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A Time to Reflect On Life

June 15th, 2008

With the passing of Tim Russert, we are all made critically aware of the fragile nature of life and our need to embrace every moment as a gift.  Obviously, within a split second, every aspect of our lives can change, and, as in Mr. Russert’s case, can end.  This is not a blog about instant death, and it is not just about recognizing our mortality.  It is about preparing for our passing carefully.

Russert
Liz Szabo, a writer with USA Today described in a recent article the cancer patient experience by saying, “Patients with advanced cancer often don’t know how long they have to live or how chemotherapy will affect their lives.”  According to a study by the Journal of the American Medical Association, many physicians either don’t give patients that type of information or the patients only “hear what they choose to hear, or very often misunderstand what is said to them.”

This situation often leads to patients requesting incredibly disruptive and sometimes painful therapies that have no hope of succeeding.  According to the study, more than 20% of Medicare patients who have advanced cancer begin a new chemo regimen two weeks before they die.  Many times patients are admitted to hospice days or hours before they die.

What has been observed in cases like this was that the patient often misses the opportunity to repair relationships, get their spiritual house in order or even prepare the necessary documents such as advanced directives.

Where is this going?  Sarah Harrington, an assistant professor at Virginia Commonwealth University School of Medicine in Richmond, co-author of the quoted article, indicated that “in the last few weeks or months of life, a lot of good work can be done.”

One of the points brought up in the article was that only about 37% of physicians told patients how long they had to live. This fact was not surprising to us because we have seen dozens of patients who were admitted to hospice over the years return home and live several more months or years. This particular prediction is not always dependable. The other fact quoted in the article, however, was that many patients learned more about their cases from other patients than from their physicians.

The article concluded with the suggestion that “patients and their families may have to take the initiative in finding answers to important questions.”  Thomas Smith, co-author and Chairman of Hematology and Oncology at VCU’s Massey Cancer Center suggested that the following questions should be asked by any patient in this situation:   What are my options?  Can I be cured?  Will I live longer with Chemo?  Should I consider Hospice or Palliative Care?  Who could help me cope?  What do I want to pass on to my family to tell them about my life?

Eldercare_visit
Palliative care is not limited to cancer.  All end-of-of life diagnoses qualify patients for hospice and palliative care.  Tim didn’t need or have this opportunity, but for those who do, embrace it. The primary thing that can be delivered to the patient and their family is the comfort of having caregivers dedicated to helping you move through your transition.  It is what they do.  These amazing people, volunteers, employees and physicians are dedicated to “paying it forward.”

So, as we eventually face our own mortality, as we evaluate what it is that we want to share with our families, as we consider the legacy that we wish to leave, having a clear mind and looking to those professionals who can help us is not only necessary, it is imperative. This transition can come in the blink of an eye.

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Posted in Boomers, Healthcare, Hospital, Hospital Administration, Hospital Blog, Hospitals, Medicare

$4.3 Trillion in U.S. Health Care Spending?

May 9th, 2008

“Money doesn’t make you happy.  I now have $50 million, but I was just as happy when I had $48 million.”
–Arnold Schwarzenegger

According to an article in Internal Medicine News by Mary Ellen Schneider, spending on health care in these United States is projected to reach 20% of the gross domestic product on the one hundredth anniversary of my father’s birth, 2017.  Of course that projection is only an estimate made by CMS, the Centers for Medicare and Medicaid Services.  That estimate is, of course, based upon a continued escalation of nearly 7% each year for the next nine years.  In lay terms, that escalation would mean that the total dollars spent on health care would hit $4.3 trillion…Whatever a trillion is? I still can’t fathom a billion of anything.)

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We all should realize by now that this spending in the public sector, Medicare and Medicaid, will increase due to the first wave of Baby Boomers entering the Medicare system in 2011.  My 78 million peers, like the lemmings, are working their way toward the proverbial wall, and for those of you who will have to carry the load until we are wearing our wings, that is not a pretty financial picture.

The same economists from CMS are predicting a decrease in reimbursements to physicians over the next several years while Home Health will likely grow faster than most other sectors except perhaps prescription drugs.

What does it all mean?  We are spending more on health care in the United States than any industrialized country in the world and, truthfully, our overall age of death is significantly surpassed by many of those “spending less” countries.  How can that be?  Well, for one thing, we have 47 million uninsured citizens in this country and no one really knows how many illegal aliens. Why so many uninsured?  They don’t vote.  The vast majority are young, single mothers with small children, and this does not take into consideration the illegal aliens who are also not insured.

Back to the answer. . . prenatal care is inadequate and infant mortality in the United States is still an embarrassment. A few of the countries that do better than us in the world in infant deaths per thousand are:  Australia, Austria, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Ireland, Japan, South Korea, New Zealand, Norway, Portugal, Spain, Sweden Switzerland and the United Kingdom.  Hmmmmmm?  Could it be because we spend 30% of our annual health care dollars on the last thirty days of life, and less than 4% of our monies on preventative and wellness care?

Of course, Hospice would be a tremendous help.  We could reduce expenditures on end of life care, properly care for our babies with the excess funds, and ensure that our uninsured are properly covered as well, but what politician is willing to touch that electric third rail of the electorial subway tracks?

We could begin by putting in a network of sidewalks, bike trails, and walking trails.  We could actually walk once in a while and treat our bodies like a true temple, not the “Temple of Doom.”

HospiceOne of the least often heard issues revolving around these expenditures is the continuation of our archaic hospital system.  It is based on the acute care model, and the vast majority of our diseases are chronic.  We rush the victim to the hospital, patch them up, send them home and then rush them back again without any commitment to behavioral modification.  I have seen individuals reverse their heart disease from diet, exercise, and stress management.  Why can’t we embrace this concept, reward these activities, and change our society?  The millions of bicycles in Europe are no accident.

So, as I’ve quoted in some other blogs, “Change or Die,” or just spend ourselves into oblivion as we attempt to prop up a system that should have gone out with the Industrial Revolution.  Good luck kids, your ole man needs you to keep working to cover my health insurance.

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Posted in Books, Boomers, Healthcare, Hospital, Hospitals

Managers, Smanagers…It’s Over

April 17th, 2008

Kenneth Cloke and Joan Goldsmith wrote a very interesting book entitled The End of Management. In this book, they assert that managers are the dinosaurs of our modern organizational ecology. They go on to assert that the “‘Age of Management’ is finally coming to a close.”  Their treatise is that “the need for overseers, surrogate parents, scolds, monitors, functionaries, disciplinarians, bureaucrats, and lone implementers is over. . . ”

End_of_management_cover_2If, by now, you managers are wondering what comes next, our authors assert that the new need, the true need in modern day business is for “visionaries, leaders, coordinator coaches, mentors, facilitators, and conflict resolvers.”

In a recent conversation with an “old school” manager/friend, I reached out to explain to him why he was alienating his subordinate.  I explained very carefully that management as a self-contained system fails to open the heart or free the spirit.  This approach has truly taken our organization to new heights.  Of course, one can only work within one’s comfort zones, and many managers, especially, old school managers, only know one approach, and that is, the industrial revolution way.

Let me suggest that you analyze the quality of the individuals with whom you work.  Then, step back and realize just how amazing those individuals are with “butterfly” qualities.

Do not penalize your charges because of your insecurities.  Build a team that “has your back” by empowering them to be all that they can be.

The revolution quoted by Cloke and Goldsmith is one of “turning the inflexible, autocratic, static, coercive bureaucracies into agile, evolving, democratic, collaborative, self-managing webs of association.”  From our perspective, the object is to allow those butterflies the freedom to fly.

How do you manage a butterfly?  Work together on the goals and then get out of its way.  Provide it with just the very basic, fundamental needs and goals of your organization, and then trust it, love it, empower it, and encourage it.

If I could possibly find one example that would clearly embrace our success as an organization, it is that of doing everything possible to kill “parent to child management.”  It is not enough to move into the 21st century with our thinking; it is most important to identify those individuals who get it and then give them the space “to do it.”

Are they traditional?  Do they do everything the way you were taught in the “dark ages of the industrialized style of management?”  Nope.  Will it drive you crazy when you look for them, and discover that they are not on the flower where you expected to find them?  Sometimes.  Will they accomplish more than you have ever dreamed if you treat them with dignity, respect, love and freedom?  Oh, yeah.

You see, it is not about control.  Control is only necessary for those who are not trustworthy.  Better than trying to control a non trustworthy individual, simply help them find work somewhere else.  If they don’t get the mission, don’t understand the philosophy, and don’t work to their capacity, they shouldn’t be there.

On the other hand, if they are loyal, trustworthy, committed, and caring, back off and allow them to soar, and you will never see results of the kind they that they will deliver to you or your organization.

If they look at it as a job, if they are only comfortable with myriad rules, time clocks and books of policies, they are stuck in the past.

Leadership means trust.

The End of Management, Kenneth Cloke & Joan Goldsmith

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Posted in Books, Healthcare, Hospital, Hospital Administration, Hospital Blog, Leadership

Random Thoughts. . . Learn From Your Mistakes

March 21st, 2008

Make sure you know the question before you give the answer.

My kids taught me a lot about this job. At age seven, my son said, "Dad, where did I come from?" I knew that question was coming, but I had not expected it that soon. "Son," I said, "Let me explain about life" As I began my meticulously rehearsed tale of the birds and the bees, I slowly explained the nuances of life, love and more bees.

I was perspiring profusely as I stumbled over these sensitive descriptions. After about ten minutes of squirming, stuttering and stammering I said, "Do you understand, son?" To which he turned to me and said, "Heck, Dad, I knew all that stuff. I just wanted to know what hospital I came from, Mercy or Windber?"

Learn to share.

Hospitals deal every day in life and death issues. They are extremely complex and multifarious places. Emotions can run very high as well as we deal with the challenges and mysteries of life. Helping people to share has been a very large part of my life. Helping them to share resources, time, space and all aspects of life is a very important contributor to our success as both care givers and human beings. When I was eight, my Aunt Mildred gave me three pieces of bubble gum. As I was walking home with all three pieces stuffed into my jaw, a group of kids jumped me, pinned me down, took my gum right out of my mouth and divided it up between them. It would have been a lot easier on me if I had just kept a few pieces out to share.

Finally, don’t repeat it if you don’t understand it.

In any organization there always seems to be someone who takes great pleasure in telling the story when they aren't really sure of its meaning. After standing near Jack, a 15 year old sixth grader at school one day, my vocabulary expanded exponentially. He talked about mysterious things that made no sense to me, but he was big and I was small. In my world, that meant that Jack knew all. That night when my mom told me, the little third grader, to get ready for bed, I looked up at her standing beside my grandmother, aunt and dad and said, "I don’t have to go to bed, you @$#%&*$@!"

My limp cleared up right before I had to walk across the stage to pick up my college diploma thirteen years later.

Learn from your mistakes.

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Posted in Children, Healthcare, Hospital, Hospital Administration, Hospital Blog, Leadership, Motivation, Weblogs

Horses and Health

March 13th, 2008

Due to my personal fund raising commitments this year, the staff here at my organization probably feels like hiding under their desks when they see me coming. You see, this is the year that we did a feasibility study to decide if we will have enough community support to raise needed funds to construct expanded emergency and obstetrics facilities and to provide WMC with a reserve for the future. That effort will be made public in a very few weeks.

The reason for their angst, has been that, for whatever reason, this is the year that their boss, me, has been solicited to solicit contributions for numerous other organizations in the area. As a board member for the Keystone Chapter of the American Red Cross, we worked with a tremendous group of local leaders, including our Congressman Jack Murtha, who helped us conduct a successful $300+K campaign that literally gave that organization new life.

Then we were approached by the Boy Scouts of America for their annual dinner to help generate enough cash to support their efforts as well. Over $110,000 was raised for that effort, the results of which will ensure the continued growth of the Penns Woods Council of the Boy Scouts of America.

Next, came the Girl Scouts of Talus Rock; that project is currently underway and hopefully, will produce the needed funds for expansion and growth. Oh, yeah, and the Winter Jazz Concert is coming up, too. Finally, this is the tenth anniversary of the Arcadia Performing Arts Theater, and that place surely needs to be endowed with a reserve fund that will ensure its continued success.

Several years ago one of our employees explained philanthropy to me in this way. Each one of us have several pockets, and each pocket can represent our varied fund raising interests. In the spirit of giving, it is clear to us that, if you like the organization, believe in the mission or, for whatever reason, care about the vision provided by the board or the leadership involved, you make your decision to give or not to give.

When my own mother passed away, we discovered that, although her pensions amounted to less than half of the average salary in our area —which is about $10,000 less than the average U.S. salary, she was donating at least 50% of that money to organizations in which she believed. So, here’s one more worthy cause.

A few years ago, a wonderful, caring, local physician approached us regarding children at risk. During the numerous meetings that we held, we discovered the incredible healing qualities that equestrian therapies can provide. Yesterday, this topic was reintroduced by a dedicated, committed physician, Dr. Deb Baceski. She met with me to discuss the Somerset Therapeutic Association for Riders, S.T.A.R. located on the web at STA4R.org. According to their website, “Established in 1995, STAR has been providing safe, closely supervised riding lessons to physically and/or mentally challenged children.” It goes on to explain that; “In a typical training session, a handicapped child is helped to mount a carefully trained horse, and is then escorted on a ride for twenty minutes by three volunteers . . . ”

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One of the challenges that STAR is facing right now is that of the sometimes brutal winter weather that residents of this area have grown to know and “?” love. Dr. Baceski approached us for assistance in a program that she calls, The HORSE POWER Project. This project involves constructing an indoor riding arena so that the free therapy provided through this program is not interrupted by frost bite.

Although my organization is also quietly involved in soliciting assistance in our own expansion needs, this horse power project is not financially overpowering. The volunteer Physical Therapists, Physician Assistants, Teachers and Physicians who enable this empowering, socializing, learning program to go on for those individuals isolated by their disabilities, can’t do it alone.

So, take a look at sta4r.org, and, if you personally believe in this volunteer effort, or if you know of someone who could help them network their way to an enclosed arena, we invite you to show your support. Their address is 305 Highpoint Drive Somerset, PA 814-445-4909. Give if you want, but at least talk to someone who might.

“The best and most beautiful things in the world cannot be seen or even touched. They must be felt with the heart.”
—Helen Keller

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Posted in Children, Development, Disability, Healthcare, Recreational Therapy, Sports