CHCCFINC. A Christian healthcare blog

We live in societies that shape the beliefs each one of us hold dear and although everyone’s beliefs are different in nature we in fact share many

7 years war

similarities to what others believe. This similarly of belief depends in large part due to our historically shared cultures. Of course, the spectrum of values within each culture is varied; right down to the individual but majorities in belief do occur and even between disparate societies themselves. In order for us to see why our American culture is the way it is and why we are having trouble in defining what we can as a society deem moral we have to look back in time.

If we go back to our founding fathers and then move forward in time, you will find our what we viewed as ethical shaped by ethical theories such, Utilitarianism, Deontology, Rawlian Social Justice, Divine law and Natural law theories. These ethical value clusters were pretty much grafted into our culture through English common law, puritan theology, Lockean individualism, populism, associationism, and by the French enlightenment. Like it or not, this is what we now have to work with. With all these ethical theory’s of what is right and wrong, you can see why we as a nation today are so divided. Later on ethical theories such as Hobbes social contract, and recently Feminism have been added to our American value system.

Our collective American values are what we see in our culture today. After studying these value systems outlined above it is my opinion that what we are seeing today is a direct split between such theories as Divine Law, Natural Theory and Hobbes social contract. These theories makes up a large part of our Americans value system. As for me, when I write such articles for my blog I maintain my personal objectiveness as best as possible. What I believe as morally right and true in this two part series is withheld to make objective points on the subject. Please bear with me on that one and understand if possible.

I believe Hobbes social contract makes up a large part of our American value system, in part because Lockean theory was quite common during the American colonial era and written in our constitution, embodied into it at the time. It is visible in the rights and laws we have today in America. Throughout our history, natural rights and institutional agendas as well as community social bonds have required the strength of contract law to balance our personal wants with our community needs. This can be seen since the founding of Mosaic law and before. It is these contract laws that are prevalent in America today that balance our personal wants with our community needs.

However, an overview of major Western European ethical theories is required to see the context of our American values. This overview of western European ethical theories is necessary because it is these Western European beliefs that form our current value systems and the values of our society, they may form a majority or many minority view points but they make us as Americans what we are and what might need to change. These European and American values are what we use to define what we consider right or wrong. According to James Rachels, “Morality is, at the very least, the effect to guide ones conduct by reason- that is the best reasons for doing.” When we are faced with a decision, were one option would benefit ourselves but hurt someone else and another option to help someone else but hurt ourselves which one would we pick? Would we rather promote the good of others rather than ones own good? Of course we would say I would help the other person but would you really? Hypothetically, what if you were on a life raft and you had a choice to save yourself or give up your seat to a drowning person, knowing that if you did you would then have to get out of the boat and drown instead, would you do it? Is this a Christian philosophy, utilitarian, a social justice philosophy? What if I were to say all three? Can there be a basis for minimum moral truths we can all agree on? Would this end the constant strife we have against what we view as competing values? I sure hope it would.

An example: Let me quote from the Bible Mathew 5: 40-42 “40. If anyone wants to sue you and take away your tunic, let him have your cloak also. 41. And whoever compels you to go one mile, go with him two. 42. Give to him who asks you, and from him who wants to borrow from you do not turn away.” -NKJV

baby crying

Now a definition of utilitarianism:  It is the theory of personal values that decisions should be made such that the outcome should satisfy the most people, or give the most benefit, prompt the least pain and provide the most happiness to the most people possible.

Similar? Maybe? Can we agree that being kind to one another, promoting happiness without being amoral about it and helping one another is a good thing for society? If you were Christan, agnostic or an atheist could you agree on this? I would hope so and why should we all agree on this? So we can have our children grow up in a world without fear of a nuclear war, war in general, hate crimes, violence, poverty, hunger and disease.

Lately the world has much to worry the masses over. Most people know it only from

minute glances at the news channels. It only takes a second to see bad reports covering everything from guerrilla wars, ethnic cleansing, arms races, earthquakes, world poverty, and of course the largest oil spill in human history. However, course there have been beautiful shining star examples of hope and love in the past few years of humanities compassion for each another. Just a few examples are when Americans pulled together after the September 11 World Trade Center bombings, the humanitarian aid which poured in after the countries after the 2004 Indian Ocean tsunami, the aid which reached the Haitian’s after that countries 2010 earthquake, the global effort to contain the pandemics of SARS and H1N1. In the past few years, we have seen brilliant minds come together to drive scientific progress toward cures for HIV/AIDS, cancer and in the elimination of Malaria.

However, it seems the world has always been pulled toward both good and bad. We tend to act like double-edged swords toward ourselves. If you were brave and you asked someone would you rather help someone in need or hurt them, do good or bad of course, a rather redundant question the answer would be something along the lines of, “Well, I would never hurt someone, at least not intentionally.”

Then why is there so much damn suffering in the world? Why do people hurt each other; tribal wars in Somalia, with Apartheid in South Africa, the crisis in the Balkans, landmines that still blow up little children in Vietnam, the ethnic cleansing in Darfur, the regime of North Korea where death by starvation is commonplace, or the wholesale annexation of Tibet by China? Why do people start wars, commit fraud, create massive Ponzi schemes steal or just plain hinder progress?

One of the many reasons might be how easy we are swayed by popularity, group pressures, the need to be wanted, the need to succeed, the wants of pride and wealth. We think either we need to go along or we want to in order to get. What if we all were to say no to following the crowd? What about that stuff that is deep inside us? What drives our soul, our ethical fortitude? Let me explain. How strongly do you believe in what you believe and why? Do you know what you believe before making certain actions; before you have to decide to do or not to do them?

Ask someone what he or she believe and they will usually respond by mentioning their faith, religion or philosophical mindset. They may mention they are Christian, Atheist, naturalist, evolutionist, Pagan, Catholic, Baptist, Methodist, Hindi, Islamic, Buddhist, Taoist and the list can go on. Maybe we would not have so many conflicts if we could all realize that although religions, faiths and philosophies differ in many ways, each of these have as their foundation fundamental ethical truths that we can all agree on and make decisions on. If we believe these as truth then we can make good ethical decisions together. The other option is gridlock, strife and turmoil. We have all seen where that leads this world. If you have a faith or prescribe to a religion, a type of ethical lifestyle, how accurately do you adhere to its principles, its morals and its rules? If you are an atheist what moral laws do you align your actions to? I mean how closely do any one of us follow what we believe when we make everyday decisions? Can we voice our beliefs in words? What disturbs me is the answers to any one of these questions, because more likely they will be pretty vague. You cannot compromise with others if you do not know what you are willing to give up, what you are not willing to give up and what you are willing to take. You might get a muted response to the above questions, something like, “Well I just like to do good things for people and be a good person?” Ah, but what is good? How would you define it? Don’t lie, don’t steal, don’t cheat, don’t murder and so on.

Pin this dilemma on someone and you might understand my point: What if you pose this hypothetical situation to deal with to someone: It is World War II and a Nazi SS troop is going house to house looking for concealed Jews. You have hidden a Jewish family in the attic of your house. An SS soldier enters your house and asks, “Where have you hidden the Jews?” Would you lie and say, “I have not hidden anyone.” Alternatively, would you tell the truth knowing that the family would face certain death at the hands of the Nazis? Most people, including me would lie to save the hidden family from the SS soldier. Does that mean I or we advocate lying? -No, not really.  Okay for conditional lies? Then well, how conditional? Should you lie to save your job? What if you had to lie to prevent yourself going to jail?

In society today we seem so much more in a permanent state of chaos, upside down and constantly changing, if we all had a more unified view of what is morally right and morally wrong it would bring this world a bit closer together. Can we lessen the polarization between us all that apparently has caught us by surprise in the last twenty years? Thought common understanding I think so. Are there truths we can all agree on and act on? Can this world gather around small truths so we can agree to stop fighting each other, stop ourselves from all this war? I believe we can. In the second installment of this series I will cover major moral philosophical theories based on two of my favorite books on morality:

The Elements of Moral Philosophy by James Rachels

Biomedial Ethics by Thomas Mappes and David Grazia

What does this have to do with our Children? Would you want to raise your children in a world constantly at war with itself? Would you want your grandchildren to grow up in a world full of disease and hunger?

“Bear” with me guys, I am moving my blog over from blogger and have to strip out a lot of HTML formatting behind the scenes so it will look rough for a little while! Check back soon though!

Update: 7-29-10 (still working on it)

Imported Crude Oil

There are over 1000 toxins known to be in crude oil, the same type of oil that has been gushing from the sea bed of the Gulf of Mexico for 30 days now. Because of how a spill like this will affect the humans involved in the cleanup I decided to write a quick list of some of the major toxic compounds in crude oil that are known to be a health risk to humans. Of course this does even touch the list of issues that will occur up and down the whole gulfs food chain. Long after the clean-up has finished those hired or volunteering in the effort may face damage to their health. They are the ones might have to come home from a doctor’s appointment years after the news stops reporting and tell their family the tragic results of the tests that the doctor had to run on them. They are the ones who will have to put their lives and their family’s lives on hold to treat the chronic medical conditions that have developed long after we stop protesting and fill our gas tanks up again to drive to store.

Petrol-chemicals have the ability to penetrate any biological barrier some examples being such skin, the mucus membranes of a person, and a person’s lung tissues. Petrochemical toxins are also fat soluble and so can be stored quite a long time in the fatty tissues of people and animals. The liver takes fat in the body during fasting and converts it to energy; these stored toxins thus are released into the liver for processing due to a person’s metabolic processes.

Crude Oil contains aromatic hydrocarbons. It is interesting to note that when you eat a burger the fat is broken down to fatty acids which have hydrocarbon chains. Hydrocarbon chains are in oil, hmmmmm? Most crude oil toxins are in a class of chemicals known as xenoestrogens which the body recognizes as a type of estrogen or which it can take and break down into estrogen. In our bodies fatty acids are primarily used to produce hormone-like substances that regulate a wide range of functions and they are manipulated by cancers for their own growth.

If a person inhales enough of crude oil vapors the side effects can include nausea, dizziness, respiratory problems and headaches. Pregnant women who inhale a large quantity of crude oil fumes can suffer miscarriages along with smaller birth weights for babies carried to term. Not only are the vapors of crude oil toxic but they are often released in large quantities during an oil spill, this is because of the nature of the toxins in oils, they are aromatic and saturated hydrocarbons. Hydrocarbons have very low boiling points. The boiling point of crude oil hydrocarbons is low enough that only warm weather is required to evaporate them into the air.

Studies before the gulf spill have shown that the neutral extractable (methylene chloride) fraction of biodegraded Alaska North Slope crude oil is responsible for much of the toxicity to fish embryos found at that site. Other airborne toxins after an oil spill also include toluene, benzene and polynuclear aromatic hydrocarbons. Those toxins are known to be cancer-causing agents. Benzene has been linked to childhood leukemia. It is also listed and recognized as a neurotoxicant. Neurotoxicants are known to induce confusion, fatigue, irritability, and other behavioral changes. Neurotoxins affect the central nervous systems of animals. In addition, methyl mercury and lead are also found in crude oil. These toxins cause central nervous system toxicity, and can also cause degenerative diseases of the brain (encephalopathy).

My the price we pay (not at the pump for unclean energy)….

Okay but enough about oil, how about natural gas and the process of fracking:

Here is an open discussion on fracking at Gizmodo:

http://gizmodo.com/5595590/is-hydraulic-fracturing-for-natural-gas-ruining-peoples-lives

Healthcare costs are to put it mildly an anchor around the necks of families these days, tie that in with a mortgage and car payment and we have a real issue. You can’t pay for everything, something has to give and more often than not it is your health insurance forms. A family of four can have annual premiums up in the thousands, not to mention co-pays deductibles and the pharmacy bills thrown in. What if your job does not offer you health insurance, or you own your own business, what then? You might have to get a private market plan, but then how can anyone realistically afford it? Disappointed? Truth is not many people can. I know a guy who has a real successful car dealership but he has no health insurance, maybe too expensive right? There might be some alternatives to the private market that may just get the bill for health care low enough so you and your family can afford it.

There are a couple of strategies to go about this- you need to ask yourself some questions?

Do I belong to any groups or have a membership some place?

Does my field have an association I can join?

Do I belong to a chamber of commerce?

Do I make too much for Medicaid but too little for a private health plan?

We will answer the last question first. Many states like NY offer the Family Health Plus plans which allow a person or family to make some multiple of income above the poverty line and still qualify for subsidized health care. Here is the link for NY, but do a search with your own state, or head to your states government website where you may be able to find the link there under the Department of Health and Human Services:

http://www.health.state.ny.us/nysdoh/fhplus/

Home away from home

Are you a student still, many college students under 25 can still be covered under their families health plan, but what if your over 25? Many colleges offer some type of health plan of their own, however many do not advertise it so well.

Here is a good example of a health plan from NYU found right on their web site:

http://www.nyu.edu/shc/about/insurance.html

International Students:

http://web.plattsburgh.edu/admissions/international/currentstudents/healthinsurance.php

Are you a small business? Do you belong to a local Chamber of Commerce- if you do good news, they offer group health insurance! Here is an example:

http://www.orangeny.com/cwt/external/wcpages/chamber/chamber-health-plans.aspx

And another:

http://acchamber.org/HealthInsuranceProgram.aspx

Belong to a Sorority, Fraternity or an Alumni? You may be in luck because they may offer health options you did not know about.

Here are some examples:

http://www.alphaxidelta.org/index.php?src=gendocs&ref=Alumnae_Services&category=Alumnae

http://www.alumniinsuranceprogram.com/iv/insurance/index.asp?assnid=726&all=yes

http://www.padcommunity.org/page.php?page_id=9215

Belong to a professional organization, an example from The American Institute of Certified Public Accountants

http://www.aicpa.org/About+the+AICPA/Membership+Information/Regular+Membership.htm

The Writers Guild of America

http://www.wga.org/content/default.aspx?id=63

And one last one from the National Association for the Self-Employed

http://www.nase.org/Membership/MembersBenefits/BenefitDetails.aspx?BenefitId=38

So you can get in twice!

Maybe health insurance companies can offer double coupon days so we can save more when we go shopping (sigh…)

Yes, our healthcare system is not functioning the way we would like it but then what large system does these days? You kind of have to take what you have and make the best of it right?Angry  We need to be proactive and make the crooked roads straight. Now that everything is poking into our wallets and purses for the cash inside, we must fend the bills off- cut them as much as we can. One way we can is with prescriptions medications. With many families losing there health insurance and those still with insurance, their premiums are on the rise, cutting prescription bills can be easier than we think. One way we can cut prescription costs is through generics. I will show you who is offering generics on the cheap and the lists they keep, but before I do a couple of pointers you may not know of:

Endless Paperwork

Pharmaceutical companies spend a lot of money on research to develop new medications, once these medications come to market they must recoup their investment in the development of the drug and add their profit. Now the profit part is debatable, but they do this by sending sales representatives to hospitals, clinics and various doctors. These sales reps bring in samples and offer food, trinkets and provide various educational advice on the medications their company is promoting Gift with a bow, mostly brand name high cost medications. This has the effect of keeping these new brand medications in the doctors mind when he or she writes a prescription for you. It is not collusion, just the way sales works- you see a the same toothpaste commercial on TV long enough you just might pick that brand up without thinking about it at the store next time you go in for milk, bread and soap.

Knowing this when you go to the doctor, bring in your insurances medication formulary. If the doctor prescribes a medication, check the formulary and if its on there okay, then check the tier, if its third tier watch out your going to pay a good sized co-pay. If the medication is brand and it is not on the list, it will be full price. I cannot tell you how many times I have seen someone almost pass-out when they go to the counter at the pharmacy and when they go to cash out find out their prescription costs 300 dollars or more (it was off formulary) the typical response is NO! NO! I have insurance, yes but not for that perception. Embarrassed Unfortunately, this is what it has come to and we must be proactive! If the drug is not on the formulary ask the doctor for an equivalent that is on the formulary, the doctor would be glad to do so because they have to deal with the same insurance issues you do for their practice!

If you go to the pharmacy and your prescription gets filled and they tell you its not covered or is 300 dollars when you know its covered, don’t fight with them- you will lose. Calmly go back home to your computer and go to your insurance website, look for their prescription formulary, you should be able to print it out and bring it to the pharmacy. Once the pharmacist or pharmacy tech reads it they will change their mind and you win again my friend!

Okay, generics: These are the places you can go to find generic plans many pharmacies and food stores have lists of over 300 types. I have the direct links here where available, but being the internet links are outdated quickly, if a link goes bad just go to the site itself- it will be there somewhere. Also ask your doctor for a generic and if you later find a brand name has a generic tell him to change it, you need to eat as well…

CVS

http://www.cvs.com/CVSApp/images/promotions/landingpages/rx/rx08037_health_sav_pass/health_savings_pass_medicationlist.pdf

Good Neighbor Pharmacy

http://www.gnppsc.com/downloads/GNPPN_Generic_30-day.pdf

http://www.gnppsc.com/downloads/GNPPN_Generic_90-day.pdf

Kmart 5 dollar 10 dollar and 15 dollar generics also over 50 women’s medications for 25

http://www.kmart.com/ue/home/kmart_pharmacy_5_dollar_list_jan2010.pdf

Kroger

http://www.kroger.com/generic/Pages/alpha_listing.aspx

Giant Stores 9.99 generics and free antibiotics

http://images.giantfood.com/media/pharmacy/generic_drugs_gntl_20091112.pdf

Giant Stores list of 14 day free antibiotic prescriptions

http://images.giantfood.com/media/pharmacy/antibiotic_list_giant-1.0.2.pdf

Medicare Prescription Drug Plan Finder

http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp?version=default&browser=Firefox|3.6|WinNT&language=English&defaultstatus=0&pagelist=Home&ViewType=Public&PDPYear=2010&MAPDYear=2010&MPDPF_MPPF_Integrate=N

Publix offers several generic oral antibiotics which are free, just bring in your prescription and receive a 14 day supply

http://www.publix.com/freeantibiotics/

Rite Aid

http://www.riteaid.com/www.riteaid.com/w-content/images/pharmacy/20100203_EVRA947_RXSavings_Directory.pdf

Shop Right

http://www.shoprite.com/Cnt/documents/SR-90GtoBFINAL03.03.10.pdf

Target Generic list actual url sort by alphabetical or by condition 4 and 10 dollar 30 day, 10 and 24 dollar 90 day

http://sites.target.com/site/en/health/page.jsp?contentId=WCMP04-040590

Walgreens

https://webapp.walgreens.com/MYWCARDWeb/pdf/Value-PricedGenericsList.pdf

Walmart

http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

Happy hunting and remember why we are doing this next time we have to vote…

How many times have you heard that you must outsource to remain competitive? Crying We need to reduce labor costs… Surprised American’s can’t produce high quality industrial products? Well I thought a message about the opposite would influence the few -maybe save a few jobs, a few family incomes. We tend to have forgotten the long by gone days where the employee was treated well first, then the customer, then the shareholder- in that order…Well paid, tenured employees mean well fed and happy families who can then go to the store to buy products. Here is a good example of a company which stood its ground not only here but now exports its products from the US worldwide, Lincoln Electric.

The American Way

Lincoln Electric produces arch welders for a variety of industries with its headquarters located in Ohio. Lincoln was established when James Lincoln joined his brother who had created the company only a few years before 1097. The brothers believed that a strong, motivated person through reward could accomplish great things. Everyone had the capacity in them to do extraordinary things and become who they wanted to be…

Could this still apply today?

Lincoln’s treated everyone equal from manager to assemblyman, success was based on high levels of productivity, individual effort from its employees and the sharing of its gains as a company with consumers, employees and shareholders. Lincoln as a company practiced an open door policy where barriers to communication between “workers” and managers were eliminated. Lincoln’s culture is merits based not privileged based on title or seniority. You are rewarded well for your work, if you work well. How can a company such as this still be competitive in today’s economy?

Simple answer: The rules did not change, we think they did. Sarcastic

As Lincoln Electrics business began to expand the company considered entering foreign markets. However they as a company were told the stereotypical adage: “American goods don’t sell well in other countries” (being Europe)

Lincoln at the time (during the early 1990s) decided to accept the advice of its European distributor counterparts and began to set up wholly owned subsidiaries in other countries to manufacture Lincoln equipment locally.

However, it was not long before Lincoln’s foreign ventures failed to deliver the gains forecast. This was because Lincolns American organizational culture and work system was resisted in the countries with which it set up manufacturing and distribution locations. Local managers in those countries in which it owned subsidiaries were unwilling or unable to enforce Lincoln’s individual effort, merit based corporate culture.

Well, after roadblocks in Germany and Brazil, and issues in Japan and Venezuela, the company went with its heart and shifted to what they originally had planned to accomplish- exporting quality made arc welders to compete with those made locally in other countries.

And you know what, not only did they compete with other countries products on their own soil but out sold them on their own turf. Contrary to what foreign distributors had told them, their products did quite well in Germany. Lincoln did not have to set up partnerships in that country, but it could export their goods directly from America to them.

From then on the company focused on exporting welders and has done well, as it always has…made in America and made well, by well compensated employees.Party

Swim upstream when everyone is surfing down to the bay….

lincolnelectric.com

I have been pouring over a lot of healthcare statistics lately, among them the costs of maintaining a hospital and what can be saved from their budgets. Of many of the topics I looked at are paperless script systems, EHR/HIT systems,

bar-coding systems, and how insurance claims are allocated. Another topic I have gone over is the cost in medical errors, specifically medication errors. Nurses this time are most often charged with medication errors when they occur because they are most visible when they reach the patient. This then brought me to find ways to reduce those errors. On a rabbit track I headed off into the culture they have with there hospitals and their administration. I found that their is a reluctance to report errors because of a lack of support. If Nurses do not report self made errors whether it was systemic or not there is no real way to re-design a hospitals infrastructure to lower those error rates and save more lives and cut the costs of such disasters. I call this a social contract between nurses and their healthcare organizations. Social contracts have rules just like written contracts, although not quite apparent.

The New Morality

When a nurse enters into a contract to work in a healthcare agency such as a hospital, more often than not, what he or she assumed would be the working environment there does not exist. For a Nurse in such situations there must be emotional shock occurs because in many instances the employment conditions they have to work within are poor, just ask a nurse who has gone off shift. Hospital staff is continually under stress, having to deal with overcrowding of their ER’s, having to use poorly designed outdated EHR/HIT systems, must bear with continual budget cuts, and they have to deal with lack of autonomy when deciding decisions about their own guilt or innocence- more often than non, the legal system does this for them. Hospitals have merged, closed and cut back on staffing when required. Many hospitals, especially inner-city facilities are lacking the necessary infrastructure repairs in order to keep up with federal and state regulations. Nurses are the largest workforce in a hospital and so bear the brunt of the labor that must be accomplished each day in a hospital. When a nurse is hired, they come to realize only after they are employed that the contract they step into when they began work has failed them. So after a while, I began to think of various ways to categorize hospital culture or even organization culture because I thought this might help pinpoint what needs to be altered. You cannot fix what you cannot understand. I thought there must be a type of ethics involved, it is healthcare right?

Deontology, Utilitarianism, Prudent Pragmatism, Feminism, Rawlins social justice theory, oh how-about-Hobbes social contract?

Well, Hobbes social contract offers other motives for not reporting a sharp end error or an error made by oneself then that of contract failure as other papers view it, which would be as a legal breach and not as a social one- okay

Since Hobbes social contract aligns with both the organizational structure of a hospital and the act of system information modeling, how then does Hobbes ethical theory help with error reporting? Hobbes social contract identifies what key areas trust must be established and indicates the motives as of why medication error reporting has been so lax. It shows through theory not in a legal sense but in a societal form, we agree to be civil and follow law not because we are legally bound, but because we legally bind ourselves in order to escape social chaos. We can’t just go around doing anything we want right? We would trash the world and what good would doing what we want then be? We would live in a garbage dump and have short lives. So we make contracts with each other as societies that give us enough freedom but enough law so that we can do lots of things we want but not everything we want.

In health care constituents need to define what is considered a violation of their social contract, what needs to be changed for a decline in medication errors and for there to be an increase in reporting errors to occur. Unfortunately, nurses must agree to the current set of social rules that exist in their places of work because there is no other alternative at this time, unless they disenfranchise themselves from the healthcare system.

In addition, Hobbes points to the emotional more value centered person and how his or her values and their rational mind can be over-ridden, replaced by the need for personal preservation. Hobbes social contract points out what rules must be established in a hospital setting, its clinical guidelines and how teamwork should be socially defined. Hobbes social contract points out what is required to maintain the social contract between the enforcement side and the acceptance side. Hobbes social contract also dictates when social contracts become unattainable and can be broken such as in your own self-preservation. Hobbes social contract defines a just culture of trust and fairness that can be extended into information system modeling, error reporting and into health care organizations themselves.

Okay: Here is the laundry list then:

The board of directors must uphold the social contract for which clinicians have entered into, namely to be employed in a safe and adequately staffed facility. The board must provide adequate resources in order for the hospital in order for it to function at safe and efficient levels. Within health care organizations the board of directors must place patient safety above all other goals. They must keep the CEO on target with the reductions of malpractice incidents always in focus.The CEO must guarantee or attempt to limit short-term gains for the long-term stability of her hospital. The CEO/CFO should attempt to balance hospital finances, limit ER overcrowding, limit the potential for their hospital to close and limit their hospital’s number of mergers unless they are critical to the continued function or efficiency of their hospital. Vice presidents should be visible and approachable by staff, as social contract theory demands such, that representatives who have appointed power over others be available so the social contract cannot be manipulated from above or below that level in the social contract. Vice presidents should provide an atmosphere that medication safety is everyone’s responsibility to the staff supervisor and that safety is a core value throughout the chain of command. Clinical supervisors on a continual basis should inform nurses and doctors that safety decisions are made at all levels, not just at the staff level. Supervisors should instill a value system of family-centeredness and one of empathy not fear. Finally, staff should accept a “just-cause culture” and not a system of blame. However, nurses or other clinicians can only expect just-treatment when reporting errors, if they believe they will get just treatment from reporting it and they will only believe it themselves when they see just-treatment exercised over time.

This “just-culture” will only exist if enforced organization wide. Hobbes social contract highlights the fact that the lack of error reporting is a personal decision based on morality and this morality is contract based. This contract-based morality extends not only to the staff of the hospital but to its administrators and those who develop EHR systems for them to utilize. Staff enter into contracts by agreeing to work in health care agencies and that these contracts are failing them, both written and socially unwritten ones. So if these contracts are failing them after-the-fact and errors are being produced whether by nurses or by the systems they work for, why would they report them if given a chance not to? It is not to lie but to defend oneself against a broken in hospital healthcare organizational contract that forces much burdens upon them yet little freedom to express why there errors are occurring or even if it was their fault- it could have been the poorly written script, a technician error, a bed change, improper dispensary filling, or other such behind the senses mistake. Once fair and just treatment is occurring often enough, in enough hospitals nation-wide, then error reports will increase, infrastructure will be adjusted to lower the number or errors system-wide and costs per hospital will decline for those errors, lives will be saved and we will save money too.

A social contract is as every bit as binding as a legal one, in this authors opinion.

The Elements of Moral Philosophy by James Rachels

AACN Position Statement

Healthcare At the Crossroads

Medical Errors: The Scope of the problem

Sentinel Events

We have made it through another rough year folks, now the season turns cold with a little snow on the horizon. This Christmas we can be thankful for all we have, our families, our wives and husbands, our children, our health and freedom- but I think we can be a little Grinchy about the costs we have paid in cash, jobs and homes for the spending of a few well placed influential’s. This holiday season, we should reflect on our losses and how to prevent them in the future, our kids will thank us if we set them upon the rock instead of on the sand.

The past is no predictor of the future- but since we must live through the future and the past has already been done, we need to look back, we should not make the same mistakes twice, or three times. It is uncomfortable but once we do it we can move on to create the world we all wish to live in and pass on to our grand-kids.

We have hear various figures on this one most often 11 trillion dollars, but we have to factor in all our public held debt, contractual requirements, Social Security and Medicare. This total figure of what needs to be paid sooner or later is about 56.4 trillion. Sound like a lot- it is. For a further explanation just click on this link from the Peter G. Peterson Foundation

If you feel your more of the traditional type regarding our national debt numbers you can head over to our National Debt Clock which as I type is now at 12.06 trillion- of course it rises so fast that by the time I finish this sentence its gone up a few million dollars. The clock is flash based so you can see the numbers jump in real time. A few interesting points about the clock is our debt held by foreign countries which is at 3 trillion and each persons held liabilities which is about 345 thousand- our estimated personal assets are only 242 thousand. Yes- there is the trade deficit too .

Of course we as individuals have much to blame on ourselves, in 2007 we actually out spent the amount of our gross domestic product, all funded by credit- we know how that story ended. The chart below was excerpted from NPRs Planet Money

NPR does not promotes or endorse any third party’s causes, ideas, web sites, products or services.

In terms of where we rank with the debt each person holds we are ranked 14th on a complied list of 188 above Australia and below Finland, the UK ranks 3rd with debt per capita held. For the complete chart click here-

NationMaster.com

Today a bachelors degree does not command as much income anymore, the odds of a person who has a bachelors makes is in 25 to 35 are making less than the poverty level are 1 in almost 24- this according to the Book of Odds

The world has much so much poverty we need to take a look at how this is related to health and life expectancy. This chart was created from the World Bank. Pay particular attention to the blue spheres, those countries have the poorest population with the shortest live expectancy. Poverty is related to life expectancy worldwide including at home in America- more on that in another blog article.

You buy a cup of coffee and a bagel before you go to work do you ever think about how much that costs, maybe 2.00 to 3.00 dollars? What can you do with 3 bucks? According to the World Bank and included in an article at the site Globalissues.org half the world lives on 2.50 dollars a day. Consider this as well: We spend more on cosmetics in the US that the world does on achieving basic education its poorest, 8 billion US dollars on cosmetics vs. 6 billion for basic education in developing nations- also taken from

Globalissues.org

World HungerAccording to the Food and Agriculture Organization of the United Nations, currently there are more than 1 billion people in the world who are hungry every day.

Figure © FAO, 2009- Hyperlinks to non- FAO Internet sites does not imply any official endorsement of or responsibility for the opinions, ideas, data or products presented at these locations.

Current bank right-down estimates for 2007 through 2010 as a result from our so called toxic assets (remember we live in these toxic asset houses and raise families but…) in an article by Reuters is estimated to be 1 trillion for the US and 1.6 trillion for the EU .

According to CNN’s Money and Main Street we lost approximately 1.3 trillion worth of wealth right from our pockets due to the depress- I mean recession.

According to Bread.org 16,000 children each day in the world die from hunger related illnesses. That sobering statistic also from Bread.org originates from a journal article written for the the Lancet.com

In an article by Unicef there are more than 140 million children from the ages of 6 to 11 in the world that do not go to school and school of course is one way to escape poverty. It would take 6 billion a year to put keep these children in school which according to Unicef in 1997 is less than 1% of the money the world spends on weapons.

In another Unicef report over 2 million children die each year due to poor water quality and lack of sanitation. For that article click here as well.

Average level of debt a US student graduates college with 21,000 dollars- taken from moneycentral .com

Average level of medical debt for those who filed for bankruptcy is 12,000 dollars- taken from fixourhealthcare.ca.gov

Average level of consumer credit card debt 5,612 dollars, but that is down some from last quarter- taken from prnewswire.com

So how did the world get this way- we over spent on everything, priorities and non-priorities. In a world of limited resources we (the world) not just America, borrowed from the wealthy, billions of people owe trillions to millions. Those who lent money and resources also borrowed to lend more than they could otherwise from those with still more resources. At some point the cycle becomes unmanageable, which is what we are beginning to see. What is different about today’s recession that did not occur during the great depression, many more people in the world and a greater ability to do more harm to them or more good for them. How do we reduce this debt? Simple, we learn live within our means, with moderation and return to the values of sharing.

Remember during this holiday season it is always easier to share than to have it taken out as taxes.

What about the few who hold all this debt: Careful of those who rule in high places, the last thing we should do is spend our way out of this recession- look at the messengers, isn’t that how we put the chains on in the first place?

The Rosetta Stone

Ambitious global attempts have been undertaken to analyze many countries’ healthcare systems to document what has facilitated positive change and what has not. Everyone then armed with the data sit and pour over the stacks of paper to figure out how to better our healthcare system and suggest policy. Once it gets to the sub-committee though it dies a slow death to be transformed into some would say pork or other type of species the public would rather not look at.

One such an attempt to dig into the world health care systems is the World Health Report of 2000 which used weights to create an index of quality care. Using a composite of the twelve most stoneclipartan7industrialized nations they tabulated results and ranked them. Based on how well their health system works Greece ranked 14 with universal access and national healthcare services, the United States ranked 37 with variable access and supplemental insurance and Brazil ranked 125th with universal rights but contracted and national services. The US had a rank of 7th out of 12 that encompass a national system of healthcare, but those of higher ranking invariably provide universal healthcare while the US does not.

Statistical infant mortalities also have been used as a measure of healthcare effectiveness in a country as well. Infant mortalities in studies have been measured comparatively while in other studies within countries. In Australia, it was found that the lowest two classes set above the bottom class had 23% of the total infant deaths. These were the semi-skilled and skilled working class, and not the poorest unskilled. If you think about it his has implications for the US because these classes of people, who are also within the United States, are unlikely to be poor enough for US social insurance policies but not rich enough to afford healthcare. By implication if we have a very high infant mortality and 45 million are uninsured then infant mortality is a very good indicator of those who were poorer and uninsured, but employed with an income great enough to not be eligible for state run insurance.

In other words if similarities exist among certain countries and situations with their people then you can be certain that the statistics do not lie. You cannot fight statistics, except through misinformation and fear of change.

Unfortunately, the US links together voluntary insurance with private employer insurance and social insurance to provide healthcare coverage with the largest social insurance coverage administered through Medicare and Medicaid for a total of 17.3% of the US healthcare expenditures in 2000. Each country that has mixed coverage healthcare benefits have one common detriment in that all have issues ensuring quality on all the levels the mixture provides and in cost effective means, hence the current debate on universal healthcare and cost.

Everyone wishes for high quality healthcare but measuring the quality of care and improving it can be difficult to quantify. Continuous quality improvement, total quality improvement and the ever present process re-design are just a few of the many methods available to a healthcare systems management. But how can hospitals and other large clinical facilities find the money necessary to re-design ageing buildings, and retrofit older EHR/HIT systems, or throw them out and upgrade complexly? If we rank 37th in how our health system provides for its citizens but we spend the most per capita on health care where is all this money going? Hospitals are not receiving this money, their rates from Medicare, Medicaid and HMO insurance have been cut progressively over the years. In a few words: Follow the bread crumb trail of current health insurance commercials back to the source. While watching the news count how many health advocacy commercials and the words they use are for or against universal healthcare, note words such as experimental and government run are used.

A partial explanation of how costs are incurred by a hospital and how they are locked into a poor revenue stream is noted below:

In any organization, some aspects of the entity will drive costs and other parts will drive revenue. In a healthcare organization, cost centers generally do not have contact with clients and therefore are likely to induce costs without providing the corporate entity with income, that is the hospital. Most hospital expenses are fixed until a set point when new staff, equipment or even facilities are needed which creates a credible reason for strategic planning. Hospitals are constantly planning, why? They have very ridged streams of income but it is predictable so planning for new equipment, more staff or technology updates can be estimated for and monies can be allocated over time. There is little in the way of providing profitability to the organization except for fee services and perhaps donations. But, donations are down and fee for service has just about vanished into a relic.

A few ways hospitals are getting by with less is the electronic storage of documents and data; paper charts have to be stored while electronic charts can be expanded indefinitely and shared among facilities within the system. Electronic data has the capacity to be readily available and the details of the raw information can be adjusted for the specific treatment of each patient and return patients. One such very successful system was implemented by the U.S Military, AHLA which services 9 million patients through TRICARE.

Sadly, sometimes an economic loss cannot be contained with technology, restructuring or otherwise and divestment or a selling off of unprofitable components of the organization can occur.

1 stone = 6.35029318 kilograms

With efficient patient scheduling for appointments cost savings can result as well. There are many methods to schedule appointments, some being: standard, wave, resource-based, and open access scheduling. To facilitate payment to the physician or physician group, or reimbursement for services from insurer, CPT coding is used as well as statistical implications for payment on the insurer side such as usual, customary, and reasonable payment schedules, dictated by the data the insurer obtains over time in a geographical area. So this is being creative, squeezing money from the stone. So who are the people and organizations not being creative?

In 2000 we spent 4,499 dollars per person on health care but in 2001 as quoted from the book Health Care Administration: Planning, Implementing and Managing Organized Delivery Systems: 4th ed by Lawrence F. Wolper, 48 million Americans were without health insurance. In 2000 Medicaid accounted for 15.6 percent of all health care costs, while Medicare accounted for 17.3 percent of all health care costs for that year. In the year 2000 out of pocket health expenses comprised a total of 15.3 percent of total health care expenditures for that year. Ask yourself, “Where all the other health care expenditures came from, how were they paid and by what organizations?” and “Why were so many people uninsured then and are now?”

Why are hospitals doing without, our infant mortality so high. In 2004 our infant mortality rate slipped again to 23rd in the world. Why do we spend 10 to 20 percent of our personal income on our health care bills-the out of pocket costs and premiums? It should be noted that these costs are not associated with Medicare and Medicaid, they are from employer HMO sponsored plans. Why are 100 hospitals cutting more than 50 doctors and staff at a time when we spend so much? Hospitals are hurting, we are hurting, who or what organizations are not? What organizations have had enough cash to provide lots of health care commercials during your news hour? Again a link brought up on an early post that shows how hospitals are hurting in this recession. See the bottom link on going lean for other ways hospitals are getting creative or rather money from the stone: AMA Hospital Crisis

Hospitals Going Lean

Health Reform

APHA Infant Mortality