A Passion for What You Do
I walk into the classroom the
first day of the seminar. I am on an impossible mission.
I face eighteen people, average
age: 35. Most of them are executives in the health
sector. Most (if not all) of them will one day become
CEOs. Mine is the last course before they graduate from an
intense work-and-study program at the University of
Minnesota.
My mission: To make them want
to write a paper of consequence; a paper they will be proud
of; a paper good enough to be published, and to do it in 3 ½
weeks.
I don't want a warmed over
Master's Thesis, or a topic that they have written on
before. I want them to choose a topic that they care about
- passionately. My class is the only one remaining between
them and freedom.
I circulate papers written by
past students; some of the papers having been published in
professional journals. I remind the students of their
power: For 3 ½ more weeks, they can call anyone and say,
"I'm a graduate student at the University of Minnesota. I
would like to ask you some questions about a paper I am
researching."
Among the 800 students who have
taken this class, I know that many called the best minds in
our field. They also called heads of government
departments, heads of corporations, and they called the
White House. None of them were turned down. Would you
ignore a call from a graduate student you could help?
Will they be graded on a
curve? No. I'll grade the papers by publication
standards. They may all get 'A's. Or, they may all fail
the class.
Will they have help? Yes.
They will present to the class and get feedback. They can
call me anytime at home, in the office or on my cell phone.
If I can't help, I'll steer them towards someone who can.
They will have some of the best librarians in the country at
their service, the most advanced search programs, and free
access to any book or publication on their topic.
I will invite speakers who seem
to have done the impossible:
¨
Dr. William McGuire, CEO of the
United Healthcare Group, who brought that company from $600M
to $72B in fifteen years;
¨
Andrew Czajkowski, former
CEO of Blue cross/Blue Shield of Minnesota who, against
all odds, took on the tobacco industry and won the
largest settlement in U.S. history;
¨
Joel A. Barker, whose film
on paradigm shifts remains the best-selling business
film ever;
¨
Dr. Vernon E. Weckwerth,
who single-handedly built the ISP program at the
University of Minnesota into a global powerhouse
for leaders in 45 countries; and
¨
Connie Evingson, a jazz
singer, writer and producer of her own shows around the
world, who will give students feedback on their
role-playing of leadership styles.
The
students are absolutely fearless in choosing topics. Here
is Carol Backstrom pointing out the obvious:
(Author) agrees that managed care" has taught us a
fundamental lesson of what we want out of medicine. We are
interested not just in cost savings but in health
improvement" (2004).
To understand quality
improvement, start with a simple observation: You get what
you pay for. We want the medical system to improve our
health, but we reimburse it for treating us when we are
sick. Medical care is not the same as health improvement,
and the system does poorly when they differ. A better
medical care system would pay for health improvement, rather
than for provision of services (Cutler, 2004)."
-Carol
Backstrom: Quality Recognition Programs: Fad or
Silver Bullet?
What interests do you think
health providers have in diease prevention when they are
only paid when we are sick? What
is the path to our own best possible health?
"Estimates of
the total healthcare costs associated with these non-healthy
behaviors alone (tobacco, drugs, alcohol and obesity)
account for roughly one third of all health care costs."
"Inequities in the distribution of healthcare (i.e., under
the proposed plan) will not be a function of the 'haves' and
the 'have nots,' but rather a function of 'the dids' and
'the did nots'."
- Thomas A. Schmitt, Health Economics
Dr.
Kenneth Rose writes about what it would take to be a healthy
nation:
(McGinnis,
1993; Thorpe, 2005; Institute For the Future, 2005) Thorpe
goes on to say, "Much of the growth in health care spending
over the past twenty years is linked to modifiable (emphasis
supplied) population risk factors such as obesity." (Thorpe,
2005). So, it would go to reason that, by reversing those
harmful modifiable life style factors that got us here in
the first place, we could then reverse the trends in health
care spending.
Over
the years, analysis of the 10 leading causes of death
suggest that approximately 50 percent of U.S. mortality is
due to unhealthy behavior or lifestyle; 20 percent to
environmental factors; 20 percent to human genetic factors;
10 percent due to inadequacies on health care or access
(Fig. 10) (Healthy
People, 1979; CDC). In addition, figure 10 shows the
proportion of money as a nation we spend on different areas
of health care. Is it not ironic that, despite our
behaviors affecting 50 percent of our health, we as a
country only spend 4 percent of our health care dollars on
behavior related activities? The majority of our money
(88%) goes to fixing our health after our poor behaviors
have damaged it! It is quite evident that the greatest
factor that affects our health is our behaviors or
lifestyles. Therefore, in order to make the greatest
change, when it comes to health, we ought to focus on
behavioral changes, rather than access to health care
services!
Dr.
Rose gets more specific:
·
Smoking -
°
Accounts for
435,000 deaths a year (18% of total deaths)
°
Costs $138
billion in total costs in 1999
°
Associated
with 21% increase in inpatient and outpatient spending
°
Associated
with 28% increase in medications
·
Obesity -
°
Accounted for
9% of total medical spending ($78 billion in 1998)
°
Associated
with 36% increase in inpatient and outpatient spending
°
Associated
with 77% increase in medications
·
Alcohol and
other drug abuse
°
Costs $180
billion for alcohol related costs in 1995
°
Costs $114
billion for drug related costs in 1995
(Fraser, 2003; Buettner,
2005).
Some of the key findings from the
study that accounted for these
differences were:
· 5
simple health behaviors - not smoking, eat a plant-
based diet, eat nuts several times per week, regular
exercise, maintain normal weight
·
Fruits and
vegetables lowered the risk of heart disease and cancer
·
Increased
consumption of read and white meat was associated with
increased risk of colon cancer. Eating legumes was
protective.
·
Eating nuts
several times a week reduces risk of heart attacks by up to
50 percent
·
Eating whole
meal bread instead of white bread reduced nonfatal heart
attack risk by 45%
·
Drinking 5 or
more glasses of water a day may reduce heart disease by 50%
·
Men who have
a high consumption of tomatoes reduced their risk of
prostate cancer by 40%
·
Drinking soy
milk more than once daily my reduce prostate cancer risk by
70%
Last,
but not least, the Adventists place high importance on their
church, community, and supportive family relationships.
And he
concludes:
"A
long life is no accident" (Buettner, 2005).
-
Kenneth Rose, M.D., Can Lifestyle Changes
"Save" the
Health Care System for the Elderly of the
Future:
The Economics
of Health and Longevity
Meta studies in health indicate that
the surest way of outliving the human life span (85 years),
is to love your work and your life, and to meet your
economic needs.
Here is Anna Thompson going
after the secrecy in health care pricing and the impact of
competition - when it occurs:
"A
secret Harris Poll showed that consumers can guess the price
of a Honda Accord within $300, but when asked to guess the
price of a four day hospital stay they were off by $8,100
(Goodman, 2006)."
"In
2004, the American Hospital Association reported that the
average hopsitals were paid 38% of their charges (2005)."
"Simple-Care, a retired physician group, who collects cash
up front, began posting rates of common procedures ... The
price for an MRI went from $3,000 to $600 (DoBias, 2001)."
-
Anna Thompson, Health Care Pricing Transparency
Will it help to reward physicians when they perform
well?
Constraints need to be created in
P4P programs to ensure cases that tend to have poorer
outcomes, such as non-compliant patients and the poor, will
not be passed over by some physicians when payment is tied
to outcomes. It is foreseeable that access to care for some
patients will decrease under poorly structured P4P models.
-
Travis Gathright, Pay for Performance Pitfalls
Maybe
the hopeless cases will be refused ...?
How bad
is the American obesity problem?
In
1970, Americans spent about $6 billion on fast food -in 2000
they spent more that $110 billion. Americans now spend more
money on fast food than they do on higher education,
personal computers, computer software or new cars (Eric
Selosse in Fast Food Maker, 2001).
According to the National Heart, Long and Blood Institute, a
serving of chicken Caesar Salad 20 years ago would have been
about one and a half cups and would have contained about 390
calories. A serving of chicken Caesar salad today would be
about three and a half cups and 790 calories that would
account for almost forty percent of the recommended daily
calories for a 31 year old woman (USDA).
-
Katie Litsey, We Must Change
for the Children: The Economic
Costs and Trappings of Our Obesity
Culture
The most important provider of
health care at the bedside is the nurse. Is the nursing
profession improving?
In the year 2000 37% of the nursing
work force comprised Associated Degree (2 year) nurses and
in 2006 60% of the Registered Nurse graduates were Associate
Degree Nurses (Graf, 2006). These percentages show a
dangerous trend in nursing education and US healthcare.
Our
system currently requires board licensure examinations to
determine entry level in the field of Nursing. The
examination is a written examination, so it is possible to
pass without ever having touched a patient.
- Patrick J. Collins,
Nursing Shortage Ramifications and Possible Solutions |
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How well does the health sector
take care of its own?
It is
eye opening to review the statistics on back injury rates
for healthcare workers compared to other industries. Six of
the top ten workers at greatest risk for back injury on the
job are in the healthcare field - nurse aides, licensed
practical nurses, registered nurses, health aides, radiology
technicians, and physical therapists
(www.premierinc.com).
Compared to workers in heavy industry and other occupations
that are traditionally considered hazardous, the rate of
work-related injuries was 11.4 per 100 in full-time hospital
workers, 16.8 per 100 among nursing home workers, and 17.9
per 100 among nurses and nurses aides (Evanhoff et al.,
1999). This compares with a rate of 6.3 per 100 full-time
workers in the mining industry, 11.8 per 100 in
construction, and 12.2 per 100 in the manufacturing industry
(US Department of Labor, Bureau of Labor Statistics, 1996).
Patient care staff at nursing homes and hospitals is at
particular risk for overexertion back injury usually
resulting in "back strain" or "back sprain." These injuries
are considered minor and usually have inflammation, muscle
spasm, and pain associated with them. They occur when a
muscle, tendon, or ligament is forced past its normal range
of motion or strength capacity. They usually heal in 24-72
hours with rest, gentle stretching, mild modalities such as
ice or hear, and behavior modification - avoiding whatever
action caused the injury
(www.mayoclinic.com).
The problem is that often times injuries such as these are
not reported (Tate et. a., 1999). This may be because the
symptoms are minor and employees don't notice a huge
difference in how they feel. Regardless, a small strain can
turn into a big problem in a short time with repeated causal
behavior. The results of repeated risk behavior usually
lead to a cycle of inflammation, muscle spasm, and severe
pain. When it gets to this stage, medical treatment and
rehabilitation are the most viable options.
Examples of poor lifting
technique and body mechanics include repetitive twisting and
bending at the waist, failure to use the legs during
lifting, failure to keep the "load" close to one's own body
during the task, pulling instead of pushing, failure to use
the abdominal muscles during the task, poor posture during
the task, and rushing/poor planning of the lifting task.
Richard Lippin, a leader in the
field of occupational medicine said, "Face the reality that
a very large percentage of illnesses, injuries, and
hospitalizations are entirely preventable." (www.ricklippin.com).
Healthcare leaders need to take this message to heart as
they begin to implement a comprehensive prevention model
into their organizations. The ironic thing is - it will be
their own backs they are saving.
- Christopher M. Nichols,
How Healthcare Administrators Can Save
Their Own Skins:
The Impact of a Comprehensive
Ergonomic and Back Injury Prevention Program for Employees
What
about fatigue?
The symptoms of fatigue according
to the labor - studies (at the FAA) begin with errors of
omission, progress to errors of commission, and finally
result in micro sleep (periods of sleep lasting for seconds
or minutes). Fatigue is associated with 100,000 motor
vehicle accidents per year and 1,500 deaths in the US. It
is estimated that in the U.S. fatigue costs around $18
billion in employer productivity loss, and $12.5 billion in
personal and property loss. Fatigue (sleepiness,
tiredness) is the largest identifiable and preventable cause
of accidents in transport operation (between 15% and 20% of
all accidents) surpassing that of alcohol and drug related
incidents in all modes of transportation.
- Jamie Peyton Rodgers,
Are Hospitals Encouraging Dangerous
Working Conditions for Healthcare Professionals?
In this country, a physician
cannot practice in any other state if she isn't licensed by
that State. Thus, a Mayo Clinic physician, although willing
and widely acclaimed as the best in her field, may not
provide medical services to a patient in Kansas - unless she
is licensed by the State of Kansas.
Economic theory suggests
revocation of state-based licensure restrictions would
confer cost savings benefits to consumers in addition to
anticipated improvement in the efficiency and fluidity of
human resources. Research implies those benefits would
occur without compromising the quality of care received by
consumers.
The
American Medical Association remains staunchly in support of
state-based physician licensure, noting that adoption of a
national licensure system has implications beyond the
fluidity of providers and lacks the flexibility and ability
to respond to local idiosyncrasies (we'd note that the
current system lacks the flexibility to respond to
anything).
It
has been more that 45 years since Milton Friedman's landmark
work, Capitalism & Freedom, we published,
launching a new chapter in the on-going debate regarding
licensure of medical professionals. Friedman (1962)
contended:
... licensure has reduced both
the quantity and the quality of medical practice forced the
public to pay more for less satisfactory medical service,
and has retarded technological development both in medicine
itself and in the organization of medical practice.
Robinson (2001) notes:
The Internet threatens to
turn much of the system on its head. Patients with
serious chronic disease - those responsible for most
health care utilization now increasingly have more, not
less, information concerning their specific clinical
condition than do their treating physicians. Some
arrive in the office with a stack of articles downloaded
from the clinical journals that the doctor has no time
to read, with performance statistics on the services
provided by particular providers and facilities, and
with support from cybernetworks of fellow sufferers who
trade experiences, anecdotes, and Web site references.
Obviously, the typical physician will always understand
clinical medicine better than the typical patient But
we stand at the beginning of a new era.
Jackie Eder Van Hook, Executive Director of the Center for
Telemedicine and eHealth Law suggests, " thanks to
technology, we have the ability to provide access to health
care services around the world 24/7, yet we have laws,
regulations, and policies that prevent this from occurring"
(Center for Telehealth and E-Health Law, 2005).
- Kelly James, Physician Licensure in the Information
Age:
Is State-based Licensure the
Best Model for Healthcare Markets?
In the U.S., after-hours care
is extraordinarily expensive and time-consuming. Is there
an alternative to the Emergency Room?
Retail health clinics are staffed by either licensed nurse
practitioners or physician assistants. Overhead is extremely
low as the clinics are only approximately 140 square feet in
size, and are only staffed by the clinician. (Wojire,
2004). This individual is not only responsible for
providing medical care, but also for reception, billing and
management of the clinic. These clinics are often located
in either national pharmacy chains (Walgreens and CVS),
grocery stores (Cub Foods and Hy-Vee), or in discount super
stores (Wal Mart and Target (MSNBC, 2006). The clinics are
open seven days a week and have extended hours into the
evening.
The
other key component for the success of these clinics is the
services provided and the prices of those services.
Services provided at these clinics are for common illnesses,
such as strep throat, bladder infections, sinus infections,
and ear infections. Many of the clinics offer evaluation
and treatment for these conditions for a price of $45, which
is much less what it would cost for a similar service at a
physician clinic or an emergency room (Frenckeheim, 2006).
To ensure quality and safety for their patients, protocols
are in place to ensure that the midlevel practitioner will
refer patients for future care.
-
Robb Gardner, The Impact of Retail Health
Clinics
on the Future Delivery of Healthcare
Much
waiting time may be saved in these retail health clinics:
The time spent by
patients in a clinic waiting room represents a real cost to
them - despite the fact that no financial transaction has
take place. The economic concept of cost is based on the
awareness that, when resources are used in a certain way,
those same resources are not available for use in other
activities, and the benefits that would have been derived
from those other activities, are sacrificed.
- Tracy Radtke, The
Economic View of Evidence-Based Medicine
Should
we worry about hospitals being for profit?
[For Profit
hospitals] are popular due to the reason that they work
well, they increase patient, employee and practitioner
satisfaction, lower infection rates and improve the
wellbeing of patients.
- Shelia Orr, Economics
and For-Profit Hospitals
What
can better health do for a country?
"Better health
could improve our country's annual earnings by 11% to 30%,
and would increase educational attainment (Hadley, 2002)."
- Amy Kelleher, Health
Care Reform in the United States: The Time is Now
And for
developing countries?
Bonnel (2000)
estimates that over a twenty year period, a prevalence rate
of 20% of HIV/AIDS would be accompanied by a 67% drop in
GDP.
- Fandoalo Amegandji,
The Implications of Health in
the Economic
Growth on Developing Countries
Around
8 million deaths a year could be avoided from such
conditions as HIV/AIDS, malaria, TB and child infectious
diseases.
In
sub-Saharan Africa the economic loss due to HIV/AIDS we
estimated to be at least 12% of annual GDP.
Sachs
tells the story of a family where a little girl had
contracted malaria. The mother had to make a 10 km walk to
the closest health facility. Upon arriving there, they were
told that they were out of quinine and had to return the
next day. The little girl survived the night and received
treatment the next day, but stories like this can be
repeated throughout the developing world.
- Victor Gauto, Health
and Economic Development
What is
possible?
Today the average life expectancy of one of the world's 6.5
billion citizens is 67 years and 6 months (CIA World
Factbook, 2006). However, the range of life span by member
nations of the world varies tremendously, from a low of
almost 33 years in Swaziland on the continent of Africa to
just above 82 years in the urban Chinese Island State of
Macao. Over the course of the last two thousand years human
life expectancy has risen from 7,000 days (less than 20
years) to over 25,000 days (almost 70 years) currently, and
by 2050 the average life expectancy of the one of the 9.3
billion citizens of the planet will be almost 75 years of
age (U.S. Census Bureau, 2002).
[The
Knowledge Economy]
first cited by Peter Drucker in his work The Age
of Discontinuity: Guidelines to Our Changing Society (1969),
[stated that] the knowledge Economy is built on abundance of
resources, not scarcity. This is in diametric opposition to
other eras in human history characterized by steep
competition for scarce resources (Marx, 1856). Some have
argued that the emerging knowledge society generates its
wealth through the economic exploitation of understanding
(World Bank, 2005).
-
Michael A. Spine, Electrification, Urbanization
and Computerization:
Life Expectancy in
the Knowledge Age
We are
getting older ...
Bill
McGuire, CEO for United Health, Inc., recommends that we
must deal with the increase in spending on healthcare for
seniors from $700 billion annually going to $1.6 trillion by
expanding support care. He says we must look at the
expansion in complexity and chronicity of seniors due to the
interventions earlier in their lives that prolong the lives
of people we wouldn't have to take care of otherwise if they
had died earlier. McGuire says we "get better in the use of
resources relating to chronic disease and end of life care."
-
Dan
Strittmatter,
Programs for the All-Inclusive Care for the
Elderly (PACE)
as Another Solution to the
Growing Cost of Care for Seniors:
A Review of PACE and How It Could Work in
Minnesota
Clearly, a number of students
showed a passion for learning that is every teacher's
dream. They learned from some very accomplished guest
lecturers. They learned from the literature. And they
learned from each other.
They say that you can count all
the seeds in an apple, but you cannot count all the apples
from one seed.
My "Mission Impossible" may
have succeeded this year. At least three of the student
papers are publishable. But more could be published
if their authors take the time and trouble to do so. Even
more importantly, many of their proposals are doable. And
the passion that will be needed for implementation will
provide the direction and energy. Maybe the seeds of this
learning will change the world?
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