diligent:
Today's announcement should not be construed as an attempt to substitute the judgment of the Division for that of committed, knowledgeable and diligent boards. The most expensive mistake an organization can make is to place the wrong person at the helm or the wrong people in the board room. The charitable sector needs to compete for executive talent with the for profit sector in an employment marketplace often insensitive to tax or charitable status. Our most effective managers will be and should be fairly compensated and we acknowledge that the results of the most perfect of compensation systems will be found offensive by some. Members of our charitable boards should be talented, qualified and experienced. Nevertheless, unless this Division and our charitable boards address these issues head on, particularly given recent economic trends and the serious crisis in health care costs, the discretion now vested in our boards is more and more likely to be subjected to far more dramatic externally imposed limits and controls.
I do not write this to give any sense that I begrudge the insurance company board members their annual retainer and meeting fees, but I wonder how the custom evolved that they should be paid. Has it always been such, or is this a recent development? Is there is anything special expected of them in return for that payment that we do not expect of unpaid board members serving other non-profits?
Apparently, people with lots more statutory authority than I have had similar questions. Our Attorney General, Martha Coakley, has issued an announcement through her Division Chief David Spackman that she intends to have her Non-Profit Organizations/Public Charities Division investigate this practice, noting:
In the area of director compensation, we will address the unusual practice of compensating otherwise independent directors at four of our eight charitable health care insurers. The basis for compensation has not, to the Division's knowledge, ever been clearly articulated to the public and we are asking each of the current boards to take a fresh look at the practice. If the practice is to continue at any of them, it should do so only on the basis of a sound and well considered foundation, for which the benefits and risks have been fully explored and appropriately considered, and in a manner in which the independence of the board has been preserved.
The announcement also suggests a more thorough and contemporaneous review of insurance company and hospital executive compensation, also a welcome step. As I would expect, the Attorney General takes a measured and thoughtful approach to the issue, but she also reminds us of the overall context and the need to be especially diligent:
Today's announcement should not be construed as an attempt to substitute the judgment of the Division for that of committed, knowledgeable and diligent boards. The most expensive mistake an organization can make is to place the wrong person at the helm or the wrong people in the board room. The charitable sector needs to compete for executive talent with the for profit sector in an employment marketplace often insensitive to tax or charitable status. Our most effective managers will be and should be fairly compensated and we acknowledge that the results of the most perfect of compensation systems will be found offensive by some. Members of our charitable boards should be talented, qualified and experienced. Nevertheless, unless this Division and our charitable boards address these issues head on, particularly given recent economic trends and the serious crisis in health care costs, the discretion now vested in our boards is more and more likely to be subjected to far more dramatic externally imposed limits and controls.
McNeil shares the facts
A group of us hospital administrators heard an excellent talk this morning by Dwight McNeil, the new MA Assistant Commissioner for Health Data Analytics in the state's Division of Health Care Finance and Policy (shown in picture). As you might expect, he showed us some interesting data, including the three charts above.We in Massachusetts tend to think we live in Lake Wobegon, always being above average, especially when it comes to health care delivery. Not so, as demonstrated quite clearly here. We look good versus the US as a whole, but not so against the other New England states, and worse so versus the best in class.
Tuesday, September 01, 2009
Not here, thankfully
A Boston friend visiting a relative sent these pictures to give a view of how hand hygiene (note empty soap dispenser) and tap water ("Do not drink") are dealt with in an out-of-state hospital.
Thank you, Governor Patrick
Governor Patrick and his folks deserve lots of credit for figuring out how to preserve health care benefits for legal immigrants in Massachusetts, as documented in today's Boston Globe story by Stephen Smith. See here for an earlier request to help out on this front.
The solution is not perfect, but it is a practical and thoughtful response to the matter.
It is a sad state of affairs that this issue arose at all. This is about legal immigrants, people who work hard, pay taxes and otherwise are like everybody else in the state. The only difference between them and "us" is that they don't yet have the right to vote. As such, they were all too easy for the body politic to ignore.
As we consider appropriate tributes to our late Senator Kennedy, omission of insurance for this group is the kind of thing he would have found anathema. Bravo to Governor Patrick for recognizing the Commonwealth's obligation to them as part of the health plan that is being viewed as a model while the country considers its own national plan.
The solution is not perfect, but it is a practical and thoughtful response to the matter.
It is a sad state of affairs that this issue arose at all. This is about legal immigrants, people who work hard, pay taxes and otherwise are like everybody else in the state. The only difference between them and "us" is that they don't yet have the right to vote. As such, they were all too easy for the body politic to ignore.
As we consider appropriate tributes to our late Senator Kennedy, omission of insurance for this group is the kind of thing he would have found anathema. Bravo to Governor Patrick for recognizing the Commonwealth's obligation to them as part of the health plan that is being viewed as a model while the country considers its own national plan.
Better water
Remember the bottled-water-versus-tap-water taste test I wrote about a few weeks ago? Here's a recent note sent to folks in the hospital from our catering department head. The response was very positive:
Dear catering customer .
I am emailing you to inform you that BIDMC catering will be removing bottled water from our menu. Instead, we will default to tap water with ice in pitchers with reusable glasses. We have made this decision for environmental reasons detailed below. However, as a large catering consumer, you will also save money by switching to water pitchers. The transition date is September 14th, 2009. From that date moving forward, if water is ordered, you will receive as stated above. If, for any reason, you feel you need bottled water for your event, please contact me directly.
Thank you,
Gail Spileos
Reasons for “Going Green”
In the past few years we have received many requests to recycle catering bottles, and we hope to have that program in place soon. However, eliminating the bottles is even more environmentally sustainable. Each year, 55,000 bottles, or almost 5% of the 1.2 million bottles cans consumed here at BIDMC, are catering water bottles even though an identical product is available directly from our tap. The decision to phase out these bottles eliminates both unnecessary plastic and the fuel needed to truck water from a bottling plant to a distribution site and then on to BIDMC.
I understand that part of the reason we have been serving bottled water instead of tap has to do with the misperception that our tap water is dirty and unsafe. Because this perception has more to do with the successful marketing campaigns of bottled water companies than reality we would like your help in supporting and promoting this shift to a more environmentally sustainable model. This shift will be successful if we work together to educate our meeting participants.
What folks should know is that tap water is at a minimum as clean and safe as bottled water but often it is cleaner and safer. The MWRA tests our drinking water for 227 contaminants every year and publishes its result on its website. Bottled water companies are held to a lower standard because they don't have to test their water in certified labs. They also don't have to publish the results of any of the tests they do perform. As a result, as an institution that is committed to the public health and safety, we can say unequivocally tap water is certainly no less safe than bottled water and may, in fact, be safer.
There is also a perception that tap water tastes lousy. However, in a recent blind taste test here at BIDMC, 60% of the participants preferred the taste of tap water to that of bottled water and another 15% had no preference. This means we are currently serving water that was only preferred by 25% of the participants. The switch to tap water will mean a shift to the water preferred by the majority of participants.
Dear catering customer .
I am emailing you to inform you that BIDMC catering will be removing bottled water from our menu. Instead, we will default to tap water with ice in pitchers with reusable glasses. We have made this decision for environmental reasons detailed below. However, as a large catering consumer, you will also save money by switching to water pitchers. The transition date is September 14th, 2009. From that date moving forward, if water is ordered, you will receive as stated above. If, for any reason, you feel you need bottled water for your event, please contact me directly.
Thank you,
Gail Spileos
Reasons for “Going Green”
In the past few years we have received many requests to recycle catering bottles, and we hope to have that program in place soon. However, eliminating the bottles is even more environmentally sustainable. Each year, 55,000 bottles, or almost 5% of the 1.2 million bottles cans consumed here at BIDMC, are catering water bottles even though an identical product is available directly from our tap. The decision to phase out these bottles eliminates both unnecessary plastic and the fuel needed to truck water from a bottling plant to a distribution site and then on to BIDMC.
I understand that part of the reason we have been serving bottled water instead of tap has to do with the misperception that our tap water is dirty and unsafe. Because this perception has more to do with the successful marketing campaigns of bottled water companies than reality we would like your help in supporting and promoting this shift to a more environmentally sustainable model. This shift will be successful if we work together to educate our meeting participants.
What folks should know is that tap water is at a minimum as clean and safe as bottled water but often it is cleaner and safer. The MWRA tests our drinking water for 227 contaminants every year and publishes its result on its website. Bottled water companies are held to a lower standard because they don't have to test their water in certified labs. They also don't have to publish the results of any of the tests they do perform. As a result, as an institution that is committed to the public health and safety, we can say unequivocally tap water is certainly no less safe than bottled water and may, in fact, be safer.
There is also a perception that tap water tastes lousy. However, in a recent blind taste test here at BIDMC, 60% of the participants preferred the taste of tap water to that of bottled water and another 15% had no preference. This means we are currently serving water that was only preferred by 25% of the participants. The switch to tap water will mean a shift to the water preferred by the majority of participants.
Monday, August 31, 2009
A distinct sort of society
Whether you agree with him or not, you have to admire David Brooks' ability to turn a phrase, and more. Here is a remarkable summary of aspects of the American character, particularly with regard to the nature of change in our country. My readers from other countries might find that it provides a window into our politics. I think it says a lot about the current debate on health care issues and why a consensus in this complex field is difficult -- for example, why the single payer movement runs into problems, but also why advocates of laissez-faire get little traction. It comes from a column in the New York Times this past weekend.
We in this country have a distinct sort of society. We Americans work longer hours than any other people on earth. We switch jobs much more frequently than Western Europeans or the Japanese. We have high marriage rates and high divorce rates. We move more, volunteer more and murder each other more.
Out of this dynamic but sometimes merciless culture, a distinct style of American capitalism has emerged. The American economy is flexible and productive. America’s G.D.P. per capita is nearly 50 percent higher than France’s. But the American system is also unforgiving. It produces its share of insecurity and misery.
This culture, this spirit, this system is not perfect, but it is our own. American voters welcome politicians who propose reforms that smooth the rough edges of the system. They do not welcome politicians and proposals that seek to contradict it. They do not welcome proposals that centralize power and substantially reduce individual choice. They resist proposals that put security above mobility and individual responsibility.
Sunday, August 30, 2009
Fresh fish frenzy
What do you do when your hunter-gatherer spouse has a successful session on Cape Cod Bay and you find yourself with lots of blues and stripers? Here -- in a healthier version of Julie and Julia -- are three of my simple recipes, enjoyed by us and lots of friends this weekend.Grilled bluefish
Put freshly caught bluefish fillets on the grill, skin side down, with a coating of yogurt mixed with enough soy sauce to create a smooth mixture. Cook with the cover down for 12-15 minutes, never turning. Eat while hot.
Leftover bluefish fillets
Find neighbors willing to take them.
Ceviche (variation on my cousin's recipe from Panama)
Skin and fillet a striped bass. Cut into 2cm cubes. Prepare a bath of chopped onions, corn kernels from fresh corn on the cob, chili powder, ground pepper, and enough fresh squeezed lime juice (about 2 cups) to cover the fish. Let marinate in the refrigerator for 24 hours. Serve cold with taco chips.
Whole poached striped bass (in memory of my mother's approach)
Prepare the bass by scaling and gutting, leaving all skin and fins in place. Place on a large piece of heavy duty aluminum foil. Lay on fresh parsley and oregano, and place more of the same in organ cavity. Squeeze lemon juice atop and place sliced lemons on the fish. Apply ground pepper. Seal the aluminum foil tightly around the fish. Place on a cookie sheet in a pre-heated 425 degree oven for 40 minutes. Options: Eat while hot with no accompaniment, or let cool to room temperature or refrigerate over night and serve with raita.
Leftover fresh striped bass
There never is any, but neighbors are always willing to solve this problem.
Tuesday, August 25, 2009
A music break
As I take a short blogging break for a few days, I leave you with excerpts of this speech forwarded to me by a friend. The talk was by Karl Paulnack, Director of the Music Division of the Boston Conservatory, delivered in September 2004. Read the whole thing. There is one particularly moving section that I have not put here. (Comments are welcome, but they will not appear for a while.)
One of my parents' deepest fears, I suspect, is that society would not properly value me as a musician, that I wouldn't be appreciated. I had very good grades in high school, I was good in science and math, and they imagined that as a doctor or a research chemist or an engineer, I might be more appreciated than I would be as a musician. I still remember my mother's remark when I announced my decision to apply to music school—she said, "you're wasting your SAT scores!" On some level, I think, my parents were not sure themselves what the value of music was, what its purpose was. And they loved music: they listened to classical music all the time. They just weren't really clear about its function. So let me talk about that a little bit, because we live in a society that puts music in the "arts and entertainment" section of the newspaper, and serious music, the kind your kids are about to engage in, has absolutely nothing whatsoever to do with entertainment, in fact it's the opposite of entertainment. Let me talk a little bit about music, and how it works.
One of the first cultures to articulate how music really works were the ancient Greeks. And this is going to fascinate you: the Greeks said that music and astronomy were two sides of the same coin. Astronomy was seen as the study of relationships between observable, permanent, external objects, and music was seen as the study of relationships between invisible, internal, hidden objects. Music has a way of finding the big, invisible moving pieces inside our hearts and souls and helping us figure out the position of things inside us. . . .
I have come to understand that music is not part of "arts and entertainment" as the newspaper section would have us believe. It's not a luxury, a lavish thing that we fund from leftovers of our budgets, not a plaything or an amusement or a pass time. Music is a basic need of human survival. Music is one of the ways we make sense of our lives, one of the ways in which we express feelings when we have no words, a way for us to understand things with our hearts when we can't with our minds. . . .
What follows is part of the talk I will give to this year's freshman class when I welcome them a few days from now. The responsibility I will charge your sons and daughters with is this:
"If we were a medical school, and you were here as a med student practicing appendectomies, you'd take your work very seriously because you would imagine that some night at two AM someone is going to waltz into your emergency room and you're going to have to save their life. Well, my friends, someday at 8 PM someone is going to walk into your concert hall and bring you a mind that is confused, a heart that is overwhelmed, a soul that is weary. Whether they go out whole again will depend partly on how well you do your craft.
You're not here to become an entertainer, and you don't have to sell yourself. The truth is you don't have anything to sell; being a musician isn't about dispensing a product, like selling used cars. I'm not an entertainer; I'm a lot closer to a paramedic, a firefighter, a rescue worker. You're here to become a sort of therapist for the human soul, a spiritual version of a chiropractor, physical therapist, someone who works with our insides to see if they get things to line up, to see if we can come into harmony with ourselves and be healthy and happy and well.
Frankly, ladies and gentlemen, I expect you not only to master music; I expect you to save the planet. If there is a future wave of wellness on this planet, of harmony, of peace, of an end to war, of mutual understanding, of equality, of fairness, I don't expect it will come from a government, a military force or a corporation. I no longer even expect it to come from the religions of the world, which together seem to have brought us as much war as they have peace. If there is a future of peace for humankind, if there is to be an understanding of how these invisible, internal things should fit together, I expect it will come from the artists, because that's what we do."
One of my parents' deepest fears, I suspect, is that society would not properly value me as a musician, that I wouldn't be appreciated. I had very good grades in high school, I was good in science and math, and they imagined that as a doctor or a research chemist or an engineer, I might be more appreciated than I would be as a musician. I still remember my mother's remark when I announced my decision to apply to music school—she said, "you're wasting your SAT scores!" On some level, I think, my parents were not sure themselves what the value of music was, what its purpose was. And they loved music: they listened to classical music all the time. They just weren't really clear about its function. So let me talk about that a little bit, because we live in a society that puts music in the "arts and entertainment" section of the newspaper, and serious music, the kind your kids are about to engage in, has absolutely nothing whatsoever to do with entertainment, in fact it's the opposite of entertainment. Let me talk a little bit about music, and how it works.
One of the first cultures to articulate how music really works were the ancient Greeks. And this is going to fascinate you: the Greeks said that music and astronomy were two sides of the same coin. Astronomy was seen as the study of relationships between observable, permanent, external objects, and music was seen as the study of relationships between invisible, internal, hidden objects. Music has a way of finding the big, invisible moving pieces inside our hearts and souls and helping us figure out the position of things inside us. . . .
I have come to understand that music is not part of "arts and entertainment" as the newspaper section would have us believe. It's not a luxury, a lavish thing that we fund from leftovers of our budgets, not a plaything or an amusement or a pass time. Music is a basic need of human survival. Music is one of the ways we make sense of our lives, one of the ways in which we express feelings when we have no words, a way for us to understand things with our hearts when we can't with our minds. . . .
What follows is part of the talk I will give to this year's freshman class when I welcome them a few days from now. The responsibility I will charge your sons and daughters with is this:
"If we were a medical school, and you were here as a med student practicing appendectomies, you'd take your work very seriously because you would imagine that some night at two AM someone is going to waltz into your emergency room and you're going to have to save their life. Well, my friends, someday at 8 PM someone is going to walk into your concert hall and bring you a mind that is confused, a heart that is overwhelmed, a soul that is weary. Whether they go out whole again will depend partly on how well you do your craft.
You're not here to become an entertainer, and you don't have to sell yourself. The truth is you don't have anything to sell; being a musician isn't about dispensing a product, like selling used cars. I'm not an entertainer; I'm a lot closer to a paramedic, a firefighter, a rescue worker. You're here to become a sort of therapist for the human soul, a spiritual version of a chiropractor, physical therapist, someone who works with our insides to see if they get things to line up, to see if we can come into harmony with ourselves and be healthy and happy and well.
Frankly, ladies and gentlemen, I expect you not only to master music; I expect you to save the planet. If there is a future wave of wellness on this planet, of harmony, of peace, of an end to war, of mutual understanding, of equality, of fairness, I don't expect it will come from a government, a military force or a corporation. I no longer even expect it to come from the religions of the world, which together seem to have brought us as much war as they have peace. If there is a future of peace for humankind, if there is to be an understanding of how these invisible, internal things should fit together, I expect it will come from the artists, because that's what we do."
Monday, August 24, 2009
Jeans and Genes on Groupon
And now for a gentle laugh. Today's post from groupon.com had an ad for a local store selling blue jeans. There is often a humorous commentary associated with these ads, and this one struck my fancy: "Jeans are not to be confused with genes, the DNA components that contain cell-building information and hereditary traits. However, there is some overlap between the two. Here's a helpful Venn diagram to help you keep them straight."By the way, if you are not familiar with Groupon, check it out as a prime example of Internet-based marketing. The retailer offers a discount deal in the city of your choice, but only if enough people sign up for it. The viral power is amazing, because after you sign up for something you want, you contact all your friends asking them to do the same so you can get the deal. Meanwhile, the retailer gets noticed by people with an affinity for his/her product or service, and gets a bundle of cash in prepayments. The folks at Groupon get some kind of fee. Everyone is happy.
Thoughtful views on hospital infections
Sharon B. Wright, MD, MPH, Director of Infection Control/Hospital Epidemiology at our place, sent me this note back in March:
I was at the national hospital epidemiology meetings about 1.5 weeks ago and was talking with some of my colleagues about your blog. Seems like they went back to their institutions and thought up what I think is a great idea – starting our own blog about thoughts on current controversies in infection control.
Well, the group has kept it going, and the blog is very good. I think many would find it of interest, so here's the link to Controversies in Hospital Infection Prevention.
I was at the national hospital epidemiology meetings about 1.5 weeks ago and was talking with some of my colleagues about your blog. Seems like they went back to their institutions and thought up what I think is a great idea – starting our own blog about thoughts on current controversies in infection control.
Well, the group has kept it going, and the blog is very good. I think many would find it of interest, so here's the link to Controversies in Hospital Infection Prevention.
Standards for this blog
The commentary on a post below prompts me to write this post. I have been writing this blog for three years and have had very few occasions to reject comments submitted by readers. Indeed, there have been many thoughtful, heartfelt, heated, and humorous contributions. Even those who disagree with what I or others have said have done so in a fashion that is not disagreeable.
During this time, the readership of the blog has grown substantially, and I think that has a lot to do with the level of civility on these pages. But as readership has grown, it has attracted some people who might be used to the kinds of comments found on many other blogs and in the comment section of newspaper websites. So, I thought it would be good to reiterate the standards that I apply for this blog.
First, as noted at the outset, I cannot comment on individual and legally confidential patient care issues in this forum -- although I can refer patients of our hospital to the appropriate people if they have problems or complaints. I also cannot comment on individual and legally confidential personnel matters of our employees -- although I can refer people to the appropriate folks in the hospital to help them. Accordingly, if you submit a comment that falls in to these categories, I will not post it, but I will refer it along.
Second, I will not post comments that make ad hominem arguments and use foul language, that "flame" rather than make points in a civil fashion, or that have prejudicial implications about race, religion, ethnicity, or sexual orientation.
Third, I will not post comments that are clearly designed to advertise a for-profit product, service, or company in the health care field. I retain discretion to post comments that advertise something that would be of general interest.
Fourth, I usually will not post comments that are excessively long. This is tricky because sometimes the person has something interesting to say, but my sense is that most blog readers do not want to drag through very long posts and comments. Encountering a really long comment, many will give up and not reach other comments that follow. So please do the opposite of Pascal: If you have something to say, take the time to write a short letter.
Sometimes I will post a comment telling the commenter that his or her comment has been received but not posted. Other times, I will simply delete it.
Anonymous comments are fine, and I understand why they might be prudent in some cases, but I personally think you can often be more persuasive if people know who you are and where you come from. Also, it feels good to "stand on a soapbox" and be "seen." People have given their lives to allow us to have freedom of speech. Try it!
So, please dive in, keep reading, and send us all your thoughts on the issues of the day. Thank you for your loyal readership and for spreading the word about this blog.
During this time, the readership of the blog has grown substantially, and I think that has a lot to do with the level of civility on these pages. But as readership has grown, it has attracted some people who might be used to the kinds of comments found on many other blogs and in the comment section of newspaper websites. So, I thought it would be good to reiterate the standards that I apply for this blog.
First, as noted at the outset, I cannot comment on individual and legally confidential patient care issues in this forum -- although I can refer patients of our hospital to the appropriate people if they have problems or complaints. I also cannot comment on individual and legally confidential personnel matters of our employees -- although I can refer people to the appropriate folks in the hospital to help them. Accordingly, if you submit a comment that falls in to these categories, I will not post it, but I will refer it along.
Second, I will not post comments that make ad hominem arguments and use foul language, that "flame" rather than make points in a civil fashion, or that have prejudicial implications about race, religion, ethnicity, or sexual orientation.
Third, I will not post comments that are clearly designed to advertise a for-profit product, service, or company in the health care field. I retain discretion to post comments that advertise something that would be of general interest.
Fourth, I usually will not post comments that are excessively long. This is tricky because sometimes the person has something interesting to say, but my sense is that most blog readers do not want to drag through very long posts and comments. Encountering a really long comment, many will give up and not reach other comments that follow. So please do the opposite of Pascal: If you have something to say, take the time to write a short letter.
Sometimes I will post a comment telling the commenter that his or her comment has been received but not posted. Other times, I will simply delete it.
Anonymous comments are fine, and I understand why they might be prudent in some cases, but I personally think you can often be more persuasive if people know who you are and where you come from. Also, it feels good to "stand on a soapbox" and be "seen." People have given their lives to allow us to have freedom of speech. Try it!
So, please dive in, keep reading, and send us all your thoughts on the issues of the day. Thank you for your loyal readership and for spreading the word about this blog.
Sunday, August 23, 2009
And now for an entirely different view
A friend referred me to this article by David Goldhill in the Atlantic. It raises some provocative thoughts about whether the current Washington approaches to health care coverage will help. It is worth reading in its entirety, but here are two key paragraphs from the conclusion. I'm still mulling it over. See what you think:
The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.
A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.
The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.
A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.
Saturday, August 22, 2009
A surgeon's story: The sequel
Jim Hurst, who's story you read below, was honored last night at Fenway Park. A group of nurses from the TSICU paid him a surprise visit.
Friday, August 21, 2009
Yours truly on NECN
I don't often lead you to television appearances that I have made, but I think this recent one on New England Cable News with Chet Curtis is pretty cogent. See if you agree.
That's one big green bus
Arriving home the other day, I was confronted by this rather large vehicle parked on our narrow street. After a moment's confusion as to why a big bus, green at that, would be parked there, I realized that Ben Gifford must have come home for a visit with his friends.The Big Green Bus is a project of a group of Dartmouth students. Their philosophy: With a grass roots approach, meeting American citizens one-on-one across the country where they live and work and play, we can prompt individual action and lifestyle changes that will all add up to a difference for the future.
Read more on their website and enjoy the energy and idealism of these young people as they try to make a difference in the country's use of energy. As someone who began my career in promoting energy conservation, efficiency, and renewable resources, I love to see college students engaged in this cause.
By the way, of course the bus runs on waste vegetable oil. The fast food places love to see it arrive, and not just because the vehicle is full of hungry young people!
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