Healthcare Reform, a dinner topic for many Americans, has topped the headlines for 18+ months.  During this period, certain suggestions on reforming healthcare grabbed my attention.

Last week we focused on how polarized the pro’s and con’s on reform have become.  Although poignant, the arguments for and against were meant to stir emotions on this pressing issue.

So, this week we turn our attention to reform alternatives – beyond those typically proposed – to continue stirring the passion pot!

Proceedings’ Time Management

Let’s start with Mary R. Grealy’s, writer for Disruptive Women in Healthcare, first-hand opinion on how time was managed at the 2010 Healthcare Summit.  The title really sets the tone: “Missed Opportunities and the Mandate Dilemma.”

“I can’t help but believe that a valuable opportunity was squandered during the health reform legislative process.  This was a time for a dialogue between political leaders and the American people on the steps necessary to achieve accessible, affordable health insurance for all…

Instead, we spent valuable months arguing over whether government should take the unprecedented step of creating a health insurance entity to “compete” in the private marketplace.  The disproportionate focus on the government plan option undoubtedly helped fuel fear of expanded federal influence over healthcare and, subsequently, to the anti-mandate legislative measures we’re seeing today.”

In another portion of the post, Grealy compares an individual’s responsibility to carry health coverage to one’s responsibility to have property insurance.  If everyone could take out a policy when their house was on fire, then our property insurance system would fail.  She articulates that our health insurance will crumble to ruins in the same light if the healthiest of us could defer insurance until an illness arises. 

Urine, or You’re Out

One of the more ingenious ideas for reforming the current healthcare budget stemmed from nothing more than a FWD:  Alright – you caught me!  Now and then a catchy subject line piques my interest and “Urine or You’re Out” did just that.

I unfortunately do not have an author with whom to attribute this idea, so please allow for a bit of ambiguity:

“Like most folks in this country, I have a job. I work, they pay me. I pay my taxes and the government distributes my taxes as it sees fit.  In order to get that paycheck in my case, I am required to pass a random urine test (with which I have no problem)

What I do have problem with is the distribution of my taxes to people who don’t have to pass a urine test.

So, here is my Question: Shouldn’t one have to pass a urine test to get a welfare check because I have to pass one to earn it for them? (I’ve taken the liberty to delete a bit of description here…if you are interested in it – let me know in the comments section below!)

 I guess we could title that program, ‘Urine or You’re Out’.” ~ Anonymous

Stop Cushioning Wallets

This idea may not have the shock factor of the last, but has been receiving publicity as of late.  Rosemary Gibson, author of “The Treatment Trap, Stop Running Red Lights AND Pay for Health Care Reform” compares medical treatments to traffic lights.

• Life-threatening procedures, such as fixing a ruptured appendix are considered green. 
• Yellow procedures involve weighing benefits and risks, such as the recent mammogram discussion.
• “Overuse”- a term coined by a panel from the Institute of Medicine –are red procedures where negatives outweigh the positives.

And, look at these research findings Gibson references:

In a survey conducted by the American College of Physician Executives, eighty percent of physicians who responded said they were very concerned or moderately concerned about their physician colleagues over treating patients to boost their income. Fifty-four percent said they were concerned about their peers admitting patients to a hospital to increase their bottom line. The survey respondents are in leadership positions in hospitals, medical practices and other health care organizations.

Wrap-Up

Overall, please note that in my opinion there is no simple, quick, stress-free option for  Healthcare Reform !  I just found the arguments for and against reform, as well as the ideas floating around for enhancing the reform process, interesting.

My hope is that these two posts stretched you beyond the ‘comfort zone.’  If you have other creative ideas for reducing costs in the healthcare budget, or ways to speed up the reform process, please comment below. 
 

In observance of National Patient Safety Awareness Week, the ECRI Institute is offering a free communications risk analysis through Saturday, March 13, 2010.  Per ECRI’s 3/4/2010 news release,

"communication is cited as a root cause in nearly 70% of reported sentinel events, surpassing other commonly identified issues such as staff orientation and training, patient assessment, and staffing. The increasingly complex healthcare environment can complicate the communication process and hinder the information exchanges necessary for optimum care."

Healthcare professionals have access to downloading "Communication" – the full risk analysis – from ECRI Institute’s Patient Safety Center Website.

We hope this resource is beneficial for your organizations!  For more information, see ECRI’s full news release. 

Health Reform – controversial topic, yes, I know!

Welcome to Part I of the Healthcare Reform saga.  Scouting through a few of my favorite journalist I realized the vast perceptions on both sides of the spectrum.

Moving beyond the typical pro / con arguments, some venture to suggest ways to cut healthcare costs all together.  The idea here is that Healthcare Reform does not solely concern providing health insurance for all Amerians.  With the plethora of information available, I have chosen to separate this post into Part I: Polar Opposites and Part II: Why Didn’t the White House Think of This!

So, here we go.  Passion at its finest…

***Please do not read into the Pro’s being listed first.  One side had to be listed first, and Pro’s generally come before Con’s…I truly am trying to show both sides without a bias!***

Pro – Reform

Unnecessary Death Counts Will Rise

Ron Pollack, Executive Director of Families USA states, “Failure to pass health reform—in effect, doing nothing to make health coverage and care affordable—results in…the ultimate, inexcusable consequence—lost lives.”

“Every day in 2010, approximately 68 non-elderly adult Americans across the nation will die prematurely due to lack of health coverage. If health reform fails, the Consumer Health Report "Lives on the Line: The Deadly Consequences of Delaying Health Reform", warns that the number of deaths would grow from 68 per day in 2010 to 84 per day in 2019,” summarizes Caralyn Davis from FierceHealthcare in “No insurance? Consequences Could be Deadly”.

Stimulate Economic Productivity

"Providing all citizens the right to health care is good for economic productivity. When people have access to health care, they live healthier and longer lives, thus allowing them to contribute to society for a longer time. The cost of bad health and shorter life spans of Americans suffering from uninsurance amounts to $65-130 billion annually." From Pro & Con’s Argument: "Should all Americans have the right (be entitled) to health care?"

Constitutional Right

Many Americans have jumped on the band wagon that Health Insurance being affordable and provided to all citizens falls under the protection of the Preamble of the Constituation which states its purpose is to "promote general welfare."  Remember however that promote, not provide.  Much the same letters, but very different meanings.

These comments only scratch the surface on the conviencing arguments pro healthcare reform.  But, one would be naïve to look at just one side of the story…

Anti – Reform

Deter Competition = Hike Prices & Limit Quality of Services

I found many well-written arguments for government play in Healthcare leading to an overall increase in prices (the monopoly effect) and decrease in quality care.  However, I felt Chandler J. Rapsom from Workforce Management eloquently summarized the idea in the article “What Health Care Reform Really Needs: Effective Wellness and Free-Market Competition.”

"By removing any incentives for individuals to take control of their health and wellness, chronic conditions will soar in both prevalence and severity…By failing to include mandates that would level the playing field and allow insurers, third-party administrators and self-insured employers to compete equitably for providers and patients, there is no incentive for dominant carriers to keep premium costs down and expand the scope of coverage."

The increase in demand for healthcare may also decrease quality of care due to healthcare professionals becoming overstretched.

Detrimental to American Big Business

As sticky a subject as when his book, “Where Have All the Leaders Gone,” first came out, Lee Iacocca lists the debauchery in American politics and mentions that Healthcare costs already run American corporations into the red.

"We’re running the biggest deficit in the history of the world, and it’s getting worse every day!

We’ve lost the manufacturing edge to Asia , while our once-great companies are getting slaughtered by health care costs."

Why force companies to increase spending on Healthcare when this could further inhibit entrepreneurship and achieving the proverbial American Dream?

Socialism Decreases Strive for Excellence

Although some argue that Healthcare Reform should not be classified as socialism, many believe the similarities are too obvious to brush aside.

"Providing a right to health care is socialism and is bad for economic productivity. Socialized medicine is comparable to food stamps, housing subsidies, and welfare–all of which is charity. Distributing charity to society makes people lazy, decreases the incentive for people to strive for excellence, and inhibits productivity." From  Pro & Con’s argument: "Should all Americans have the right (be entitled) to health care?"

Part I Wrap-Up

So, if these Pro’s and Con’s got your blood boiling or gears turning, just wait for the ideas coming up in next week’s posting – Part II: Why Didn’t the White House Think of This!  Feel free to add comments or other arguments on the Pro’s and Con’s to Healthcare Reform.

Christine P. Carrington, President of NurseTesting Creative Solutions, has been recognized by Cambridge Who’s Who for demonstrating dedication, leadership and excellence in healthcare consulting.

March 3, 2010 — Christine P. Carrington, President of NurseTesting Creative Solutions, a has been recognized by Cambridge Who’s Who for demonstrating dedication, leadership and excellence in healthcare consulting.

As the president of NurseTesting Creative Solutions, Ms. Carrington is responsible for consulting with

healthcare staffing organizations and preparing them for national certification by The Joint Commission. Her services include providing cost effective clinical operations and risk management support, as well as, staffing operations start up support for new healthcare staffing organizations.

Elevating Frontline Performance-Best Practices for Improving Nursing Staff Performance.

Ms. Carrington began her career as a staff nurse in a hospital, advancing into progressive nursing management roles. Prior to working for her current company, she worked for a national healthcare staffing organization, where she was instrumental in the company being recognized as one of the leading, quality focused healthcare staffing organizations. Ms. Carrington’s experience includes clinical operations, resource allocation, workforce management, strategic sales, consultation with hospitals and health systems in the development of customized strategic staffing partnerships, and Joint Commission Health Care Staffing Services Certification. She attributes her success to her hard work, dedication, passion for her profession and her ability to establish great relationships with her clients.

Ms. Carrington received her Master’s Degree in Nursing Administration from the University of Illinois at Chicago in 1998 and is a member of the American Organization of Nurse Executives. She served as advisor to The Advisory Board Company for publication of “Elevating Frontline Performance-Best Practices for Improving Nursing Staff Performance.” She served on Joint Commission’s Healthcare Staffing Certification Advisory Council. Ms. Carrington served on the Board of Managers for InteliStaf of Oklahoma LLC, a joint venture with the INTEGRIS Health System. She intends to continue expanding the consulting division by adding additional services in other areas of healthcare as well as establishing the company as a trusted name in healthcare.

About NurseTesting Creative Solutions
NurseTesting Creative Solutions, formerly NT Consulting Services – a division of NurseTesting.com which is an Amistaff Healthcare Techology product – was founded in 2008 in response to the healthcare staffing industry’s need for consultants experienced in Joint Commission’s Health Care Staffing Services Certification. NTCS’ consulting services assist healthcare staffing firms prepare for Joint Commission certification and provide cost effective clinical operation and risk management services. NTCS also provides staffing operations start-up support for new healthcare staffing organizations. NTCS consultants are nationally experienced Nurse Executives with 20+ years of healthcare staffing experience and extensive experience and success with Joint Commission Health Care Staffing Services Certification.

For more information about NurseTesting Creative Solutions, visit http://www.nursetesting.com/consulting.

About Cambridge Who’s Who
Cambridge Who’s Who is an exclusive membership organization that recognizes and empowers executives, professionals and entrepreneurs throughout the world. From healthcare to law, engineering to finance, manufacturing to education, every major industry is represented by its 500,000 active members.

Cambridge Who’s Who membership provides individuals with a valuable third party endorsement of their accomplishments and gives them the tools needed to brand themselves and their businesses effectively. In addition to publishing biographies in print and electronic form, Cambridge Who’s Who offers an online networking platform where members can establish new business relationships and achieve career advancement within their company, industry or profession.

For more information, please visit http://www.cambridgewhoswho.com.

After reading Christopher Cornue’s Disruptive Women in Health Care post last week on Nurses, Lawsuits, and Patient Safety, I was inspired to write my own post discussing ethical dilemmas rising from reporting wrong-doings in the workplace.

So in case you are not familiar with the recent case in Texas, skim the following press release from SafetyShare newsletter, Premier, Inc.

“Texas jury finds nurse not guilty for reporting a physician for unsafe practices.

It took the jury less than an hour on February 11, 2010, to return a not guilty verdict for the nurse, Anne Mitchell, of felony charges of “misuse of official information,” for reporting a physician to the Texas Medical Board for what she believed was unsafe patient care.
Since news of the criminal indictment – and Mitchell’s being fired from her job – first spread through the nursing community, nurses across the country have followed developments. Labeling the criminal indictments “outrageous,” an outpouring of support – and financial contributions to the Texas Nurses Association Legal Defense Fund – has continued.

According to a New York Times article on February 9, the prosecutors claimed that Mitchell intended to damage the physician’s reputation when she reported him to the Texas Medical Board, which licenses and disciplines doctors. Mitchell explained that she felt an obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures – including a failed skin graft that was performed in the emergency room, without surgical privileges.

Conflicts of interest seemed to be part of this case with allegations that this case was, in part, a result of the local sheriff being good friends with, and a former patient of the physician, and bending the rules to protect his reputation.

A number of nurses who had previous worked at the same Winkle County Rural Health Clinic testified in court that they left the clinic because of their concern about the care provided by the same physician that had never been addressed. The case is no less perplexing as to why Mitchell was even indicted – all witnesses (even the state’s) have agreed nurses have a duty to report unsafe care.

The verdict is a resounding win on behalf of patient safety in the U.S., as well as nurses and other healthcare professionals who play a critical, duty-bound role in acting as patient safety watch guards in our nation’s health care system. The greatest concern with this case has been the disbelief that a case such as this was even allowed to reach the trial stage and what a different outcome could have potentially meant for patient safety in this country. Even with an acquittal, the felony charges and trial had a chilling effect on many nurses who may think twice before reporting unsafe practices.

A civil lawsuit has been filed in federal court charging the county, hospital, sheriff, doctor and prosecutor with vindictive prosecution and denial of the nurses’ First Amendment rights. A complete summary of the case is available on the Texas Nurses Association Web site.”

Thoughts Expanded

Especially in the medical profession, if those working hand-in-hand with you do not feel protected to disclose wrongdoings, then who will?  From an outsider’s perspective, I personally take this case to heart.  Knowledge has power.  Not coming from a medical background, my trust falls on the doctors and nurses to suggest best practices and procedures for me and my family.

And, to take this one step further, consider the fact that patients under the knife literally have “no say” in changes to protocol.

Ethically speaking, individuals fight an internal battle in these types of situations.  Although they seem black and white in nature – unsafe patient care gets reported – human emotions and moral compasses start blurring the lines.  Back lash from other co-workers, disruption to workplace flow, ruining a co-worker’s career, and many other ‘what-ifs’ could prohibit “tattle-telling.”  So it is up to the Human Resource department to create an atmosphere of open communication where making wise choices, ethically speaking, are rewarded and not condemned.

So how can you ensure that core values crossover into every department company wide?

Listen to the closing remarks from Tim Keenan, President of High Performance Technologies, Inc, in his webinar for Winning Workplaces on keeping employee communication a premium.

• Keeping Communication Lines Open – mp3 – 1.7 MB – 1:50

I completely agree with Keenan on listening, acting on what you hear, and being shameless, relentless, and creative in incorporating employee thoughts.  When employees feel their positive ideas are being heard they are more likely to bring forth troublesome issues without second guessing the decision.

The outcome of this case can be marked as a victory for nurses.  No need to fear!  Nurses should feel protected to speak their thoughts when it comes to patient safety.  If nurses do not feel they can grab hold of the reigns who will keep doctors from running wild?  Alright, that may be largely exaggerated, but you get the drift!

How do you keep lines of communication open in your organization?  Comments welcome!

In response to Mac unveiling the new, controversial iPad, our good friends at Medical Software Advice conducted an investigation to pinpoint the healthcare industry’s wish list for an ‘ideal’ tablet device.   The responses from the 178 physicians, nurses, medical students, and healthcare IT professionals may surprise you.

Over 50% of the respondents stated they were at least somewhat likely to buy a tablet in the 2010 year.  It sounds like the iPad’s timing couldn’t be better!  With over half of the target market anticipating a purchase soon, a substantial portion of the market share awaits to be claimed!

But, the question still remains….will the iPad hold up to the standards needed from the healthcare industry?

Moving from the general public to a narrow niche requires ample market research and specialized product development. Take a look at the wide variety of tasks the healthcare industry wants from the tablet:

Chart depicts what % of respondents thought a feature was a “must-have” in a tablet. 
Courtesy of Medical Software Advice, a blog about electronic health records.

From this long list of “must-haves,” Chris Thorman summed up the current deficiencies the iPad should be looking to overcome:

“It lacks a large number of features that healthcare professionals deemed important, such as resistance to dust and hospital fluids and disinfectants (the iPad does not have sealed ports); fingerprint access to the system (HIPAA compliance); barcode scanning (patient safety); and an integrated camera (documenting diagnosis). In fact, you could argue that the iPad’s difficulty in being disinfected or kept clean of hospital fluids is a deal breaker for healthcare workers.”

I found it interesting that nearly a dozen new tablet devices were showcased at the Consumer Electronic Show earlier this year.   But, before Apple’s announcement last week, a tablet was still a form of pill in my book. 

So, fellow marketers should be rejoicing over the free hype Apple’s device brought to the tablet marketplace.  After all, the iPad (or some play on that name!) has been a trending topic on Twitter since the announcement reached the general public.

For more details on Medical Software Advice’s investigation, check out their blog post: Healthcare Wants a Tablet, But Not Apple’s iPad | Survey Results

We are excited to announce that the following updates are effective immediately!  We appreciate all of our clients who provide us feedback  as you are the driving force behind the enhancements in the NurseTesting system.

Results Page

As promised, the incorrectly answered questions are now back on the results page!

• All newly validated exams will showcase the questions missed as well as the answer that was selected.
• All former NurseTesting exams will display the questions missed and the list of answers to choose from – the incorrect choice selected in bold.

- – - Make note of the difference! The only answer shown for new exams will be
the incorrect answer chosen. This should assist your organization,
as well as your caregivers, with remediation when necessary.- – -

Revision of General ICU Exam

Number of questions decreased from 70 to 62.

After obtaining a sufficient sample size, we were able to statistically identify test items that were not contributing to the overall reliability of the exam, and thus this newer version will be more streamlined and still provide good reliability in identifying those that have sufficient Critical Care job knowledge.

New Exams in the NurseTesting Exam Library

You can now find the following exams on the Send Exams screen.

• Endoscopy/GI
• Neuro ICU
• Neuro PCU

These exams are ready for sending effective immediately!

Thank you for checking in on NurseTesting’s Important News – and please let us know if you have any questions regarding these announcements!

Amistaff’s Chief Nursing Officer, James Ostmann, Sr. RN, MBA, assisted in rescuing an 81-year-old woman on his flight back from the American Society Healthcare Human Resources Association conference in Chicago. Fox News 8 picked up the story which aired last evening during the 6 o’clock news!

This is a true incident that occurred on an airplane in which Amistaff’s Chief Nursing Officer was a passenger. Praise to the airline and crew for their poise and composure during the crisis.

HIGH POINT: US Air Flight 1723 from Chicago to Charlotte made an emergency descend landing on Tuesday, November 3, 2009.  The cabin transformed into an emergency room before passengers’ eyes as Amistaff’s Chief Nursing Officer, James Ostmann, Sr. RN, MBA, rescued a diaphoretic woman suffering a potential heart attack and stroke.

While in route, the 81-year-old, French-speaking woman grabbed her chest and motioned pressure. With neurological deficits on the left-side of her body and color draining her face, Ostmann knew the patient’s condition was rapidly deteriorating.  Pilots phoned MedLink for medical consultation and received authorization for Ostmann to open the medical resuscitation kit.

Alongside a French-speaking, Medical-Surgical nurse from a Florida hospital, Ostmann reported the patient’s conditions to officials on the ground.  With an IV bag hung from the carry-on compartment and oxygen tank resting in a seat, Ostmann and the flight crew created a mobile ER. Ostmann initiated the IV and eased the woman’s chest pain with Nitroglycerin, keeping her vitals stabilized through landing.

Of the experience Ostmann commented:

“The crew handled the medical emergency with such composure. From 35,000 feet, US Air was able to ground our plane within 20 minutes. When dealing with stroke victims, time is of utmost importance with the tissue plasminogen activator’s limited 3-hour window. The fully equipped medical cart was color coded expediting treatment for the passenger. I hope to receive authorization to follow up with the attending hospital to check on her condition.”

The chilling truth is that Ostmann made a last minute change in his itinerary to board US Air Flight 1723. Coming from the American Society Healthcare Human Resources Association conference in Chicago, Ostmann decided to take the 2:00pm flight in lieu of the 12:00pm flight allowing extra time for travel. Had Ostmann not been a passenger on the same flight, this emergency descend could have had a much different landing.