One more posting in honor of Labor Day.
Recently, an op-ed was published in the Boston Globe, entitled "Unions' new role in the workplace". It was written by Kris Rondeau and Janna Malamud Smith. People with good memories will remember that Rondeau was a driving force in the creation of the Harvard Union of Clerical and Technical Workers (HUCTW) twenty years ago. The slogan she and her colleagues developed -- "You can't eat prestige" -- was one of the masterstrokes of union organizing. It took several tries, but finally the union eked out a small majority in an election and became the bargaining agent for a significant number of workers at Harvard University. They were able to do so, ultimately, because they had a personal and respectful relationship with virtually every person voting in that election. Many of those employees viewed themselves as professionals who did not want or need a union. Rondeau did not attempt to bypass those people by ignoring their concerns. Instead they were treated with just as much respect as those who wanted the union. The result was that even those on the losing side of the vote felt their views had been heard and considered and did not fall into a posture of resentment and anger.
In my previous job as Administrative Dean of Harvard Medical School, I had many opportunities to work with Rondeau and her colleagues and enjoyed what we were able to accomplish together. She and her team were great negotiators, but the key to their success during this process -- like during the organizing drive -- was that they were intimately familiar with virtually every member of their union -- both learning from them and teaching them. Indeed, the HUCTW often had a better perspective on what would make the University work better than the administrators and supervisors in the University, because they had a real connection to what was happening on the "factory floor." But, instead of being confrontational with that information, they used it to educate the management, too, and worked together to enhance both the lives of workers and the underlying mission of the University.
In their op-ed Rondeau and Smith offer the opinion that this approach to union-management relations should be a guide for the future. This is a great vision, but whether or not it will be achieved is questionable. Just look at the comments under the article to see opposing views. There are clearly those who will always believe that "allying with the employer is the wrong approach and ultimately not in workers' interests; when workers' and bosses' interests occasionally coincide, it's the exception rather than the rule."
But the HUCTW history supports one point in which I believe quite firmly. If the organizing approach being advocated by the SEIU and many politicians is adopted -- i.e., the elimination of elections -- they will have created a cancer of discontent within the very union expansions they hope to achieve. Why? Because there will always be a significant number of workers in every company -- whether 30%, 40%, 50% or 60% -- who would choose to vote against unionization in a secret ballot process. By disenfranchising that group through the use of a card-check system, the unions will be sowing the seeds of resentment that will hurt them for years to come.
In America, we accept the idea that we might be on the losing side of an election, and we live with that result. But, if we are precluded from being allowed to have a say, we remain angry for a long, long time.
This was put more elegantly than I have done in comments I received from an organizer in one of the local Boston unions:
I must say I don't understand why anyone would think that to take away a person's right to an election is good idea. It's seems to me that it would create a feeling of disempowerment instead the feelings that should be created: The feelings of pride and of finding your voice, realization of the fact that you have value to add and a respectful way of sharing it.
Sunday, August 31, 2008
Saturday, August 30, 2008
Don't mention the part about ending elections!
A special message in honor of Labor Day:
A little while back, I wrote of George McGovern's opinion piece advising members of the Democratic party not to support the adoption of the so-called Employee Free Choice Act, the legislation supported by the SEIU to remove the need for elections as part of a union organizing drive. My post got picked up by a website called EFCA Updates, a blog I had never heard of published by a law firm called Kilpatrick Stockton LLP, which apparently represents managements of companies with regard to labor issues. The firm also cited other blogs with points similar to mine; but this made me curious what other folks out in the blogosphere might have said in response to Senator McGovern's editorial and generally on this topic.
So, I did a blog search and discovered tons of commentary on the issue pro and con. (I will not refer you to the ones who engaged in ad hominem attacks on the former Senator. Why is it that some people feel the need to denigrate those who disagree with them? Why can't they let the strength of their arguments carry the day?)
Remarkably, while the blogosphere is full of ideas, the topic still does not make it into political debates. This blog presents the issue with a Minnesota candidate in an interesting way that you might or might not find convincing. But I think it contains an element of apt political analysis: People running for the Democratic nomination in their states have stressed their support for EFCA as part of their campaign in part to garner the SEIU's and other organized labor extensive funding of and involvement in those primary campaigns.
But then, when the candidates get to the general election and have to convince non-party regulars to vote for them, they may not be all that anxious to have this issue front and center in their campaign. After all, as Senator McGovern noted, it is really hard to explain to the general public why workers should not have the right to a secret ballot election when it is long-held American value. I note, for example, that even Barack Obama avoids this important aspect of the proposed legislation when he puts it this way:
Ensure Freedom to Unionize: Obama believes that workers should have the freedom to choose whether to join a union without harassment or intimidation from their employers. Obama cosponsored and is strong advocate for the Employee Free Choice Act, a bipartisan effort to assure that workers can exercise their right to organize. He will continue to fight for EFCA's passage and sign it into law.
I want to be quite clear that I have great respect for Senator Obama and for his persuasive powers of oratory and his ability to deliver a clear message. But something tells me that he is never going to be so direct as to say the following on the campaign trail or in a debate with Senator McCain:
I will sign legislation allowing unions to be certified as the sole bargaining representative in companies, hospitals, and other institutions without having to hold an election. Although it is vitally important under our democratic system for Senator McCain and me, every member of Congress, every Governor, and all other public officials to go through a process of secret ballot elections, unions shouldn't need to have workers do that. The idea of a secret ballot is old-hat because workers will be intimidated when they are alone in the privacy of the voting booth. In contrast, there is no danger of intimidation when union officials and fellow workers approach individuals one at a time to collect authorization cards. It is perfectly fine in such an environment if 50.1 percent of the workers at a company sign an authorization card that binds themselves and the other 49.9 percent of the workers to be members of a union. That's why we don't need elections anymore.
A little while back, I wrote of George McGovern's opinion piece advising members of the Democratic party not to support the adoption of the so-called Employee Free Choice Act, the legislation supported by the SEIU to remove the need for elections as part of a union organizing drive. My post got picked up by a website called EFCA Updates, a blog I had never heard of published by a law firm called Kilpatrick Stockton LLP, which apparently represents managements of companies with regard to labor issues. The firm also cited other blogs with points similar to mine; but this made me curious what other folks out in the blogosphere might have said in response to Senator McGovern's editorial and generally on this topic.
So, I did a blog search and discovered tons of commentary on the issue pro and con. (I will not refer you to the ones who engaged in ad hominem attacks on the former Senator. Why is it that some people feel the need to denigrate those who disagree with them? Why can't they let the strength of their arguments carry the day?)
Remarkably, while the blogosphere is full of ideas, the topic still does not make it into political debates. This blog presents the issue with a Minnesota candidate in an interesting way that you might or might not find convincing. But I think it contains an element of apt political analysis: People running for the Democratic nomination in their states have stressed their support for EFCA as part of their campaign in part to garner the SEIU's and other organized labor extensive funding of and involvement in those primary campaigns.
But then, when the candidates get to the general election and have to convince non-party regulars to vote for them, they may not be all that anxious to have this issue front and center in their campaign. After all, as Senator McGovern noted, it is really hard to explain to the general public why workers should not have the right to a secret ballot election when it is long-held American value. I note, for example, that even Barack Obama avoids this important aspect of the proposed legislation when he puts it this way:
Ensure Freedom to Unionize: Obama believes that workers should have the freedom to choose whether to join a union without harassment or intimidation from their employers. Obama cosponsored and is strong advocate for the Employee Free Choice Act, a bipartisan effort to assure that workers can exercise their right to organize. He will continue to fight for EFCA's passage and sign it into law.
I want to be quite clear that I have great respect for Senator Obama and for his persuasive powers of oratory and his ability to deliver a clear message. But something tells me that he is never going to be so direct as to say the following on the campaign trail or in a debate with Senator McCain:
I will sign legislation allowing unions to be certified as the sole bargaining representative in companies, hospitals, and other institutions without having to hold an election. Although it is vitally important under our democratic system for Senator McCain and me, every member of Congress, every Governor, and all other public officials to go through a process of secret ballot elections, unions shouldn't need to have workers do that. The idea of a secret ballot is old-hat because workers will be intimidated when they are alone in the privacy of the voting booth. In contrast, there is no danger of intimidation when union officials and fellow workers approach individuals one at a time to collect authorization cards. It is perfectly fine in such an environment if 50.1 percent of the workers at a company sign an authorization card that binds themselves and the other 49.9 percent of the workers to be members of a union. That's why we don't need elections anymore.
Cormorants in Cape Cod Bay
This group always finds this exposed rock at low tide on which to dry their feathers.
Thursday, August 28, 2008
Welcome Blogger referrals!
Welcome to those of you who got here via Blogs of Note. I am honored to be listed. Please scroll down and you will find a wide variety of topics covered. While most postings are about issues surrounding running a hospital, medicine, and health care, you'll also find other stuff that might be entertaining or informative -- and I've recently included some lighter topics that seem appropriate for the end of summer.
Please come back often!
Please come back often!
Wrong way to apply for a job
I know we all receive "cold call" letters from people looking for jobs. I do not know what kind of employment agencies advise people to send these to a CEO, in that the letters are usually not in response to open positions and generally are not attuned to the needs of the organization. And we all have websites now that list open jobs and encourage people to apply using that vehicle, which, by the way, is a major source of recruitments. But you can't fault people for trying in their own way.
But, every now and then, one comes in that is worthy of note. This one came by email today, with no personalized salutation. Something tells me that a person seeking a job in the security field is using the wrong medium if he is seeking a job through broadcast emails!
As a Director of Security Operations, I led investigative teams, uncovering fraud and real and potential threats to personnel and assets. Also, I designed and conducted training courses increasing security awareness.
My strengths include emergency planning and response, loss prevention, counter-terrorism, and I am knowledgeable of on-going issues relating to enforcement of ITAR regulations. I exposed internal corruption for one of my employers saving $300M and secured an at-risk facility in Honduras. For another employer, I identified $4M in inventory losses and implemented a preventive program.
I have posted a short version of my resume and welcome your response.
But, every now and then, one comes in that is worthy of note. This one came by email today, with no personalized salutation. Something tells me that a person seeking a job in the security field is using the wrong medium if he is seeking a job through broadcast emails!
As a Director of Security Operations, I led investigative teams, uncovering fraud and real and potential threats to personnel and assets. Also, I designed and conducted training courses increasing security awareness.
My strengths include emergency planning and response, loss prevention, counter-terrorism, and I am knowledgeable of on-going issues relating to enforcement of ITAR regulations. I exposed internal corruption for one of my employers saving $300M and secured an at-risk facility in Honduras. For another employer, I identified $4M in inventory losses and implemented a preventive program.
I have posted a short version of my resume and welcome your response.
Wednesday, August 27, 2008
Laurie Edwards live!
A note from fellow blogger and author Laurie Edwards:
Dear Friends,
I hope you are enjoying the last few weeks of summer. As we look ahead to fall, I want to let you know about a joint author event I am doing at Newtonville Books on Thursday, September 18 at 7pm. My colleague Rosalind Joffe will read from her new book, Women, Work, and Autoimmune Disease. I will read excerpts from my book, Life Disrupted: Getting Real About Chronic Illness in Your Twenties and Thirties, and we will both take questions.
We are excited to be doing this together as part of Newtonville Books' Lecture Series, and hope to see many of you there. Please feel free to forward this message to any friends or family who might be interested in these books and in attending the event. Thanks so much!
Best,
Laurie Edwards
Newtonville Books
296 Walnut Street
Newtonville, MA 02460
Dear Friends,
I hope you are enjoying the last few weeks of summer. As we look ahead to fall, I want to let you know about a joint author event I am doing at Newtonville Books on Thursday, September 18 at 7pm. My colleague Rosalind Joffe will read from her new book, Women, Work, and Autoimmune Disease. I will read excerpts from my book, Life Disrupted: Getting Real About Chronic Illness in Your Twenties and Thirties, and we will both take questions.
We are excited to be doing this together as part of Newtonville Books' Lecture Series, and hope to see many of you there. Please feel free to forward this message to any friends or family who might be interested in these books and in attending the event. Thanks so much!
Best,
Laurie Edwards
Newtonville Books
296 Walnut Street
Newtonville, MA 02460
Monday, August 25, 2008
More Than a Fan
From Michael D. Baratz, MD, Resident Physician at the BIDMC Department of Surgery:
From the time I was a 6 year-old boy, I have gotten an adrenaline rush when walking into Fenway on a summer night. Still today, at 29, the feeling remains the same. When I walked into the park on July 12th as a member of the Emergency Medical Staff, the buzz was twice as potent. I was for the first time, more than just fan. I was going to work.
The first 6 innings of the game were exciting as a fan, and nearly event-less as a doctor. I stood atop the Green Monster and saw a view of the field I had never seen. I was in earshot of the now maligned Manny Ramirez. I saw 4 home runs (3 by the home team). As the Red Sox cruised to a 10-1 lead, all I had to do was give out a few Tums and some Tylenol.
At the top of the 7th, I traded places with another resident and went down to the main First Aid stand underneath section 112. I instantly switched back to being a physician, and placed my fan-hood on hold. In addition to the usual complaints of a hot summer night: dehydration, blisters, light-headedness, and a young woman who was hit in the temple with a Kevin Youkilis foul ball (she kept the ball).
With a win in the books, and 'Sweet Caroline' on the minds of 35,000 I was expecting an uneventful end to my night. But at that moment, an EMT and a Fenway security guard knocked on the door. "Peanut allergy in the bleachers. Need a doc and an EpiPen!". The attending on staff asked me if I would go. This story would not have been interesting enough to get onto Paul Levy's blog if I had said no, right?
I grabbed an EpiPen and jogged out of the makeshift ER. I was following the EMT to our destination, when it finally hit me: we were in the first base grandstands, and she was in the bleachers. For us to get to her without playing slalom with thousands of fans, we would have to go onto the field. We did just that, and before I could even soak it in, I was jogging where J.D. Drew had been just moments before. It was a surreal moment in which I had no time to bask. The visitor's bullpen. The bleachers. My hand on the end of an EpiPen. The back of an ambulance. Over to the BI. Time finally slowed back to normal pace, and I was alone as I walked out the doors of the BIDMC ED. The events of the past few hours had just sunk in, and I felt almost like Moonlight Graham from 'The Field of Dreams'. I don’t think I can ever go back to JUST being a fan.
From the time I was a 6 year-old boy, I have gotten an adrenaline rush when walking into Fenway on a summer night. Still today, at 29, the feeling remains the same. When I walked into the park on July 12th as a member of the Emergency Medical Staff, the buzz was twice as potent. I was for the first time, more than just fan. I was going to work.
The first 6 innings of the game were exciting as a fan, and nearly event-less as a doctor. I stood atop the Green Monster and saw a view of the field I had never seen. I was in earshot of the now maligned Manny Ramirez. I saw 4 home runs (3 by the home team). As the Red Sox cruised to a 10-1 lead, all I had to do was give out a few Tums and some Tylenol.
At the top of the 7th, I traded places with another resident and went down to the main First Aid stand underneath section 112. I instantly switched back to being a physician, and placed my fan-hood on hold. In addition to the usual complaints of a hot summer night: dehydration, blisters, light-headedness, and a young woman who was hit in the temple with a Kevin Youkilis foul ball (she kept the ball).
With a win in the books, and 'Sweet Caroline' on the minds of 35,000 I was expecting an uneventful end to my night. But at that moment, an EMT and a Fenway security guard knocked on the door. "Peanut allergy in the bleachers. Need a doc and an EpiPen!". The attending on staff asked me if I would go. This story would not have been interesting enough to get onto Paul Levy's blog if I had said no, right?
I grabbed an EpiPen and jogged out of the makeshift ER. I was following the EMT to our destination, when it finally hit me: we were in the first base grandstands, and she was in the bleachers. For us to get to her without playing slalom with thousands of fans, we would have to go onto the field. We did just that, and before I could even soak it in, I was jogging where J.D. Drew had been just moments before. It was a surreal moment in which I had no time to bask. The visitor's bullpen. The bleachers. My hand on the end of an EpiPen. The back of an ambulance. Over to the BI. Time finally slowed back to normal pace, and I was alone as I walked out the doors of the BIDMC ED. The events of the past few hours had just sunk in, and I felt almost like Moonlight Graham from 'The Field of Dreams'. I don’t think I can ever go back to JUST being a fan.
Sunday, August 24, 2008
Thinking of Bruce
An excerpt from a note from Bruce's wife, shortly after he passed away. It is printed with her permission. He was a very fine person whom I had a chance to get to know after I arrived at this job. I am personally gratified that we offer an environment that made possible the quality of human interaction that Wendy summarizes.
Everyone involved with his care at BIDMC was wonderful, from the volunteers and clinicians at the chemo clinic, to the MICU, to the oncology floor. With so much intelligence and compassion, they were all archetypal BIDMC folks. But I must put in a special word for Dr. Rebecca Miksad, who oversaw his chemo treatment at Shapiro (outpatient clinic), and then followed all the way through with us to the MICU and oncology. She was magnificent. I watched this young doctor sit on my husband's bed in the MICU and deliver to him what was undoubtedly the worst news of his life.
It was a meeting that I dreaded, and one that I tried with all my might to soften for him. But it was Dr. Miksad who was the key to it all, who made it bearable, if you can imagine. She explained his dreadful prognosis with such compassion and intelligence that I could hardly believe what I was witnessing. It was amazing. I don't know how she did it, but she did, and in such a way that it respected my husband -- his intelligence and his feelings -- as much as was humanly possible. I shall never forget her for the way she dealt with us. She is going to have an amazing career. I am so grateful that she was with us.
Very best, Wendy
Everyone involved with his care at BIDMC was wonderful, from the volunteers and clinicians at the chemo clinic, to the MICU, to the oncology floor. With so much intelligence and compassion, they were all archetypal BIDMC folks. But I must put in a special word for Dr. Rebecca Miksad, who oversaw his chemo treatment at Shapiro (outpatient clinic), and then followed all the way through with us to the MICU and oncology. She was magnificent. I watched this young doctor sit on my husband's bed in the MICU and deliver to him what was undoubtedly the worst news of his life.
It was a meeting that I dreaded, and one that I tried with all my might to soften for him. But it was Dr. Miksad who was the key to it all, who made it bearable, if you can imagine. She explained his dreadful prognosis with such compassion and intelligence that I could hardly believe what I was witnessing. It was amazing. I don't know how she did it, but she did, and in such a way that it respected my husband -- his intelligence and his feelings -- as much as was humanly possible. I shall never forget her for the way she dealt with us. She is going to have an amazing career. I am so grateful that she was with us.
Very best, Wendy
Friday, August 22, 2008
Born to be . . .
Following up on the theme introduced last Friday, here is a pertinent animated view of the Baby Boomers.
Nick's done good!
My hospital CEO blogging colleague, Nick Jacobs, has written a book called Taking the Hell out of Healthcare. It is available here on Amazon. It is very good.
Here's a blurb I wrote about it:
"Nick Jacobs provides a clear guidebook to those of us who find ourselves in a hospital. He poses the questions that we should be asking --but often forget to -- and answers them in plain English so that we can enter the strange world of medicine with greater comfort and less anxiety-- then go home again feeling not only cured, but good."
And here are some other comments:
"Nick Jacobs has dedicated his life to improving the lives of others. His unique, seasoned inside look into hospitals will arm you with the information to get the best health care for you and your family."
Tony Chen, Founder of Hospitalimpact.org
"With twenty years in health care administration, Nick Jacobs brings directly to the patients and their families the information essential to comprehend the nuances of the complex quagmire of experiences that make up the American healthcare system. Jacobs is truly a committed patient advocate, and this book is a must read. "
Dr. Dean Ornish, Founder and President,
Preventative Medicine Research Institute
"Nick Jacobs' long experience in American healthcare pays off for patients and their loved ones who want to know the best way to advocate for themselves in today's healthcare maze. A critical read for anyone who wantsto get the most out of their healthcare journey."
Craig D. Shriver, MD FACSColonel MC, General Surgery Director
and Principal Investigator - Clinical Breast Care Project
Walter Reed Army Medical Center
"Nick Jacobs likes being Nick Jacobs, and that is a very good thing for hundreds of hospital staff and patients at Windber Medical Center. His is a special kind of ego that says he can do better by his patients and staff than just about anyone else. That's no idle boast. See for yourself. His brand of management has done very good things for all concerned. Learn for yourself."
Zane Knauss, Publicist and Writer
"Taking the Hell Out of Healthcare" provides the patient with a practical (and sometimes humorous) view on how to navigate the healthcare system. Don't leave home without it!"
Beth Bierbower,Vice President
Product Innovation
Humana Inc.
Here's a blurb I wrote about it:
"Nick Jacobs provides a clear guidebook to those of us who find ourselves in a hospital. He poses the questions that we should be asking --but often forget to -- and answers them in plain English so that we can enter the strange world of medicine with greater comfort and less anxiety-- then go home again feeling not only cured, but good."
And here are some other comments:
"Nick Jacobs has dedicated his life to improving the lives of others. His unique, seasoned inside look into hospitals will arm you with the information to get the best health care for you and your family."
Tony Chen, Founder of Hospitalimpact.org
"With twenty years in health care administration, Nick Jacobs brings directly to the patients and their families the information essential to comprehend the nuances of the complex quagmire of experiences that make up the American healthcare system. Jacobs is truly a committed patient advocate, and this book is a must read. "
Dr. Dean Ornish, Founder and President,
Preventative Medicine Research Institute
"Nick Jacobs' long experience in American healthcare pays off for patients and their loved ones who want to know the best way to advocate for themselves in today's healthcare maze. A critical read for anyone who wantsto get the most out of their healthcare journey."
Craig D. Shriver, MD FACSColonel MC, General Surgery Director
and Principal Investigator - Clinical Breast Care Project
Walter Reed Army Medical Center
"Nick Jacobs likes being Nick Jacobs, and that is a very good thing for hundreds of hospital staff and patients at Windber Medical Center. His is a special kind of ego that says he can do better by his patients and staff than just about anyone else. That's no idle boast. See for yourself. His brand of management has done very good things for all concerned. Learn for yourself."
Zane Knauss, Publicist and Writer
"Taking the Hell Out of Healthcare" provides the patient with a practical (and sometimes humorous) view on how to navigate the healthcare system. Don't leave home without it!"
Beth Bierbower,Vice President
Product Innovation
Humana Inc.
Thursday, August 21, 2008
Please join Tom's ride on September 7
Tom DesFosses is a patient of our hospital and a cancer survivor. He has started a bike-riding fundraiser for cancer research. The ride starts and ends at the Liberty Tree Mall in Danvers, MA, and you have your choice of 10, 25, or 50 mile routes. Depending on the length you choose, you go through Wenham, Hamilton, Essex, Manchester by the Sea, Gloucester, Ipswich, and Georgetown. All rides are very scenic and enjoyable rides. There are rest stops on all routes.
Here's what Tom says:
On September 7, 2008, I will be hosting a bicycle ride on the North Shore of Massachusetts to raise funds for leading-edge cancer research at Beth Israel Deaconess Medical Center. 100 % of proceeds raised through this bike ride go directly to Dr. Wong's Brain Tumor Fund and Dr. Lewis Cantley's General Cancer Research Fund. This research is very important to me and others living with cancer.
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 others cyclist will join me on this ride to help raise greatly needed funds for life-saving cancer research.
This bike ride is a way I can give back to the wonderful people who have prayed for me and encouraged me along the way. Special thanks go to my wife, family and friends, who have been so supportive.
Here's what Tom says:
On September 7, 2008, I will be hosting a bicycle ride on the North Shore of Massachusetts to raise funds for leading-edge cancer research at Beth Israel Deaconess Medical Center. 100 % of proceeds raised through this bike ride go directly to Dr. Wong's Brain Tumor Fund and Dr. Lewis Cantley's General Cancer Research Fund. This research is very important to me and others living with cancer.
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 others cyclist will join me on this ride to help raise greatly needed funds for life-saving cancer research.
This bike ride is a way I can give back to the wonderful people who have prayed for me and encouraged me along the way. Special thanks go to my wife, family and friends, who have been so supportive.
What I did this summer
Here are some excerpts from an essay by Ifedolapo Bamikole, a senior at UMass Amherst. She's from Nigeria and has been in the US for about 3 years. She is a biology and psychology double major, with interests in public health, international medicine, and health disparities. (Personal interests include piano, guitar, tenor sax, writing poems, and traveling.) She has spent two summers now shadowing people at BIDMC to learn about the workings of a major academic medical center. I think her observations are well written and insightful -- uncovering many of the issues we all face in the delivery of primary care -- and they will be helpful as she plans her career.
Another summer at Beth-Israel has come to a successful end after 12 weeks of projects, shadowing and observing at the hospital. My experience here last year encouraged me to come back, hoping to learn more. And I have definitely learned a lot more. The benevolence of some kind people has allowed me to be a summer intern here. But without the help, constant guidance, direction and knowledge of the people I worked with this summer, this whole summer internship would have been less than complete.
My mentors were Dr. Gila Kriegel and Dr. Carol Bates, same as last year. And I worked on 6 different projects: The Chlamydia screening, Pneuomax, Diabetes, narcotics, a time study project and health care proxy. These last 2 are on going right now. But for the 4 that have been completed this summer, the results and summaries were presented at QI meetings and panels of residents. These presentations were mostly for awareness purposes, to show how well HCA (our hospital-based primary care practice) is doing in taking care of specific patients, and highlighting areas of improvement. And after my work of collecting data, building a database and analyzing what I have, the intervention discussions that ensued from results presented at these meetings was always interesting to me, as I sit back, watch and listen to other people share their medical knowledge and come up with solutions to identified problems.
Before every project, I always got background information and education by one of the doctors to help me better understand what I was doing. Because of this I now know that women aged 25 and younger should be routinely screened for Chlamydia as this reduces the chances of pelvic inflammatory occurrences. In HCA 57% of women in this age group are being screened. This shows plenty of room for improvement. Among providers, there was no disparity in care given by resident or attending physicians in this area. Higher screening rates were found in Nurse Practitioners. This was a fact worthy of commendation to NPs. In order to see how well the practice was doing in the gynecological care of patients, I looked at the percentage of people who had received a Pap smear, as well as a Chlamydia screening and the result was nearly 80%, which is good.
The next project I worked on was the Pneumococcal vaccination which was quite similar to the last one in that I was to look for rates. Unlike the Chlamydia screening though, this involved looking at the older population (65 and older) who are at a high risk for pneumonia. And it was not gender specific. Here, I had a sample size of 100 patients to work with. And as I’ve learned, the bigger the sample size, the better for accurate figures people can actually work with. The results showed very good rates in general. 80% had received a pneumovax. And 83% were on Medicare which is normal and expected for this age group. There was not a big difference between English speaking and non English speaking rates of pneumovax. But when this was further broken down to male and female Non-English speakers, the difference jumps out at you as nearly 90% of male non English speakers got screened while a mere 56% of female non English speakers got screened. It was decided that this will be further looked into with an even larger population size to see if this remains true. Reasons why, along with solutions will be worked upon soon.
By the time I started on the Diabetes project and Narcotics project I had begun other things in the hospital. I took a class for observation status and then went to the West campus twice to observe a total of 4 different surgeries: Inguinal hernia repairs, a laparoscopic appendectomy and partial cecectomy, and one colectomy. The surgeon was Dr. Christopher Boyd and he happens to be a very nice man. He is a very funny man and was ready to explain things to me every step of the way, including why he was doing certain things and how he did it.
I observed, in Labor and Delivery, the arrival of a baby girl to new parents. It was their first child and my first time seeing a real delivery. The experience was nothing short of amazing. I felt like an important part of the team propping the woman up for the pushes, alongside her husband and helping her relax between contractions. The crowning of the baby’s head was just as fascinating as seeing the whole body come out so smoothly. And when the baby came out I was initially shocked at the color but watched the color slowly change as the baby took in oxygen in her lungs and steadily adjusted to life on this side of the world. The nurse I was assigned to was very kind in showing me all the procedures to make sure mother and baby stay in good shape. It took a while to wait for the placenta to come out. I was surprised at the large size of it. I never knew such big things could come out of a woman’s body. After the ‘second birth’, the woman had to have sutures to close up a very slight tear of about 2 inches. That is when I found out that obstetricians were also neat surgeons. And the invention of Epidural in medicine must be a blessing. This woman did not scream once throughout the ordeal.
I also got to shadow doctors. Dr. Anita Vanka and Dr. Diane Brockmeyer both graciously allowed me to sit in while they saw patients at different times. One thing I must have missed out last summer was how much a lot of these patients know about their conditions. Thanks to online information and research studies, the average patient is bombarded with a plethora of ideas, and it requires a doctor to be on her toes to envisage problems that could potentially arise from such knowledge and how to correctly advise such patients. A lot of my projects made even more sense when I started to see people in clinic with the kind of conditions I was working on. And along with the observation, I got a lot of teaching from the two doctors I shadowed, who made it a point of duty to know that I was learning something new always.
The diabetes projects was very time consuming but also very high priority because of the information that it gave. For residents it was necessary to see how well patients in their panels were having their diabetes adequately controlled. Because of the high risk for a myriad of other problems, diabetes patients need to be properly monitored by PCPs and followed up in Joslin. My results showed that there was a low number of NP visits (25% as opposed to 87% of PCP visits, in the last year). 61% of these patients were seen at Joslin Diabetes Center (Note: With whom BIDMC has a clinical partnership). But for a subset of people with hemoglobin A1Cs of ≥9, 100% were being seen at Joslin which is good. Foot exams need to be either carried out more and/or documented more as it is one of the important tests in diabetics, and the rate was only 45% (n=150). Suggestions were made at the resident meetings on how to make sure patients are getting all the necessary exams done.
My second summer back at Beth Israel Deaconess was definitely worth it. I had it reinforced in me every moment that time and accuracy was of the essence in this environment for efficiency. I can’t thank you enough for the opportunity to work here again. I am more encouraged than ever to finish my final year of college successfully and one day become like all these great doctors I have worked with.
Another summer at Beth-Israel has come to a successful end after 12 weeks of projects, shadowing and observing at the hospital. My experience here last year encouraged me to come back, hoping to learn more. And I have definitely learned a lot more. The benevolence of some kind people has allowed me to be a summer intern here. But without the help, constant guidance, direction and knowledge of the people I worked with this summer, this whole summer internship would have been less than complete.
My mentors were Dr. Gila Kriegel and Dr. Carol Bates, same as last year. And I worked on 6 different projects: The Chlamydia screening, Pneuomax, Diabetes, narcotics, a time study project and health care proxy. These last 2 are on going right now. But for the 4 that have been completed this summer, the results and summaries were presented at QI meetings and panels of residents. These presentations were mostly for awareness purposes, to show how well HCA (our hospital-based primary care practice) is doing in taking care of specific patients, and highlighting areas of improvement. And after my work of collecting data, building a database and analyzing what I have, the intervention discussions that ensued from results presented at these meetings was always interesting to me, as I sit back, watch and listen to other people share their medical knowledge and come up with solutions to identified problems.
Before every project, I always got background information and education by one of the doctors to help me better understand what I was doing. Because of this I now know that women aged 25 and younger should be routinely screened for Chlamydia as this reduces the chances of pelvic inflammatory occurrences. In HCA 57% of women in this age group are being screened. This shows plenty of room for improvement. Among providers, there was no disparity in care given by resident or attending physicians in this area. Higher screening rates were found in Nurse Practitioners. This was a fact worthy of commendation to NPs. In order to see how well the practice was doing in the gynecological care of patients, I looked at the percentage of people who had received a Pap smear, as well as a Chlamydia screening and the result was nearly 80%, which is good.
The next project I worked on was the Pneumococcal vaccination which was quite similar to the last one in that I was to look for rates. Unlike the Chlamydia screening though, this involved looking at the older population (65 and older) who are at a high risk for pneumonia. And it was not gender specific. Here, I had a sample size of 100 patients to work with. And as I’ve learned, the bigger the sample size, the better for accurate figures people can actually work with. The results showed very good rates in general. 80% had received a pneumovax. And 83% were on Medicare which is normal and expected for this age group. There was not a big difference between English speaking and non English speaking rates of pneumovax. But when this was further broken down to male and female Non-English speakers, the difference jumps out at you as nearly 90% of male non English speakers got screened while a mere 56% of female non English speakers got screened. It was decided that this will be further looked into with an even larger population size to see if this remains true. Reasons why, along with solutions will be worked upon soon.
By the time I started on the Diabetes project and Narcotics project I had begun other things in the hospital. I took a class for observation status and then went to the West campus twice to observe a total of 4 different surgeries: Inguinal hernia repairs, a laparoscopic appendectomy and partial cecectomy, and one colectomy. The surgeon was Dr. Christopher Boyd and he happens to be a very nice man. He is a very funny man and was ready to explain things to me every step of the way, including why he was doing certain things and how he did it.
I observed, in Labor and Delivery, the arrival of a baby girl to new parents. It was their first child and my first time seeing a real delivery. The experience was nothing short of amazing. I felt like an important part of the team propping the woman up for the pushes, alongside her husband and helping her relax between contractions. The crowning of the baby’s head was just as fascinating as seeing the whole body come out so smoothly. And when the baby came out I was initially shocked at the color but watched the color slowly change as the baby took in oxygen in her lungs and steadily adjusted to life on this side of the world. The nurse I was assigned to was very kind in showing me all the procedures to make sure mother and baby stay in good shape. It took a while to wait for the placenta to come out. I was surprised at the large size of it. I never knew such big things could come out of a woman’s body. After the ‘second birth’, the woman had to have sutures to close up a very slight tear of about 2 inches. That is when I found out that obstetricians were also neat surgeons. And the invention of Epidural in medicine must be a blessing. This woman did not scream once throughout the ordeal.
I also got to shadow doctors. Dr. Anita Vanka and Dr. Diane Brockmeyer both graciously allowed me to sit in while they saw patients at different times. One thing I must have missed out last summer was how much a lot of these patients know about their conditions. Thanks to online information and research studies, the average patient is bombarded with a plethora of ideas, and it requires a doctor to be on her toes to envisage problems that could potentially arise from such knowledge and how to correctly advise such patients. A lot of my projects made even more sense when I started to see people in clinic with the kind of conditions I was working on. And along with the observation, I got a lot of teaching from the two doctors I shadowed, who made it a point of duty to know that I was learning something new always.
The diabetes projects was very time consuming but also very high priority because of the information that it gave. For residents it was necessary to see how well patients in their panels were having their diabetes adequately controlled. Because of the high risk for a myriad of other problems, diabetes patients need to be properly monitored by PCPs and followed up in Joslin. My results showed that there was a low number of NP visits (25% as opposed to 87% of PCP visits, in the last year). 61% of these patients were seen at Joslin Diabetes Center (Note: With whom BIDMC has a clinical partnership). But for a subset of people with hemoglobin A1Cs of ≥9, 100% were being seen at Joslin which is good. Foot exams need to be either carried out more and/or documented more as it is one of the important tests in diabetics, and the rate was only 45% (n=150). Suggestions were made at the resident meetings on how to make sure patients are getting all the necessary exams done.
My second summer back at Beth Israel Deaconess was definitely worth it. I had it reinforced in me every moment that time and accuracy was of the essence in this environment for efficiency. I can’t thank you enough for the opportunity to work here again. I am more encouraged than ever to finish my final year of college successfully and one day become like all these great doctors I have worked with.
Wednesday, August 20, 2008
Art too bad to be ignored
Looking for something to do to round out your summer? I have just the thing: A visit to MOBA, the Museum of Bad Art, conveniently located in the basement of the Dedham Community Theatre, just outside the men's room. As noted by the management, the nearby flushing helps maintain a uniform humidity. The gallery is open whenever movies are showing, typically 5 to 11pm on weekdays, noon to 11 on weekends and school holidays.
The curatorial standards of the museum are rigorous and clear:
The pieces in the MOBA collection range from the work of talented artists that have gone awry to works of exuberant, although crude, execution by artists barely in control of the brush. What they all have in common is a special quality that sets them apart in one way or another from the merely incompetent.
So, who's the lady in the picture above? That's Louise Sacco, the museum's Permanent Acting Interim Executive Director. She's also one of the photographers for FanFoto for games at Fenway Park. I met her at a Red Sox game earlier this year. Louise reports that she got the job at Fenway in a tough competition with lots of, er, younger photographers. At the interviews, they all talked about their geeky love of photographic equipment, Photoshop, pixels, and the like. She said she thought it would be fun to meet lots of people in the park. She was hired on the spot.
Back to MOBA. Like any legitimate museum, MOBA depends on its gift shop to reach its financial goals. You can buy items here.
Lean is not about dieting
Following yesterday's story, here's another example of the Lean methodology in action, as presented in an email from one of our nurses to her colleagues this week. Note the involvement from others in the hospital that have had experience on their own floors. Wait, are they having fun, too!? I have heard too many reports of that. Quick, call out the seriousness brigade and put a stop to it.
From: Serrano,Marjorie I. (BIDMC - Nursing)
To: Nursing Farr 6 All
Subject: LOOK At THE CLEAN SUPPLY ROOM!!!
Lean Update on Farr 6 Clean Supply Room
As you could see, there was a lot of activity in the clean supply room today. The Lean team from the President’s office, Distribution plus 11R’s Marnie Pettit, RN and Martha Clinton, PCT, and Farr 7’s Beth Morrison, and Catherine McCollin worked with the Farr 6 team to redesign the clean supply room for better flow. We will be back tomorrow to continue this work.
We received training on key Lean principles which taught us that spending time searching and fetching items means less time spent on real work – time with our patients. Even when we can easily find an item, does it make sense for us to put items out of reach, i.e. too high or too low? Why not imitate the supermarkets that place frequently used items at eye level, like bread!
Lean calls these non-value added steps, “waste”. We spent the day removing as much waste out of the clean supply room process as possible. Last week, we counted the par stock right after it was fully stocked, then counted again the day after before it was restocked. This gave us the number used for one day and was used to determine the amount needed on your supply room carts (called the par number). We realized we had more stock than we needed in some cases and not enough in other cases based on this count so we removed all excess stock as well as added additional stock where needed.
Once we regained additional space, we organized the stock logically by function and for flow. For example, you will see we now will have zones for Housekeeping, ADL, GU/GI, Wound Care, Procedures and Respiratory. We then placed the most frequently used items at eye level to reduce bending and reaching. Most items are now in bins and the bin sizes indicate the amount of stock needed. The bins will have 3 labels: the “common name label” on the front of the bin – what most of you call the item, the “picture of the item label” on the bottom of the bin to tell you when that bin is empty what belongs there, and finally the “reorder label” also on the bottom of the bin that tells you the item number, cost & the ordering amount so when you are out of an item, you have the information needed when calling distribution.
Some examples of changes:
Items moved to the kitchen: Pitchers, liners, straws, cups
Items moved from Med Room to Clean supply room: Stat Lock for Piccs
Some skincare items were removed at the suggestion of the wound care specialist. These items will be reevaluated at the wound care task force tomorrow. (Keri Oil, Keri Lotion, Duoderm, Sheepskin, A+D Ointment, Antibiotic Ointment
Items that were added include: Duoderm Gel, Barrier Wipes, 5x5 Allevyn Foam, Non sterile suction tubing, Wound Cleanser, 9” armboards
Cable ties were moved to the resource drawer with the gun
Flashlights are now stored on equipment shelf in RN station.
Sustaining the gains
Lean taught us that this is a continuous improvement process so please give us your feedback and we will continue to improve. All of us own this process and keeping the Clean Supply room neat and tidy depends on all of us.
Thanks to Marnie, Pam, Bettyna, Marie, Singh, Beth, Catherine, Marnie, Martha, Bill, Jenine, Sam, Brandan
Margie
Tuesday, August 19, 2008
There's something happening here
Fellow blogger Jessica Lipnack has sent me news about an extraordinary social media experiment being led by General William B. Caldwell. General Caldwell believes that the strength and expertise of the military can be enhanced by the free flow of information offered by blogs. He has lent his considerable stature as a Three Star General to the concept, and he is in a unique position of influence in that he heads a major component of the officer training center for the US Army.
Here is the introductory paragraph from his product:
The US Army Combined Arms Center Blog Library is intended to inform and educate readers while providing a medium for intellectual discussion and debate about important issues involving the US military in today's environment. The blogs contained in this library are intended to elicit comment. Our blog rules provide a wide degree of freedom. They are intended to allow individuals to express opinion and ideas in the interest of intellectual discourse and increased mutual understanding. We strongly encourage intellectual comments and debate.
Recently, members of Congress offered guest postings on this blog. I am sure that having these champions for our soldiers do so provides still another level of institutional support for this concept.
But this is not just a forum for general policy discussions. For example, look at this post: Campaign Planning in Counterinsurgency. This and other topics traditionally would have been quietly discussed in classroom settings. Here, though, General Caldwell and his colleagues have created an open forum to stimulate debate and creative thinking. The blogs permit this to go on asynchronously, enabling individual reflection on the principles taught in the classroom and allowing people's thoughts to evolve over time, while connecting back in a helpful way to their colleagues. The asynchronicity is logistically important, too, when you consider that our soldiers are stationed in many time zones across the world. I am guessing that our military men and women will gain new insights from this type of learning and sharing.
It is impressive, too, that General Caldwell has not been held back by the traditional view that public disclosure of military topics represents a breach of security. As we all know, many of these topics are in the public gristmill anyway, and many claims of a need for secrecy are overstated. While I am sure that some areas will always have to remain off-limits for national security reasons, it is good practice for military officers and others to express their ideas in a public forum and experience the nonhierarchical give-and-take of social media.
In short, this is a really impressive venture. Jessica first wrote about this several months ago here. One of the comments on that post, however, is indicative of the objections that could arise:
I think the military is one of the few places where Web 2.0 / Enterprise 2.0 / social media paradigm is not appropriate.
Here is the introductory paragraph from his product:
The US Army Combined Arms Center Blog Library is intended to inform and educate readers while providing a medium for intellectual discussion and debate about important issues involving the US military in today's environment. The blogs contained in this library are intended to elicit comment. Our blog rules provide a wide degree of freedom. They are intended to allow individuals to express opinion and ideas in the interest of intellectual discourse and increased mutual understanding. We strongly encourage intellectual comments and debate.
Recently, members of Congress offered guest postings on this blog. I am sure that having these champions for our soldiers do so provides still another level of institutional support for this concept.
But this is not just a forum for general policy discussions. For example, look at this post: Campaign Planning in Counterinsurgency. This and other topics traditionally would have been quietly discussed in classroom settings. Here, though, General Caldwell and his colleagues have created an open forum to stimulate debate and creative thinking. The blogs permit this to go on asynchronously, enabling individual reflection on the principles taught in the classroom and allowing people's thoughts to evolve over time, while connecting back in a helpful way to their colleagues. The asynchronicity is logistically important, too, when you consider that our soldiers are stationed in many time zones across the world. I am guessing that our military men and women will gain new insights from this type of learning and sharing.
It is impressive, too, that General Caldwell has not been held back by the traditional view that public disclosure of military topics represents a breach of security. As we all know, many of these topics are in the public gristmill anyway, and many claims of a need for secrecy are overstated. While I am sure that some areas will always have to remain off-limits for national security reasons, it is good practice for military officers and others to express their ideas in a public forum and experience the nonhierarchical give-and-take of social media.
In short, this is a really impressive venture. Jessica first wrote about this several months ago here. One of the comments on that post, however, is indicative of the objections that could arise:
I think the military is one of the few places where Web 2.0 / Enterprise 2.0 / social media paradigm is not appropriate.
The military relies on the chain of command and respect for the hierarchy to operate effectively, especially when lives of the soldiers and civilians is on the line. The web 2.0 paradigm flattens the structure and effectively allows anyone to say anything. That breaks down the chain of command.
The other issue is possibility of soldiers inadvertently revealing operational matters, operational history or location information that could expose information to combatants.
These are interesting points, but I, for one, am confident that people of General Caldwell's intellect and thoughtfulness will work through those issues in a way that is consistent with the core values of military strategy and execution. He and his colleagues deserve our enthusiastic support and appreciation.
Bullish on the Container Store
Quick, buy stock in the Container Store. As we continue with our expanded use of Lean process improvement techniques at BIDMC -- often originating from a BIDMC SPIRIT call-out -- a big part of each project seems to be reorganizing stuff. Here's an example from a recent exercise in our food service area.
The "before" picture shows you what things were like for the folks who organize and retrieve kitchen and serving supplies. Notice the mish-mosh of boxes, and look to see how hard it is for the staff member to reach the high shelf. Also, consider how dangerous it is for her to do so, with the chance of boxes falling on her head. The supplies themselves are kept in the original packing boxes, requiring someone to open a box each time something is needed. Only after opening the box, too, can they see if the inventory is running low.
The "after" picture shows you the change. Notice that the top shelf is now off-limits. Meanwhile, supplies have been organized in see-through containers, each with a clear label showing what is packed therein. The bins are easily pulled to permit removal of the supplies. And, because the original delivery boxes have been emptied, inventories are clear on a continuous basis.
As we say in the hospital world, this is not brain surgery, but it does require a thoughtful view of the work situation. That view, by the way, is constructed by the people who work in this area, not by some high ranking administrator. They get guidance from our Lean project team in the basic principles, but they are the ones who own the solution.
Monday, August 18, 2008
From my former life
An op-ed in yesterday's Boston Globe about management of large public works projects, based on my experience running the metropolitan area water and sewer agency. (You know, it is hard to squeeze things into the 700 word limit they give you!) I am hoping it will be helpful, not only in the specific advice offered, but in reminding people that it is possible for the state to build high quality large public works projects. We are going to need the public's support for those over the coming decades as we plan and implement other major infrastructure improvements.
Sunday, August 17, 2008
Henna, Xeloda, Roche, Europe, August
Monique Doyle Spencer's Op-Ed about the use of henna as an antidote for a known side-effect of Roche Pharmaceutical's important cancer drug, Xeloda, has been picked up and published by the International Herald Tribune. Roche is based in Europe, so maybe the article will get more attention there. On the other hand, it is August, and people in Europe often take off the whole month. That probably would explain why I have received no reply to my note to the CEO of Roche on the same topic.
Meanwhile, even though it is August, Monique did receive an apologetic note from a staff person at Roche, particularly for the part about inquiring about her long-dead mother, but the person missed the point again. With her permission, I include excerpts from a follow-on note from Monique:
I appreciate the kind letter you sent. I understand how mistakes like this happen and I'm sure everyone felt chagrined....
I have exactly one issue. I am deeply frustrated that no one has answered my question: Does anybody at Roche seek remedies for side effects due to Roche's products? Is that anybody's job?
To be honest, I have no interest in becoming a henna poster child. Yet ... when henna came my way, it made a great difference in my ability to tolerate Xeloda. The Xeloda will extend my life and the henna is the ONLY reason I can tolerate the Xeloda....
In New England, the Boston Globe and WBZ radio reach a broad audience, so I am receiving phone calls and letters asking for my help. I've created a web page to send people to, giving them full instructions about henna. Elderly people often do not have internet access, so in some cases I've given people henna or sent them printed instructions.... I expect word to continue spreading. I've already noticed the story appearing on cancer bulletin boards, and I've posted on a few to pass information along.
My point is that people really suffer from HFS. For some it keeps them out of their favorite sports, for others it is crippling pain. I just want somebody with the means to help them! I hope that Roche will look into it, or fund a study to prove or disprove henna's efficacy.
Can you help?
Thanks again for your kind letter.
Regards,
Monique Doyle Spencer
Meanwhile, even though it is August, Monique did receive an apologetic note from a staff person at Roche, particularly for the part about inquiring about her long-dead mother, but the person missed the point again. With her permission, I include excerpts from a follow-on note from Monique:
I appreciate the kind letter you sent. I understand how mistakes like this happen and I'm sure everyone felt chagrined....
I have exactly one issue. I am deeply frustrated that no one has answered my question: Does anybody at Roche seek remedies for side effects due to Roche's products? Is that anybody's job?
To be honest, I have no interest in becoming a henna poster child. Yet ... when henna came my way, it made a great difference in my ability to tolerate Xeloda. The Xeloda will extend my life and the henna is the ONLY reason I can tolerate the Xeloda....
In New England, the Boston Globe and WBZ radio reach a broad audience, so I am receiving phone calls and letters asking for my help. I've created a web page to send people to, giving them full instructions about henna. Elderly people often do not have internet access, so in some cases I've given people henna or sent them printed instructions.... I expect word to continue spreading. I've already noticed the story appearing on cancer bulletin boards, and I've posted on a few to pass information along.
My point is that people really suffer from HFS. For some it keeps them out of their favorite sports, for others it is crippling pain. I just want somebody with the means to help them! I hope that Roche will look into it, or fund a study to prove or disprove henna's efficacy.
Can you help?
Thanks again for your kind letter.
Regards,
Monique Doyle Spencer
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