Friday, 13 March 2015
Monday, 9 March 2015
Princess Health and Health Care Run by Those "Who See the Practice of Medicine as a Set of Economic Transactions," or as a "Moral Endeavor?". Princessiccia
generic management generic managers market fundamentalismCalls are getting louder for restoring medicine and health care as a calling that puts patients first, versus a business that puts money first. For example, in the conclusion of her opening talk for the 2015 Lown Institute Annual Conference: the Road to RightCare, Shannon Brownlee said, [with italics added for emphasis]
On Health Care Renewal, we have long been showing the consequences of health care run by generic managers who believe the business school dogma of promoting "shareholder" value, even when their organization has no shareholders, by putting short term revenue ahead of all else. They are backed by market fundamentalists who believe all of human life can be reduced to business transactions. The results have been very profitable to some, particularly to the very same generic managers, in terms of every rising executive compensation untethered to any clear evidence for these managers' achievements, beyond making money. I have suggested that this has become a major cause of health care dysfunction, of ever rising costs, shrinking access, and threatened quality. True health reform, or transformation, to use Ms Brownlee's term, would restore the priority of patients' and the public's health, and return health care to those who see it as a calling, not just a way to get rich.
So today I stand before you not as a writer turned health policy expert turned health care activist, though I�m still all of those things. I stand before you as a mother, a wife, a daughter . . . and a citizen. I stand before you filled on the one hand, with dismay . . . and on the other hand with a full measure of hope. I stand here to welcome you to the work we are all doing to transform healthcare.[The above was reprinted with Ms Brownlee's permission.]
And our first step is to name our task. It is not just stamping out overuse, though we must do that. It is not just ensuring that patients get the care they need. Though that is unfinished business.
Getting to the right care also requires that we recognize the historic choice we face between opposing world views. On one side are those who see the practice of medicine as a set of economic transactions, and healthcare as just another business. This side thinks the market solves all ills. This side sees the health professions as the labor needed to run a highly profitable industry. You are the 'providers' of services -- the help. Patients are revenue. Excuse me, 'consumers.'
On the other side of this divide are those who see healthcare as a moral endeavor. This side seeks to serve both patients and the common social good. This side knows that ignoring the patient as vulnerable human being is the quintessential failure of our system. This side acknowledges our need for hospitals, and for companies to manufacture drugs, and devices, and scalpels and surgical gloves. But the delivery of healthcare should not be designed for their benefit.
If we want to get to the right care, we must begin to envision a vastly different system. A just system. A system whose purpose is to serve patients and communities. A system that is not just reformed, but radically transformed.
The purpose of this conference, the reason we are all here today, is to find our way towards that transformation.
On Health Care Renewal, we have long been showing the consequences of health care run by generic managers who believe the business school dogma of promoting "shareholder" value, even when their organization has no shareholders, by putting short term revenue ahead of all else. They are backed by market fundamentalists who believe all of human life can be reduced to business transactions. The results have been very profitable to some, particularly to the very same generic managers, in terms of every rising executive compensation untethered to any clear evidence for these managers' achievements, beyond making money. I have suggested that this has become a major cause of health care dysfunction, of ever rising costs, shrinking access, and threatened quality. True health reform, or transformation, to use Ms Brownlee's term, would restore the priority of patients' and the public's health, and return health care to those who see it as a calling, not just a way to get rich.
Friday, 6 March 2015
Princess Health and Food Reward Friday. Princessiccia
Food reward FridaysThis week's lucky "winner"... donuts!!
Read more �
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| Krispy Kreme donuts being made. Hopefully this image isn't appetizing enough to make you want donuts. |
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Thursday, 5 March 2015
Princess Health and A "PR Pawn" Confounds the Public Relations Burnishing of Texas Health Resources and its CEO. Princessiccia
Ebola virus generic management generic managers public relations Texas Health Presbyterian Hospital Texas Health ResourcesThe Ebola virus epidemic in Africa is hopefully winding down. The uproar, if not panic, over Ebola virus in the US has been eclipsed by the latest internet craze. However, we are still learning from the echoes of the brief, and thankfully very localized US experience with Ebola.
In particular, the country's response to the virus should continue to inspire unease about how our supposedly market based, managerially focused health care non-system can handle real public health threats.
Background - Ebola at Texas Health Presbyterian
Starting on October 2, 2015, we discussed numerous concerns about whether problems with leadership or management at Texas Health Presbyterian hospital, part of the Texas Health Resources system, contributed to the poor outcomes of its Ebola patients. First, InformaticsMD raised questions about whether a badly designed or implemented electronic health record at the hospital enabled the initial misdiagnosis of Eric Duncan, the first patient to present with the Ebola virus on US soil. These questions were reinforced when hospital managers gave conflicting responses on this issue. He expanded on these questions here.
A week later, I wrote about the "mystery of the discharged Ebola patient," asking: why don't we know yet exactly what happened when our Ebola patient zero first appeared? I wondered then whether a decision by management to shift the health system's emphasis from acute care to "population health management," whatever that is, might have lead to problems addressing what was a severe, acute medical problem (albeit with public health implications.) About a week later, I wrote about the questions raised by inconsistencies in hospital managers' statements, about Mr Duncan's clinical status and the failure to initially accurately diagnose his infection, about the hospital's readiness to handle Ebola patients, and about whether hospital professional staff may have been silenced by administrators, and if so, why?
By late November, 2014, a Texas Health Presbyterian nurse had gone public with accusations that the initial care of Mr Duncan had been chaotic; Mr Duncan had died; and two nurses who cared for him after he was admitted after his second emergency visit to Texas Health Presbyterian had contracted Ebola infections; but no new Ebola cases had been diagnosed in the US, and Ebola was starting to fade from the media. At that time, I wrote that the three questions above remained unanswered. However, Texas Health Resources, the parent system for Texas Health Presbyterian, had hired Burton-Marsteller, a big public relations firm, and managers of both companies generated considerable verbiage, but no specific answers and no real enlightenment. Hospital managers had already pointed their fingers elsewhere, at the US Centers for Disease Control and Prevention (CDC) for inadequate guidelines, unnamed third parties for exploiting the crisis, and the media for sensationalizing it. Hospital managers had sponsored a pep rally, but the health professionals who appeared there either seemed to stick to talking points, or remained "tight lipped." The hospital settled a lawsuit filed by Mr Duncan's relatives, and Micahel Barden, the THR president, submitted to an interview in which he boasted of a "high level of communication" and asserted the system had "maintained the trust level," but did not supply any specifics.
Since November, 2014, no further specifics have appeared about what happened at Texas Health Presbyterian.
The Public Relations Burnishing of Texas Health Resource Management
Instead, since October, 2014, a series of events and media reports seemed more about burnishing the management of Texas Health Resources, and particularly its CEO, Barclay Berdan, than about learning from the problems that occurred when the US first encountered the Ebola virus.
On November 29, 2014, Modern Healthcare published an interview with Mr Berdan including leading questions like:
The answer to that last question was particularly upbeat:
Note that this implied communications had always been good, trust had always been maintained, and morale had never declined. There were no followup questions, particularly whether staff morale could have seemed good because dissent had been silenced?
On December 5, 2014, the D Healthcare Daily reported on an event in which Mr Berdan participated, and treated him as an honored expert. Berdan was quoted, for example,
The article trumpeted how selflessly Berdan has led THR to teach other hospitals about Ebola, with the underlying assumption that it had valuable lessons to teach:
On December 5, 2014, D Healthcare Daily also noted that at the event, an award was given to caregivers who dealt with ebola at Texas Health Presbyterian, but who accepted the award on their behalf?
After Berdan gave his little speech, next up on stage were:
Although the actual caregivers were supposedly being honored, airtime and coverage went to board chairs.
Then last month (February, 2015), it began again. Another interview with Mr Berdan appeared in D Healthcare Daily. It allowed Mr Berdan to pontificate on issues like the hospital system's growth plans, and to go back to the idea of population health as more important than acute care,
Ebola, and the questions I raised above, were not featured.
Finally, in the March issue (available in late February, 2015), D Magazine published, "How Texas Health Managed its Ebola Crisis," focused, of course, on CEO Barcaly Berdan. It featured a large color photograph of Mr Berdan. It seemed to suggest that the most important issue was maintaining the reputation of the hospital system, rather than for example, being transparent about and learning from mistakes. It featured a big informal portrait of Mr Berdan, and started with how Mr Berdan managed the first news conference about Ebola, rather than, for example, the details of Mr Duncan's encounters with THR.
The article described Berdan as an "unassuming man who speaks with confidence and fatherly authority," an "able communicator," a man whose "word is his bond," and eventually, "a battle tested CEO." It stated that "the treatment of Duncan - and the safety of the men and women who volunteered to care for him - rested squarely on his shoulders." Yet, of course, Mr Berdan's highest degree was an MBA, from University of Chicago, no less. He may have had a public relations battle, but he did not have to walk into a room containing a highly infectious Ebola patient. He actually should not have had any authority over the actual treatment of Mr Duncan. That should have been in the hands of the patient's doctors and nurses.
The article obliquely addressed the unanswered questions, but did provide substantive answers. Why was Mr Duncan not diagnosed accurately?
Was the hospital prepared to take care of Ebola patients?
Were health professionals silenced? The hospital paraded four nurses in front of 60 Minutes' cameras:
The final section of the article was entitled, "On the Mend." Again, the emphasis was on PR.
The hospital settled a lawsuit with Mr Duncan's relatives for an undisclosed sum. After the settlement was announced, Mr Duncan's nephew proclaimed:
Maybe getting a big sum of money can make one more philosophical about human imperfections.
The article ended up describing how
It all sounded so rosy, at least for a few days.
A "PR Pawn" Strikes Back, or, Nina Pham Administers a Corrective
Only a few days after the D Magazine piece appeared, the Dallas Morning News published an article about Nina Pham, the first THR nurse to have been infected with Ebola virus after caring for Mr Duncan. Pham had never previously been portrayed as a dissident, and had been seen in the media as a young professional gamely facing down the virus and supporting her fellow nurses. Now, however, rather than participating further in the feel good celebration of THR and Mr Berdan, Ms Pham announced she would be suing the hospital and THR.
Pham reaffirmed the contention that Texas Health Presbyterian was not prepared to care for Ebola patients.
In particular,
And
Finally,
She also contradicted much of the feel good public relations speak found in the articles above. The D Magazine article had referred to Pham and the other nurses who care for Mr Duncan as "the men and women who volunteered to care for him." In contrast, the Dallas Morning News article said "she did not volunteer to care for Duncan, but felt she couldn't say no."
During the crisis, Pham was seen in a video where she appeared gamely optimistic. However,
While the hospital argued that Pham gave permission to make the video,
Charla Aldous, Pham�s attorney, put it all more simply:
Summary
So it looks like back to the drawing board for the public relations flacks who have been defending the "reputation" of Texas Health Resources, and, in my humble opinion, mainly the reputation of its CEO, Barclay Berdan. After questions about its preparedness for and the care of Ebola patients, and about whether managers overrode and silenced health care professionals, the hospital system had put on a big public relations campaign, in concert with a big outside PR firm. Yet all the questions have now resurfaced as one of the hospital nurses put before the public as brave yet ever loyal to "Presby" now says she was turned into a "PR pawn."
Of course, the immediate response by the hospital and the CEO were to trot out the old talking points. In the Dallas Morning News article, spokesman Wendell Watson said,
Later, as again reported by the Dallas Morning News, CEO Barclay Berdan tried to refute Ms Pham's contention that her privacy was violated by saying:
But HIPAA rules are notoriously hard to interpret and implement.
Also,
But she had contended she was too ill, and confused on pain relief medicines to give informed consent, and aspects of her record apparently corroborate that.
So the questions about what was going on at THR persist. The latest twist in the story does emphasize how important public relations has become to contemporary hospital managers. One cannot avoid the notion that most of what went on in the C-suites of Texas Health Presbyterian and Texas Health Resources in response to the presence of three Ebola patients was about public relations, protecting the reputation of the hospital, and particularly celebrating its very well paid MBA CEO. Of course if leaders focus on public relations, maybe they will not do such a good job supporting the health care professionals who actually care for patients, and ultimately supporting the patients' and the public's health.
So as I said a while ago about this case, the rise of generic managers who value, among other things, favorable public relations perhaps to the detriment of patient care, threatens the US' ability to care for acutely ill patients, especially in the context of new or epidemic diseases. True health care reform would restore leadership by people who understand the health care context, uphold health professionals' values, are willing to be held accountable, and put patients' and the public's health ahead of self-interest.
In particular, the country's response to the virus should continue to inspire unease about how our supposedly market based, managerially focused health care non-system can handle real public health threats.
Background - Ebola at Texas Health Presbyterian
Starting on October 2, 2015, we discussed numerous concerns about whether problems with leadership or management at Texas Health Presbyterian hospital, part of the Texas Health Resources system, contributed to the poor outcomes of its Ebola patients. First, InformaticsMD raised questions about whether a badly designed or implemented electronic health record at the hospital enabled the initial misdiagnosis of Eric Duncan, the first patient to present with the Ebola virus on US soil. These questions were reinforced when hospital managers gave conflicting responses on this issue. He expanded on these questions here.
A week later, I wrote about the "mystery of the discharged Ebola patient," asking: why don't we know yet exactly what happened when our Ebola patient zero first appeared? I wondered then whether a decision by management to shift the health system's emphasis from acute care to "population health management," whatever that is, might have lead to problems addressing what was a severe, acute medical problem (albeit with public health implications.) About a week later, I wrote about the questions raised by inconsistencies in hospital managers' statements, about Mr Duncan's clinical status and the failure to initially accurately diagnose his infection, about the hospital's readiness to handle Ebola patients, and about whether hospital professional staff may have been silenced by administrators, and if so, why?
By late November, 2014, a Texas Health Presbyterian nurse had gone public with accusations that the initial care of Mr Duncan had been chaotic; Mr Duncan had died; and two nurses who cared for him after he was admitted after his second emergency visit to Texas Health Presbyterian had contracted Ebola infections; but no new Ebola cases had been diagnosed in the US, and Ebola was starting to fade from the media. At that time, I wrote that the three questions above remained unanswered. However, Texas Health Resources, the parent system for Texas Health Presbyterian, had hired Burton-Marsteller, a big public relations firm, and managers of both companies generated considerable verbiage, but no specific answers and no real enlightenment. Hospital managers had already pointed their fingers elsewhere, at the US Centers for Disease Control and Prevention (CDC) for inadequate guidelines, unnamed third parties for exploiting the crisis, and the media for sensationalizing it. Hospital managers had sponsored a pep rally, but the health professionals who appeared there either seemed to stick to talking points, or remained "tight lipped." The hospital settled a lawsuit filed by Mr Duncan's relatives, and Micahel Barden, the THR president, submitted to an interview in which he boasted of a "high level of communication" and asserted the system had "maintained the trust level," but did not supply any specifics.
Since November, 2014, no further specifics have appeared about what happened at Texas Health Presbyterian.
The Public Relations Burnishing of Texas Health Resource Management
Instead, since October, 2014, a series of events and media reports seemed more about burnishing the management of Texas Health Resources, and particularly its CEO, Barclay Berdan, than about learning from the problems that occurred when the US first encountered the Ebola virus.
On November 29, 2014, Modern Healthcare published an interview with Mr Berdan including leading questions like:
Has this Ebola crisis caused you to take a broader look at hospital-acquired infections?
How were you able to maintain high staff morale throughout this crisis?
The answer to that last question was particularly upbeat:
It was really important to make sure that we had a high level of communication and that we maintained trust inside the organization while we were in many cases being attacked from the outside, as the world moved from science to political science to social science to superstition and fear. That helped us keep the morale of the organization up and to keep people focused on the fact that we had a lot of patients to take care of.
Even though our patient census dropped by 20%, we told everybody we weren't going to reduce staffing. We were going to keep people working at their regular rates and times. We kept everybody really focused on this challenge, that we had to stay strong and get through this period of time.
Note that this implied communications had always been good, trust had always been maintained, and morale had never declined. There were no followup questions, particularly whether staff morale could have seemed good because dissent had been silenced?
On December 5, 2014, the D Healthcare Daily reported on an event in which Mr Berdan participated, and treated him as an honored expert. Berdan was quoted, for example,
The best thing you can do�if you�re a local hospital, if you�re a rural hospital or an urban hospital�is to try and figure out how to manage the safety of your employees, the safety of your institution, the safety of patients who may present with, in this case, a disease that already causes people great fear.
The article trumpeted how selflessly Berdan has led THR to teach other hospitals about Ebola, with the underlying assumption that it had valuable lessons to teach:
THR has shared what it�s learned with other hospitals, both in North Texas and across the country. It held a webinar with 1,200 medical professionals to share what it learned and changed....
On December 5, 2014, D Healthcare Daily also noted that at the event, an award was given to caregivers who dealt with ebola at Texas Health Presbyterian, but who accepted the award on their behalf?
Barclay Berdan, CEO of Texas Health Resources, was center-stage on Tuesday at the Sheraton downtown, flanked by more than a dozen staffers representing the 100-plus caregivers who helped treat the three Ebola patients in October.
The Dallas Regional Chamber presented the caregivers of Texas Health Presbyterian Dallas with the Courage of Public Service Award, an annual recognition that honors groups or officials who 'demonstrated significant leadership on important issues.'
After Berdan gave his little speech, next up on stage were:
Texas Health Resources Board Chair Anne Bass and Presbyterian Hospital Board Chair Stan Rabin walked up first,...
Although the actual caregivers were supposedly being honored, airtime and coverage went to board chairs.
Then last month (February, 2015), it began again. Another interview with Mr Berdan appeared in D Healthcare Daily. It allowed Mr Berdan to pontificate on issues like the hospital system's growth plans, and to go back to the idea of population health as more important than acute care,
I think we�re looking always to find good opportunities to improve the health of the people in the communities we serve, and that�s our mission. In fact, we have really changed the scope and direction of our organization over the last four or five years from being a great acute care hospital company�you referenced all of our hospital properties in North Texas�to really being a health company.
Ebola, and the questions I raised above, were not featured.
Finally, in the March issue (available in late February, 2015), D Magazine published, "How Texas Health Managed its Ebola Crisis," focused, of course, on CEO Barcaly Berdan. It featured a large color photograph of Mr Berdan. It seemed to suggest that the most important issue was maintaining the reputation of the hospital system, rather than for example, being transparent about and learning from mistakes. It featured a big informal portrait of Mr Berdan, and started with how Mr Berdan managed the first news conference about Ebola, rather than, for example, the details of Mr Duncan's encounters with THR.
To Berdan, it was important to show that Presby�one of Dallas County�s largest and busiest hospitals�was safe and open for business.
The article described Berdan as an "unassuming man who speaks with confidence and fatherly authority," an "able communicator," a man whose "word is his bond," and eventually, "a battle tested CEO." It stated that "the treatment of Duncan - and the safety of the men and women who volunteered to care for him - rested squarely on his shoulders." Yet, of course, Mr Berdan's highest degree was an MBA, from University of Chicago, no less. He may have had a public relations battle, but he did not have to walk into a room containing a highly infectious Ebola patient. He actually should not have had any authority over the actual treatment of Mr Duncan. That should have been in the hands of the patient's doctors and nurses.
The article obliquely addressed the unanswered questions, but did provide substantive answers. Why was Mr Duncan not diagnosed accurately?
Privacy laws prevented the hospital from discussing the care provided Duncan until he permitted them to....
Was the hospital prepared to take care of Ebola patients?
We were moving in parallel with the CDC's ongoing recommendations....
Were health professionals silenced? The hospital paraded four nurses in front of 60 Minutes' cameras:
On the evening of Oct. 26, wearing blue scrubs and seated in front of a jet-black background, nurses Sidia Rose, John Mulligan, Richard Townsend, and Krista Schaefer offered a poignant and moving narrative of Duncan�s treatment. It was the most substantive account offered to that point.
The final section of the article was entitled, "On the Mend." Again, the emphasis was on PR.
THR had positive momentum. Once a pin-cushion, its public reputation was improving.
The hospital settled a lawsuit with Mr Duncan's relatives for an undisclosed sum. After the settlement was announced, Mr Duncan's nephew proclaimed:
This facility is an outstanding facility, and we as humans are not perfect.
Maybe getting a big sum of money can make one more philosophical about human imperfections.
The article ended up describing how
North Texas seems to have appreciated the efforts of THR under Berdan....
It all sounded so rosy, at least for a few days.
A "PR Pawn" Strikes Back, or, Nina Pham Administers a Corrective
Only a few days after the D Magazine piece appeared, the Dallas Morning News published an article about Nina Pham, the first THR nurse to have been infected with Ebola virus after caring for Mr Duncan. Pham had never previously been portrayed as a dissident, and had been seen in the media as a young professional gamely facing down the virus and supporting her fellow nurses. Now, however, rather than participating further in the feel good celebration of THR and Mr Berdan, Ms Pham announced she would be suing the hospital and THR.
She says the hospital and its parent company, Texas Health Resources, failed her and her colleagues who cared for Thomas Eric Duncan, the first person in the United States diagnosed with Ebola.
'I wanted to believe that they would have my back and take care of me, but they just haven�t risen to the occasion,' Pham told The Dallas Morning News
Pham reaffirmed the contention that Texas Health Presbyterian was not prepared to care for Ebola patients.
In her 90-minute interview, Pham described working in chaotic surroundings at the hospital with ill-prepared nurses who received little guidance on how to treat Ebola and protect themselves.
In particular,
She said the extent of her Ebola training was a printout of guidelines that her supervisor found on the Web.
And
The day Duncan moved to ICU, Pham said, she and the charge nurse went in with double gloves taped to double gowns and wore double booties and a face shield. The hospital did not have hazmat-type suits, and Pham said her neck was always exposed.
'We�ve had nurses that I�ve worked with that worked in other states, and they worked in hazmat suits for flu and H1N1,' Pham said. 'Why aren�t we wearing hazmat suits for Ebola?'
After days of asking, Pham said, the nurses were given hazmat suits. She said all the decisions to upgrade the protective gear and precautions were made by the nurses 'on the fly.'
Meanwhile, the nurses devised their own hazardous waste area. In a room adjacent to Duncan�s, the nurses set up a place to take off their protective gear and shower after caring for him. In another nearby room, they placed bags of dirty linens, towels and other soiled items.
Finally,
while she became the American face of the fight against the disease, the hospital�s lack of training and proper equipment and violations of her privacy made her 'a symbol of corporate neglect � a casualty of a hospital system�s failure to prepare for a known and impending medical crisis.'
She also contradicted much of the feel good public relations speak found in the articles above. The D Magazine article had referred to Pham and the other nurses who care for Mr Duncan as "the men and women who volunteered to care for him." In contrast, the Dallas Morning News article said "she did not volunteer to care for Duncan, but felt she couldn't say no."
During the crisis, Pham was seen in a video where she appeared gamely optimistic. However,
She says that Texas Health Resources violated her privacy while she was a patient at Presbyterian by ignoring her request that 'no information' be released about her. She said a doctor recorded her on video in her hospital room and released it to the public without her permission.
While the hospital argued that Pham gave permission to make the video,
The day Pham was transferred to NIH, a notation was made in her medical file that 'she does not have the mental capability to make end-of-life decisions,' [Pham's attorney Charla] Aldous said. But PR people from Texas Health were trying to talk to her for a media release 'about how much she loves Presbyterian,' Aldous said.
Texas Health, with a PR firm�s help, developed a slogan � 'Presby Proud' � aimed at restoring the community�s faith in the beleaguered hospital.
Before Pham�s flight to Maryland on Oct. 16, she said, a doctor wearing a video camera under his protective hood came into her room and said he was filming her for educational purposes. Pham said she did not give permission for the video, which was released to the media.
'Thanks for getting well. Thanks for being part of the volunteer team to take care of our first patient,' a man�s voice said in the video. 'It means a lot. This has been a huge effort by all of you guys.'
'I could tell they wanted me to stay just because they kind of knew, they could see I was getting better. They wanted that �yes we cured her� kind of attitude. They wanted a win, especially after a loss.' - Nina Pham
Charla Aldous, Pham�s attorney, put it all more simply:
Texas Health Resources 'used Nina as a PR pawn.'
Summary
So it looks like back to the drawing board for the public relations flacks who have been defending the "reputation" of Texas Health Resources, and, in my humble opinion, mainly the reputation of its CEO, Barclay Berdan. After questions about its preparedness for and the care of Ebola patients, and about whether managers overrode and silenced health care professionals, the hospital system had put on a big public relations campaign, in concert with a big outside PR firm. Yet all the questions have now resurfaced as one of the hospital nurses put before the public as brave yet ever loyal to "Presby" now says she was turned into a "PR pawn."
Of course, the immediate response by the hospital and the CEO were to trot out the old talking points. In the Dallas Morning News article, spokesman Wendell Watson said,
Nina Pham bravely served Texas Health Dallas during a most difficult time. We continue to support and wish the best for her, and we remain positive that constructive dialogue can resolve this matter.
Later, as again reported by the Dallas Morning News, CEO Barclay Berdan tried to refute Ms Pham's contention that her privacy was violated by saying:
We adhered to HIPAA rules in determining what information to share publicly.
But HIPAA rules are notoriously hard to interpret and implement.
Also,
We had Nina's consent to share the information about her that was released.
But she had contended she was too ill, and confused on pain relief medicines to give informed consent, and aspects of her record apparently corroborate that.
So the questions about what was going on at THR persist. The latest twist in the story does emphasize how important public relations has become to contemporary hospital managers. One cannot avoid the notion that most of what went on in the C-suites of Texas Health Presbyterian and Texas Health Resources in response to the presence of three Ebola patients was about public relations, protecting the reputation of the hospital, and particularly celebrating its very well paid MBA CEO. Of course if leaders focus on public relations, maybe they will not do such a good job supporting the health care professionals who actually care for patients, and ultimately supporting the patients' and the public's health.
So as I said a while ago about this case, the rise of generic managers who value, among other things, favorable public relations perhaps to the detriment of patient care, threatens the US' ability to care for acutely ill patients, especially in the context of new or epidemic diseases. True health care reform would restore leadership by people who understand the health care context, uphold health professionals' values, are willing to be held accountable, and put patients' and the public's health ahead of self-interest.
Tuesday, 3 March 2015
Princess Health and Build Your Own Yogurt Maker, Sous-vide Cooker, and All-purpose Fermenter for $40. Princessiccia
I make a half gallon of yogurt, twice a month. I like making my own yogurt for many reasons, but it's a bit of a pain. Since I make large batches, I can't use a standard yogurt maker. I often get distracted and over-heat the milk, and the method I use to incubate the yogurt is wildly inefficient (my beloved Excalibur dehydrator). I also need a constant warm temperature for various other fermentation projects, and that's often difficult to achieve with the tools I have.
I finally found a better solution: a temperature controller that accurately regulates the temperature of a slow cooker by turning an outlet on or off. I simply set the temperature of the controller, place the temperature probe into the slow cooker, and plug the slow cooker into the temperature controller outlet. The slow cooker then stays at whatever temperature I want. Here's what the temperature controller looks like:
Once built, the temperature controller with or without the slow cooker can be used for a variety of other tasks (including regulating cooling devices). Here are some ideas that come to mind:
You can build the whole thing for about $40, including the slow cooker.
Read more �
I finally found a better solution: a temperature controller that accurately regulates the temperature of a slow cooker by turning an outlet on or off. I simply set the temperature of the controller, place the temperature probe into the slow cooker, and plug the slow cooker into the temperature controller outlet. The slow cooker then stays at whatever temperature I want. Here's what the temperature controller looks like:
Once built, the temperature controller with or without the slow cooker can be used for a variety of other tasks (including regulating cooling devices). Here are some ideas that come to mind:
- Sous-vide cooker
- High-capacity yogurt maker
- Bread dough riser
- All-purpose thermophilic fermenter (e.g., for tempeh, natto, koji)
- Beer/cider/wine fermentation temperature controller
- Kegerator controller
- Freezer-to-fridge conversion
- Egg incubator
- Soil temperature controller for seed starting
 |
| Don't worry, I'm not turning into a food blogger. But this sous-vide-cooked chicken I made with my DIY temperature controller was pretty tasty. I used this recipe from NomNom Paleo. |
Read more �
Monday, 2 March 2015
Princess Health and Rideout Hospital, California: CEO Pinocchio on quality of patient care during hospital computer crash. Princessiccia
Appeal-Democrat healthcare IT crash healthcare IT risk Patient care has not been compromised Rideout Hospital Robert ChasonEHRs and other clinical IT are touted as essential to improving safety, among many other benefits.
Yet when hospital systems crash, the common refrain by hospital executives to the press, when such stories are reported, is "...but quality of care was not compromised."
In fact, I've made an indexing term for this refrain. The following query link retrieves the posts so indexed, numbering almost 30 at present: http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised
One hospital in California 40 minutes north of Sacramento had a crash and its CEO made exactly that claim. However, a patient's husband disagreed, and called the CEO a liar. Why? His wife was affected by the crash in a very unsafe manner.
The Appeal-Democrat is a local news source for Sutter and Yuba counties, California, serving readers since 1860. Emphases mine:
Claims that hospital paralysis through health IT outages and malfunctions don't compromise patient care insult my intelligence. Such claims insult the intelligence of patients and their families, too. Outages and malfunctions nearly always compromise the quality and safety of care.
Patient safety is put at risk because hospitals are not making adequate efforts to keep these systems up 24x7. Many might say they can't afford it. You don't put in life-critical information systems half-baked, however. Not in medicine, anyway.
Yet when hospital systems crash, the common refrain by hospital executives to the press, when such stories are reported, is "...but quality of care was not compromised."
In fact, I've made an indexing term for this refrain. The following query link retrieves the posts so indexed, numbering almost 30 at present: http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised
One hospital in California 40 minutes north of Sacramento had a crash and its CEO made exactly that claim. However, a patient's husband disagreed, and called the CEO a liar. Why? His wife was affected by the crash in a very unsafe manner.
The Appeal-Democrat is a local news source for Sutter and Yuba counties, California, serving readers since 1860. Emphases mine:
Letter: Re: Rideout Hospital computer problems
http://www.appeal-democrat.com/opinion/letter-re-rideout-computer-problems/article_4a408cc0-be47-11e4-9b7b-93c22da930d4.html
Friday, February 27, 2015
I am writing in regard to comments made by the CEO of Rideout Hospital regarding its recent computer crash.
He said quality of care for patients had not been compromised during this incident. He is lying.
My spouse went to Rideout almost two weeks ago and had a Lexiscan of her heart when the computer system went down. The hospital doctor released her and assured her that if anything were wrong, the radiology department would spot it and she would inform us.
Here it is two weeks later and now they are saying because of the computer problem the entire test didn't get to her cardiologist until today. They think she may have had a minor heart attack and needs further cardiac intervention.
Is this the new "open and improved" truths we are getting from this hospital? Rideout CEO Robert Chason misinformed us all.
I am sure my spouse, who has fallen through the cracks during this inexcusable lapse in Rideout's technical policies, is not the only patient suffering similar situations.
Shame on Chason for minimizing the effects of this catastrophe at our local hospital.
Edward Ferreira
Yuba City
Claims that hospital paralysis through health IT outages and malfunctions don't compromise patient care insult my intelligence. Such claims insult the intelligence of patients and their families, too. Outages and malfunctions nearly always compromise the quality and safety of care.
Patient safety is put at risk because hospitals are not making adequate efforts to keep these systems up 24x7. Many might say they can't afford it. You don't put in life-critical information systems half-baked, however. Not in medicine, anyway.
Finally, the press, by accepting these Pinocchio-like statements from hospital administrations without severe challenge, only promote cavalier behavior of hospital executives.
 |
| Hospital executives: EHRs are so absolutely essential to patient safety, we spend hundreds of millions of dollars on them. When they crash, however, patient care is never compromised. |
-- SS
Princess Health and Turn, Turn, Turn - Another Health Care Revolving Door Update. Princessiccia
CDC CMS corporatism Covidien DHHS Medtronic Merck ONC revolving doors UnitedHealthIt has been a while since our last revolving door update, so it's time to take another spin.
Summary of the Revolving Door Phenomenon
Before we get to some cases, though, let me summarize an important article on the revolving door that came out since. This was published by U4, the "anti-corruption resource center" NGO based in lovely Bergen, Norway. The title was "The Revolving Door Indicator: Estimating the distortionary power of the revolving door." Although it's main point was to summarize a new measure the importance of the revolving door in a particular economic sector, it started with a very useful summary of the revolving door phenomenon. It included a useful definition
To expand,
It also included some idea of prevalence
We will discuss what the U4 report said about the implications of the revolving door after a quick review of the cases we have run across since May, 2014, involving the US government. They will be listed in order of their appearance in the news.
Former National Coordinator for Health Information Technology and Colleague at ONC to Aledade (Company Supporting Accountable Care Organizations)
In June, 2014, various versions of this story appeared. The Modern Healthcare version stated,
Note that the current concept of the "accountable care organization" [ACO] includes heavy dependence on the electronic health records (EHRs) and other health information technology that Dr Mostashari had been so vigorously promoting as head of the ONC, so this transition seems to fit the revolving door rubric.
It also turns out that one of Dr Mostashari's former ONC colleagues was already at Aledade
Former US Senators to Lobby for Medtronic and Covidien
In August, 2014, per Bloomberg,
Note that as Senator, Breaux had an important role in health policy, particularly the passage of the Affordable Care Act (ACA).
Former Assistant Secretary of Health and Human Services to Drinker Biddle & Reath (Lobbying Firm)
In August, 2014, per the Washington Post,
This seems to require no further comment.
Former Federal Trade Commissioner to Herbalife
In October, 2014, per the Hill,
Note that the FTC devotes considerable energy to health care issues, and Herbalife styles itself a "a global nutrition company" which makes "weight management" and "energy and fitness" products.
Director of US Centers for Disease Control and Prevention (CDC) to Merck as President of Merck Vaccines, then Executive Vice President for Strategic Communications, Global Public Policy and Population Health
In December, 2014, per a news release on BusinessWire,
Note that
From UnitedHealth (Optum Subsidiary) Executive to Administrator of the Center for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services
In January, 2015, per the Business Journals,
Apparently nothing succeeds like failure.
Discussion
I apologize for the somewhat desultory way I have been summarizing health care revolving door cases. My excuse is that such cases are almost never publicized as such. Most of the stories above were found when looking for something else. Despite its potential importance, the revolving door phenomenon gets little consistent coverage in the news media, and the particular issue of the revolving door affecting health care is particularly anechoic. (If one searches for "'health care revolving door," one finds discussion of patients who are frequently re-admitted to the hospital.) There is one website devoted to the revolving door affecting the US government, (OpenSecrets.org has a database here.) However, it is not searchable by sector, and seems not to be complete (that is, for example, it fails to contain most of the cases I listed above).
None of the cases above got more than minimal media coverage, yet they all involved people who at one time held high government positions, including US Senators, director of the Centers for Disease Control and Prevention (CDC), a Federal Trade Commission (FTC) commissioner, the director of Center for Medicare and Medicaid Services (CMS) within the US Department of Health and Human Services (DHHS), an Assistant Secretary of DHHS, and the National Coordinator for Healthcare Information Technology. So the anechoic effect persists regarding this issue.
Yet the revolving door is a significant issue. As discussed in the U4 article,
Also, the principal way the revolving door can benefit a company is...
Furthermore,
So,
Finally,
Summary of the Revolving Door Phenomenon
Before we get to some cases, though, let me summarize an important article on the revolving door that came out since. This was published by U4, the "anti-corruption resource center" NGO based in lovely Bergen, Norway. The title was "The Revolving Door Indicator: Estimating the distortionary power of the revolving door." Although it's main point was to summarize a new measure the importance of the revolving door in a particular economic sector, it started with a very useful summary of the revolving door phenomenon. It included a useful definition
According to Transparency International UK, the term 'revolving door' refers to 'the movement of individuals between positions of public office and jobs in the private sector, in either direction.'
To expand,
The revolving door involves two distinct types of movement. The first is from the public to the private sector, as regulators (ministers, cabinet secretaries, legislators, high-level officials, advisers) leave the public sector to enter the private sector they have regulated. The second is from the private to the public sector, as high-level executives of regulated companies enter the executive branch, the legislature, or key regulatory agencies.
It also included some idea of prevalence
The revolving door is particularly common in countries where explicit bribes cannot be paid safely, and thus regulators look forward to future employment with the regulated firms
We will discuss what the U4 report said about the implications of the revolving door after a quick review of the cases we have run across since May, 2014, involving the US government. They will be listed in order of their appearance in the news.
Former National Coordinator for Health Information Technology and Colleague at ONC to Aledade (Company Supporting Accountable Care Organizations)
In June, 2014, various versions of this story appeared. The Modern Healthcare version stated,
Dr. Farzad Mostashari, former head of the Office of the National Coordinator for Health Information Technology, is starting a new firm, Aledade, to help independent primary-care physicians form accountable care organizations. The startup has $4.5 million in seed funding from venture capital firm Venrock.
Independent practices looking to form ACOs have to expend money 'to hire the people, to get the agreements, to get the licenses, to do the legal work, to hire the executive director, and a medical director, practice transformation, the analytics software, the data warehousing, the EHR interfaces,' he said. 'All of that takes money,' often $1 million to $2 million.
Note that the current concept of the "accountable care organization" [ACO] includes heavy dependence on the electronic health records (EHRs) and other health information technology that Dr Mostashari had been so vigorously promoting as head of the ONC, so this transition seems to fit the revolving door rubric.
It also turns out that one of Dr Mostashari's former ONC colleagues was already at Aledade
Mostashari will be joined by Mat Kendall, a former leader with the regional extension center program at ONC, who will be executive vice president
Former US Senators to Lobby for Medtronic and Covidien
In August, 2014, per Bloomberg,
Former U.S. Senators Trent Lott and John Breaux are part of a lobbying effort by companies that want to preserve the option of reducing their corporate taxes by moving their legal addresses overseas.
Nine U.S. companies that have sought cross-border mergers for tax reasons, are considering doing so or are targets of such deals have been pressuring lawmakers since April on legislation to stop the practice, federal disclosure reports show.
They include Medtronic Inc., the Minneapolis-based company that is seeking to acquire Dublin-based Covidien Plc. Medtronic paid Breaux-Lott Leadership Group $200,000 in June to block legislation from moving forward. Breaux, a Democrat, was once a member of the Senate Finance Committee. Lott, a Republican, is a former Senate majority leader.
Note that as Senator, Breaux had an important role in health policy, particularly the passage of the Affordable Care Act (ACA).
Former Assistant Secretary of Health and Human Services to Drinker Biddle & Reath (Lobbying Firm)
In August, 2014, per the Washington Post,
District Policy Group, the lobbying unit of law firm Drinker Biddle & Reath, is experimenting with a new model of using outside consultants to capture new business in the health-care field.
The group, which lobbies primarily on health-care policy, has taken the unusual step of forming an advisory board that includes external consultants. The outside advisers are not employees of the firm and instead receive a consultant�s fee, which means the firm does not have to pay their salary or benefits, but can still tout their services to clients.
The board was formed in July and is made up of four Drinker Biddle attorneys and two outside consultants, Tracy Sefl, a Democratic communications strategist, and Michael O�Grady, a health economics specialist and former Health and Human Services assistant secretary under President George W. Bush. Both Sefl and O�Grady have day jobs running their own consulting shops.
This seems to require no further comment.
Former Federal Trade Commissioner to Herbalife
In October, 2014, per the Hill,
Herbalife has hired a former federal regulator to run its compliance program as it deals with allegations of running a pyramid scheme.
Pamela Jones Harbour, who served at the Federal Trade Commission (FTC) from 2003 to 2010, has been named the company�s senior vice president of global member compliance and privacy, according to media reports.
The FTC opened a probe into Herbalife�s business practices earlier this year after lobbyists, interest groups and policymakers asked for a review.
Shortly after the FTC announced its investigation, the FBI began looking into how the direct-selling company recruits new distributors.
Herbalife is best known for its meal-replacement shakes and dietary supplement products. Harbour says she has been a Herbalife customer since 2004, according to Reuters, favoring the company�s Formula 1 shake mix.
Note that the FTC devotes considerable energy to health care issues, and Herbalife styles itself a "a global nutrition company" which makes "weight management" and "energy and fitness" products.
Director of US Centers for Disease Control and Prevention (CDC) to Merck as President of Merck Vaccines, then Executive Vice President for Strategic Communications, Global Public Policy and Population Health
In December, 2014, per a news release on BusinessWire,
Merck (NYSE:MRK), known as MSD outside the United States and Canada, today announced the appointment of Dr. Julie Gerberding, 59, as executive vice president for strategic communications, global public policy and population health, effective Dec. 15. In this newly created Executive Committee position, Gerberding, who most recently served as president of Merck Vaccines, will be responsible for Merck�s global public policy, corporate responsibility and communications functions, as well as the Merck Foundation and the Merck for Mothers program.
Note that
Prior to joining Merck, Gerberding served as director of the U.S. Centers for Disease Control and Prevention (CDC) from 2002-2009 and before that served as director of the Division of Healthcare Quality Promotion.
From UnitedHealth (Optum Subsidiary) Executive to Administrator of the Center for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services
In January, 2015, per the Business Journals,
Marilyn Tavenner's replacement at the Center for Medicare and Medicaid Services is a former executive at one of the contractors for the initially botched HealthCare.gov insurance exchange.
Andy Slavitt, former group executive vice president of United Health Group's Optum unit, joined CMS last June to help fix HealthCare.gov. Now he'll be acting administrator of CMS.
An Optum subsidiary, Quality Software Services Inc., was one of the original contractors for HealthCare.gov. QSSI developed the exchange's data services hub and a registration tool that allows users to create secure accounts.
Apparently nothing succeeds like failure.
Discussion
I apologize for the somewhat desultory way I have been summarizing health care revolving door cases. My excuse is that such cases are almost never publicized as such. Most of the stories above were found when looking for something else. Despite its potential importance, the revolving door phenomenon gets little consistent coverage in the news media, and the particular issue of the revolving door affecting health care is particularly anechoic. (If one searches for "'health care revolving door," one finds discussion of patients who are frequently re-admitted to the hospital.) There is one website devoted to the revolving door affecting the US government, (OpenSecrets.org has a database here.) However, it is not searchable by sector, and seems not to be complete (that is, for example, it fails to contain most of the cases I listed above).
None of the cases above got more than minimal media coverage, yet they all involved people who at one time held high government positions, including US Senators, director of the Centers for Disease Control and Prevention (CDC), a Federal Trade Commission (FTC) commissioner, the director of Center for Medicare and Medicaid Services (CMS) within the US Department of Health and Human Services (DHHS), an Assistant Secretary of DHHS, and the National Coordinator for Healthcare Information Technology. So the anechoic effect persists regarding this issue.
Yet the revolving door is a significant issue. As discussed in the U4 article,
The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.
Also, the principal way the revolving door can benefit a company is...
The rent-seeking channel: The revolving door is used to capture public resources, through legal and illegal means, rather than to increase production or efficiency. Transparency International UK (2011) and the OECD (2009) point out that the revolving door may lead to various schemes involving conflicts of interest, both during and after a regulator�s term in public office. This in turn generates undue bureaucratic and political power for firms using such schemes
Furthermore,
The revolving door is also related to lawful behaviours (Brezis 2013), termed 'legal corruption' by Kaufmann and Vicente (2011). This phrase refers to 'efforts by companies and individuals to shape law or policies to their advantage, often done quasi-legally, via campaign finance, lobbying or exchange of favors to politicians, regulators and other government officials. [�] In its more extreme form, legal corruption can lead to control of entire states, through the phenomenon dubbed �state capture,� and result in enormous losses for societies'
So,
Firms connected through the revolving door may therefore derive undue advantages by legally and illegally influencing the formulation, adoption, and implementation of laws, regulations, and public policies. For example, when firms are connected to (former) members of Parliament [or the legislature], they may influence the enactment of laws and regulations in their favour. When firms are connected to (former) ministers [or in the US, cabinet secretaries] and their advisers, they may influence the upstream formulation and implementation of policies and regulations in their favour. When firms are connected to (former) high-level officials, they may influence the downstream implementation of regulations in their favour.
Finally,
Empirical studies suggest that the revolving door gives firms political and bureaucratic power that enables them to divert state resources by biasing public procurement processes (Goldman, Rocholl, and So 2013; Cingano and Pinotti 2013), obtaining preferential access to public finance (Faccio, Masulis, and McConnell 2006; Boubakri et al. 2012), and unduly benefiting from tax exemption, arrears, and subsidies (Faccio 2010; Slinko, Yakovlev, and Zhuravskaya 2005; Johnson and Mitton 2003).That all suggests that the revolving door in health care ought to get attention beyond posts in Health Care Renewal, but so far there has been precious little of that. The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients' and the public's health. Once again, true health care reform would cut the ties between government and corporate leaders that have lead to government of, for and by corporate executives rather than the people at large
Therefore, firms politically connected through the revolving door tend to shape laws and regulations in their favour and to divert state resources to their own benefit. They are unlikely to gain a productivity advantage, and indeed may reduce productivity in the private and the public sectors. The literature on state capture and political influence (Hellman and Kaufmann 2004; Hellman, Jones, and Kaufmann 2003; Slinko, Yakovlev, and Zhuravskaya 2005) supports the thesis that such distortions result from the high concentration of political and bureaucratic power among a few powerful firms.
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