Archive for the ‘Integrative Health’ category

Bhutan’s Philosophy of “Gross National Happiness”

October 3rd, 2010

Not everything that can be counted counts, and not everything that counts can be counted.
—Albert Einstein

At a recent conference I had the opportunity to learn about the Himalayan nation of Bhutan. Most of us had not heard of this country, but we should have, because they have done something that is reminiscent of the Broadway Musical “Camelot,” or possibly “Brigadoon.” Their King introduced a philosophy of living that is intended to shape all of the government’s activities. According to Mr. Kuenga Tshering, Director of the National Statistics Bureau of Bhutan, Gross National Happiness (GNH) was promulgated as Bhutan’s philosophy of economic and social development by the Fourth King of Bhutan as soon as he came to the throne in 1972.

The reason I’m writing about this is because I believe it is an amazing idea, a wonderful goal, and a step toward embracing  idealism.  Many of you have heard my thoughts on change, and know that I do not believe that there is only one route to follow on this journey through life.

Takstan Monastery, Bhutan (image credit: johnehrenfeld.com)

Takstan Monastery, Bhutan (image credit: johnehrenfeld.com)

The Bhutanese philosophy of “living” refers to a set of social and economic interventions that evaluate societal change in terms of the collective happiness of people.  Further, these measures are also applied to the creation of policies that are aimed at that objective. Premised on the belief that all human beings aspire to happiness in one way or another, the concept promotes collective happiness of the society as the ultimate goal of development.  Now that would be a political platform!

The philosophy of Gross National Happiness considers economic growth as one of the means towards achieving happiness, but it also offers a holistic paradigm within which the mind receives equal attention. While GNH recognizes the importance of individual happiness, it emphasizes that happiness must be realized as a collective or societal goal and not be defined as an individualized or competitive good.

The philosophy should also not cause misery to future generations, other societies, or to other  beings, and it is important to the government of Bhutan that the efforts of this philosophy be distributed evenly across all sections of  the society.

They work at strengthening the institutions of family and community; the spirit of voluntarism, tolerance and cooperation; the virtues of compassion, altruism, honor and dignity, all of whose active promotion may be a contributing factor to Bhutan’s low crime rate.

Culture also provides a framework where an individual’s or society’s psychological and emotional needs are addressed. By preserving local, regional, and national festivals, the government attends to these needs and provides a forum for maintaining social networks and promoting the conviviality of public culture.

His Majesty, King Jigme Singye Wangchuck of Bhutan

His Majesty, King Jigme Singye Wangchuck of Bhutan

Bhutan treasures the extended family network as the most sustainable form of social safety net. Aware of the possibilities of family disintegration or nuclearization, the government makes conscious efforts to revive and nourish the traditions and practices that bond families and keep communities resilient and thriving.

Their environmental policy is predicated on the perspective that human beings and nature not only live symbiotically but are inseparable from each other. According to this perspective, nature is a partner in existence; a provider of sustenance, comfort and beauty.

Environmental preservation, therefore, is a way of life in Bhutan. Currently, 72% of the country’s area is under forest cover, 26% of the area is declared as protected areas, and the state has decreed to maintain 60% of its area under forest cover for all times to come. Environmental cost is an essential ingredient of evaluating new development projects in  Bhutan.

Finally, Bhutan launched parliamentary democracy 2008, becoming the youngest democratic country in the world. All this was initiated by the country’s leader – His Majesty, King Jigme Singye Wangchuck, thus fostering people’s capacity to make choices.

Well, we have generally been making choices as a country for some time now that generally do not embrace nature, family, our fellow man, or the environment.  On a recent boat trip up the Caloosahatchee River, I expressed a dream, namely that mankind would embrace a philosophy of “National Happiness.”

Now wouldn’t that ROCK?

Not everything that can be counted counts, and not everything that counts can be counted. — Albert Einstein

Read more: http://blog.rypple.com/2010/06/chip-conleys-ted-talk-on-gross-national-happiness-gnh/#ixzz11MQ5ZTm6

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And one more thing . . .

August 12th, 2010

These blog posts are supposed to be directed toward creating healing hospitals. That objective seems to be compromised from time to time as I post genuine opportunities for hospital CFO’s and CEO’s to trim monies from their budgets, to find money that their hospitals should have received, or to initiate new ventures that will create additional, positive economic yields for their facilities.  I’m sorry, but I just can’t help myself.

One of my “gifts” as a CEO was to always find ways to pay for the challenges that we faced so that new ideas, new modalities and  new healing techniques could be introduced to our healthcare environmentI even wrote a book about it. Interestingly, the biggest push back that I experience when presenting to my former peers is that bottom line, no nonsense question: “How the heck are we supposed to pay for this stuff?”

The Benefits of Healing Hospitals

View more presentations from Nick Jacobs.

Over the years I’ve prepared charts, graphs, and narratives demonstrating the dramatic growth patterns, the huge economic surpluses, the wonderful bottom lines that were generated by embracing a “healing” philosophy, but those of you who have been lured by “snake oil salesmen” in your past lives are very leary that my passionate dialogue is simply that, dialogue. You have  no  reason to believe me when I say that improving your employee morale will improve your patient satisfaction scores. Of course it’s common sense, but if you’re too nice to your employees, they’ll think you’re a push over and they’ll take advantage of you, right?  Well, after 22 years of niceness, the one thing I can tell you is that niceness can be confused with weakness, and that needs clarification early on in your journey.

You see, my recent devotion to the economics of healthcare was prompted by the knowledge that you will be treating much larger quantities of patients for less reimbursement. Consequently, new streams of funding will be imperative. For example, the annual amount of discretionary healthcare dollars spent on integrative and holistic medicine is well into the double-digit billions of dollars.  Logic would tell you that at least a percentage of these dollars could be spent at your facilities.  The downside is that your patients have not been used to paying cash for anything except co-pays, but the reality is that “they will pay,” if the service is meaningful, helpful, and healing; money simply becomes a way to get them there.

Wellness Wheel - Image credit: Marquette UniversityIf you, however, don’t believe that massage is good for you, don’t believe that some people respond well to acupuncture or Reiki, don’t care that aroma therapy, floral essences, or pet, music and humor therapy have a place in “legitimate medicine,” that’s a problem, a personal problem.  Go on vacation to some place like Canyon Ranch, and let go for a few days.  Allow yourself to be open to new modalities.  The body and mind can work extremely well together . . . if you’ll just give them a chance.  More importantly, you can generate additional funds for your facilities that will result in additional growth in market share, in patient loyalty, and in patient and employee  satisfaction.

So, this week’s tip . . . financial transaction services: Over 1/4 of your facilities daily financial transactions are completed electronically.  We are currently providing the interface for your financial transactions that will reduce your costs of doing electronic business exponentially.  It is seamless, requires no interruption of your current banking relationships, and invisible to the patients and your staff, but why, for example, would you pay 4.5% if you could complete the same transaction for 2.5%?  It’s savings that can contribute to your bottom line to allow you to supplement your staff with those individuals who can add additional depth, healing activities, and peace of mind to your patients’ experiences.

It’s all good.

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What’s Still Missing?

April 3rd, 2010
We are on a not-so-merry-go-round which, even after health care reform, continues to promote a system of illness incentives  that are improperly reimbursed, improperly addressed, and inappropriately segmented. We continue to consider body parts as if they are not connected to or a component of the whole.
Wellness Wheel - Image credit: Marquette University

Tort reform still has virtually no teeth.  This causes physicians to practice sometimes over-the-top medicine in self-defense. When will it be time to begin to throw the switch and teach patients what we already know so well; that wellness, wholeness, and health can change the quality of our lives completely? Our medical schools need to embrace wellness and prevention as a path to health. Not unlike indigenous man, it is time that we begin to realize that our brains do have something to do with our bodies.  We live in a commodity driven society which does not always promote the best, most healthful food, even miminal exercise, stress management, or self-nurturing. Instead, because of those quarterly reports to the stockholders, these companies promote what is the most lucrative and often the easiest to sell.

Oprah.com - Health and Wellness - Nick Jacobs -  HealingHospitals.comWe know that drinking a soft drink with 10 teaspoons of sugar is not healthful. We clearly understand that quadruple cheese anything might eventually catch up with us, or that Uncle Buck’s 72 oz. steak can’t really be good for our arteries. Fried and buttered everything, a total lack of exercise, and more stress than anyone can ever dream of will not extend our lives

One night a few weeks ago I couldn’t sleep, and at 3:00 AM, I looked up and saw an apparition… Oprah. There she was, talking about food. The person she was interviewing said, “Oprah, in the 1960’s, our food cost us 18% of our annual income. ” Maybe that’s why there weren’t more restaurants at that time. Families were stretched just eating at home. He went on to say that, “In the 60’s, healthcare costs us 9% of our income.”  Finally he said, “Now healthcare costs us 18% of our income, and food costs us 9%.”

So, that’s the trade off. We can buy good, farmer’s market-type healthy, organic food and have low healthcare costs, or we can buy manufactured, additive filled food, and pay more for our healthcare.  How much further down this cul de sac must we go as a country before we begin to realize the path to health and wellness or longevity?

Health and Wellness - Nick Jacobs - HealingHospitals.com

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Healing Hospitals

October 18th, 2009

For the past several months, I have been searching for a new blog title. Nick’s Blog, NickJacobs.org, Ask a Hospital President, Taking the Hell out of Healthcare… none of them really told the story of my passion, my drive, my desire to change healthcare in a way that would be meaningful for every patient, every employee, and every physician.  Finally, the idea of what exactly I believe in, try to strive for, and teach hit me:  “Healing Hospitals.” Not only do I believe that we can make our hospitals healing places, I also believe that we can heal the hospitals themselves.

Nick Jacobs - HealingHospitals.com
Nick Jacobs, FACHE – HealingHospitals.com

For too many years, the Socratic style of teaching our docs has basically made many of them as tough as professional football players.  We have experienced “The Old Guard” in nursing, where, when new nurses come on board the older nurses are encouraged to “eat their young.”  We also know that the over-utilization of overhead paging, blood tests in the middle of the night, loud staff members, et al lead to what can only be described as a tense environment.

For the past 20  plus years, we have advocated a kinder, gentler hospital environment.  During that time we have introduced all types of non-traditional healing environments, integrative medicine, roving psychologists, drum circles, aroma, music, pet, and humor therapy as well as the elimination of bullies from the medical staff.

HCD-Cover-10_09These are just a few of the very effective mechanism that can be introduced to create healing environments in hospitals.  Healing gardens, labyrinyths, 24 hour visiting, double beds in the OB suites, and the beat goes on and on with decorative fountains, fireplaces, skylights, balconies, but most importantly dignity and respect amongst all staff and visitors toward patients.  So, “Healing Hospital” has multiple meanings. Healing will take place more quickly, thoroughly, and meaningfully in these facilities, and the entire staff will be charged with the promotion of healing by creating an overall healing environment.

Well, I’m sure if you type in nickjacobs.org or even Ask a Hospital President.com you’ll still get to us, but remember that our overall goal, our direction, our mission, our passion, and our job is to help you to create healing environments where infection rates drop, as will lengths of stay, readmision, restraint and mortality rates.  Call us at SunStone Consulting, LLC.  412-992-6197.

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Healthcare Reform? Blow it up, and Start from Scratch!

June 20th, 2009

Healthcare Reform? The premise and the incentives are wrong.  We treat sickness (which can be a good thing), however, we do it to the almost total exclusion of encouraging and incenting wellness. While in the Netherlands a few years ago, I asked a very comfortably-situated business person why she and her entire family all rode bikes. She smiled and explained that the millions of bikes in the Netherlands are a way of life because they keep people healthy.  Of course, we don’t have to ride bikes, but why not?  “It is much less costly.  It gets us where we want to go, and it is so much better for our bodies,” she said.

Photo credit: Amsterdamize
Photo credit: Amsterdamize

After going to doctor after doctor in my early thirties and then again in my early forties for a recurring and seriously painful back problem, someone suggested a Chicago-trained chiropractor.  After a very quick, one time manipulation, he said, “Follow me, please.”  When we descended the stars of his office, in front of me was literally an entire homemade work out facility.  This particular center seemed to emphasize strength training.   The Doc walked me over to a row of three machines and said, “If you use these three machine or their equivalent, just the way I show you, you will never have to come back here again.”  Then he said, “Oh, and if you drop fifteen pounds, you may be able to get off those blood pressure pills, stop taking that stomach medicine, and feel better about yourself in the process.”

The Dr. Dean Ornish Coronary Artery Disease Reversal Program is completely about health and prevention.  It is about wellness; treating yourself with the love and respect that you deserve, being kind to yourself, yet being disciplined enough to get you where you need to be in order to enjoy a healthy, pain free life.

We spend only 4% of our health care dollars on prevention.  That may sound like a lot to some of you, but do the math.  Take 4% and multiple it times $2.2 trillion …or possibly soon $3 or $4.0 trillion.  Every physician should endorse a workout facility and work to send you there, and every physician should receive bonuses for having you use it.  A primary care physician in Britain can make about $320K a year, which includes incentives directed toward encouraging healthy living for their patients.  Our primary care docs make, what, $130,000, $150,000, $180,00 in comparison?   Would you really care if your physician could make almost twice as much if you were living a wonderful, healthful, reduced stress life?

There is absolutely NO DOUBT in my mind that the reason I’m typing this here today and not deceased at age 58, like my father, is because of the work of people like Drs. Ornish, Benson, Jonas, and Weil.   It is not because of my old donut shop, the nachos and cheese, the automobiles, my Lazy Boy, or the grueling work habits that we Americans think of as normal.

And what about death?  I have to tell you that death happens to all of us.  (Sorry.)  When it happens may depend a great deal upon our recognition of that fact, but it is not avoidable.  So, why is it that we, as a society, reject death as evil, and ignore its possible existence?  How could we cut billions and billions of wasted healthcare dollars?  Hospice is the answer.  Don’t commission oncologists for drug use when there is absolutely no hope that the patient will live.  Don’t pay radiologists for radiation treatments that will not work in preventing death.  Don’t reward hospitals financially for readmission after readmission for people who should have been told to mark  their DNR’s months earlier.  Face death as part of life.

healthy_food

Finally, look at the food and restaurant industry.   For every restaurant or food company that pulls a killer food and replaces it with the reasonable alternatives, reward them through the $3 or $4 trillion health budget.  You can buy veggie hot dogs on the streets of Toronto.  (Try Morning Star Farms brand veggie hot dogs.  They rock.)

In closing; diet, exercise, stress management, balanced lives, less capitalistic rewarding of killer diets, higher reimbursements in healthcare for the “right stuff,” and acknowledgement that this will eventually end, can make it all work so much better, so much cheaper, so much easier.  Did you have your pneumonia shot yet?  Well, actually, you may not need one if you start taking care of yourself.  I’m going downstairs to workout now.

Next time?  Tort reform.

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NickJacobs.org???

April 2nd, 2009

Let me open this blog with a little housekeeping chore. Because I’ve retired from being a hospital president (Yes, they replaced me with two great people, count ‘em, two.) , I’d like to change the name of this thing. It’s not that I’ve established a P-Diddy-type Twitter following where 100,000 human beings are waiting with baited breath to see what my next move will be, it just doesn’t seem right to keep calling myself a hospital president. We know who reads this thing, and we are grateful to our loyal, talented, and brilliant followers. We also know that we can link the old blog names to get you here. So, regardless of what you typed, or what gets Googled, our genius social media maven & webmaster, Michael Russell, can help to bring you home to this site.

Okay, so as a transformational advisor, a broker of sorts, most people with whom we have consulted have described me as a person who can fix things that are broken before they actually break. Maybe we should call it the “Break it if it’s not already fixed” blog. I’d love it if it was a name that would generate millions of hits and companies would fight to advertise on it.

My first thought was to use nickjacobs in the title because there is a Nick Jacobs on Facebook who teaches Aboriginal people in Australia, and he seems popular. There is another Nick Jacobs who is a professional organist, and one who is an athlete. There’s a Nick Jacobs who is a consultant and another a paramedic in London, one who had a blog who is a yachtsman, there’s my son, the commercial real estate broker, and finally, there’s a Nick Jacobs who does pornographic movies who is not my son. Actually, that Nick Jacobs’ followers would probably be the most disappointed by this blog.

Since the .com version of nick jacobs was already taken by some guy in England, we captured nickjacobs.org, and that will work for right now.

If you have any ideas, however, that you think would really rock the blogspere, let us know and we’ll check with our domain registrar to see if it is available. In fact, if you are the winner of a Name Nick’s Blog Contest, I’d be happy to consult for free BY PHONE for at least one hour of brainstorming with you about the topic of your choice: music, healthcare, proteomics, teaching, PR/Marketing, the travel business, or even physician recruitment.

Remember, Hospital Impact is already taken, and, because my last three consulting jobs have been with a newspaper, a nonprofit arts oragnization, and a chain of hotels, we don’t want to think too restrictively. Gotta earn a little money, too.

When we ran the breast center, we found that the website got more hits than anyone could imagine. The problem was that the readers were mostly thirteen-year-old boys who probably weren’t too interested in running a hospital. After Miss America had visited us, the hits went up exponentially when those two searches were combined. Somehow, I don’t think that Nick Jacobs’ Breast Center for Miss America would probably get me the type of following I’m currently hoping to attract. On the other hand?

A very good friend recently asked me to write a brief bio about what my new life is like, and it struck me that it is very much like my old life but without any restrictions. This is what I wrote:

While teaching junior high school instrumental music in the early 1970’s, Nick Jacobs made an extraordinary discovery. He learned that, by empowering his students and surrounding them with positive influences, he no longer was providing a service or even an experience for them.

What this entirely unique teaching style resulted in was a method for helping to transform students. By providing with both passion and commitment the tools needed by them to undertake their journey, his involvement with the students became a means of dramatically helping them to make whatever positive life changes they were seeking.

It was during that early period in his career that he also discovered that this formula could work to positively change lives in almost any aspect of living as he ran an arts organization, a convention bureau, and finally a hospital and research institute.

Since that time he has dedicated his personal work to helping others make their lives better, and that is exactly what he is doing in his position as an international executive consultant with SunStone Consulting, LLC.

Maybe that will give you something to chew on? Okay, something on which to chew.

SunStone Consulting. With more than 20 years experience in executive hospital leadership, Nick has an acknowledged reputation for innovation and patient-centered care approaches to health and healing.

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The Not-So-Merry-Go-Round

March 7th, 2009

Dr. Wayne Jonas, President and CEO of the Samueli Institute, a friend and mentor, testified before the U.S. Senate on February 23, 2009 regarding his views for creating a path to health care reform. Dr. Jonas, a well respected member of the Washington D.C. health community formerly served as the Director of the Medical Research Fellowship at the Walter Reed Army Institute of Research (WRAIR), a Director of a World Health Organization Collaborating Center of Traditional Medicine and a member of the White House Commission on Complementary and Alternative Medicine Policy.

Wayne B. Jonas, M.D.

Wayne B. Jonas, M.D.

It is not my intent to copy this testimony, but only to accentuate some of the salient points contained within his work. Let’s begin by looking at some chilling facts. By 2082, healthcare expenditures will represent 49% of our Gross National Product. This is due to the fact that in 2011, the baby boomers will begin to turn 65 when, in the words of Dr. Jonas, “an avalanche of aging care needs…will bury the current Medicare system.”

Obviously, this is a case where more of the same is not necessarily better and, unless or until the system changes, and we fashion a new vision to create health, we will bankrupt our country. Dr. Jonas then went into the facts and figures that those of us in health care who believe in wellness, integrative medicine, and a holistic approach to healing have known for years. Seventy percent of chronic illness is due primarily to lifestyle and environmental issues, including proper substance use (smoking, alcohol, drugs, diet, and environmental chemicals), adequate exercise and sleep, stress and resilience management, social integration and support, and selective disease screening and immunization.

We are on a not-so-merry-go-round, which has an entire system of illness incentives that are improperly reimbursed, improperly addressed, and inappropriately segmented as if each part of our body was not a component of the whole. It is time to begin to throw the switch and to teach our patients what we already know so that wellness, wholeness, and health can be given a new definition.

Dr. Jonas specializes in Systems Wellness. Dr. Leroy Hood specializes in Systems Biology. We as a country need to demand that our medical schools embrace both concepts as, like indigenous man, we begin to realize that our brains do have something to do with our bodies, as we realize that our commodity driven society does not always promote the BEST food, the BEST exercise, the BEST of anything but, instead, because of the quarterly reports to the stock holders, promotes the most lucrative.

We know that drinking a soft drink with 10 teaspoons of sugar is not exactly healthful. We clearly understand that quadruple cheese anything might eventually catch up with us, or that Uncle Buck’s 72 oz. steak can’t really be good for your arteries. Fried and buttered everything, a total lack of exercise, and more stress than anyone can ever dream of will not extend our lives. There is a reason why most of our physicians die ten years before their patients. Between the battles to get their degrees, the incredibly long hours, the pressure of dealing in life and death issues, and the demands of dealing with a broken healthcare system, they need stress management as much as anyone.

How much further down must we go as a country before we begin to realize that millions of dollars, dozens of expensive toys, mansions, and rich food are not true measurements of success? During a visit to the Netherlands a few years ago, I told my host that I would be back in August. She looked at me, smiled, and said, “Don’t bother. The entire country will be on vacation,” and they were. Many European countries take 52 paid days off per year. Sure, their cars are smaller or they use bikes and generally they may own less clothing, but they are living longer, healthier lives.

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Make Sure That You are on the Right Side of the Paradigm Shift

January 15th, 2009

The word paradigm provides a cerebral representation of a model that, throughout our lives has remained relatively constant. Transformational changes in the manner in which we travel, how we communicate, and even in the ways that we are educated have simultaneously produced significant shifts in those models as well. In the early 90′s, we were informed that the information being transferred to us would only be viable and, in fact, would be very nearly invalid within about 18 months or so after ingestion.

Those parameters of informational decay continue to diminish exponentially as we immerse ourselves in 24-hour instant access to changing data, innovative discoveries, and altering states of acceptance of ideologies that were once believed to be infinite in their substance. Science is only valid until the next discovery.

The archetypical model of high-tech health care that was believed to be our “Star Trek” salvation from the ills of our parents, and their parents is currently being exposed as an artificial promise that has failed to deliver healing. Each decade our technologists have produced new; more sophisticated, and higher priced equipment with promises of earlier detection. Unfortunately cures have not been part of the equation. The additional technology has simply produced additional questions.

As we delve into the diva world of science, we find many reasons why significant progress has not been made, mostly related to a lack of continuity in the incentive systems. But, because of these failures to heal, we also may now be able to discern another reality that will truly contribute to the new world order of medicine.

Dr. Lee Hood, M.D., Ph.D

Lee Hood, M.D., Ph.D

Dr. Lee Hood, infamous for his work in the creation of the equipment used by our present day scientists, launched a school of thought that has been generally accepted in the scientific community, Systems Biology. Dr. Wayne Jonas has pursued with passion his work in Systems Wellness. Both of these edge-running thinkers are also working to contribute to a medical degree at a leading university that will be entitled Systems Medicine.

The uniqueness of this type of thinking is not the newness of it. It is, in fact, a melding of the old and the new, the oldest and the newest approaches to healing. What Drs. Hood and Jonas separately yet collectively are advocating is an approach to illness that embraces the complexities of genomics and proteomics and allows that knowledge to be firmly wrapped in a swaddling of information that, in many cases, has been with us since indigenous man walked the earth, an Optimal Healing Environment.

Wayne B. Jonas, M.D.

Wayne B. Jonas, M.D.

We have all been inundated by the mythical promise of cures from fraudulent presenters, and the result of those untested, unproven, and unfounded promises has created a culture of distrust, cynicism, and fear that thwarts the reemergence of those healing practices that represented not only viable alternatives, but, in many cases, the only alternatives that were available to our societies less than eighty years ago. As we more clearly understand that the human body is a comprehensive system that interacts within itself on a myriad of levels, we also can begin to understand why individual responses to certain types of healing modalities also produce very different results, i.e., Systems Healing.

The philosophies, beliefs, and practices of the American Board of Integrative Holistic Medicine, a major group of practitioners who have come together to provide not only education, training, and additional resources to physicians in general, have also come together to ensure that those Systems Healing practices that were pushed aside for the promise of high tech and high chemistry are reintroduced to medicine and healing in an appropriate and informed manners. Their work is not new to mankind, to medicine, or to healing, but it is a reemergence of those long proven, highly embraced modalities that promote and support health and wellness, the new paradigm?

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Something’s Gotta Give, Something’s Gotta Give, Something’s Gotta Give!

November 1st, 2008

My Facebook friend, Anne Zieger, editor of Fierce Health Finance, wrote a compelling piece the other day regarding the potential demise of hundreds of hospitals. Her prediction is based upon some very valid financial realities, and we are witnessing them locally as well as nationally. Not unlike the little banks in our area that seemed to have been insulated from Wall Street’s collapse, some of these national problems seem to be washing over some of the smaller hospitals with relatively minimal damage. Yes, many of us have seen as much as a 10% decrease in elective, outpatient procedures.

In fact, while visiting a really upscale mall for a photo session with my two year old granddaughter, Lucy, an employee engaged me in a conversation about the rotten economy. About five minutes into the conversation, she indicated that there are currently 150 stores in the chain for which she works, and that only five percent of them made budget last month. Portrait pictures must fall into the category of a luxury as their business is severely impacted by this economy. More directly, however, she indicated that she needed stitches removed the other day, and that, “she did it herself” rather than spend the $20 co-pay.

So, are we seeing decreases in important tests? Are we seeing patients avoiding emergency room visits? Are we seeing patients cutting their prescriptions in half? Yes, to all of these questions. Anne, however, seemed to be talking about the “big boys,” where their millions or billions in investments have recently tanked. If you are so big that your income from running the hospital is not a major source of protection, and your income from your investments is propping you up, then the problems begin to manifest themselves exponentially.

“Some hospitals are responding by digging into their investment income more deeply than usual, using it to finance capital projects, or even meet operational needs. Others are issuing bonds with the scary codicil that they’ll buy them back if finicky investors want to dump them,” states Zieger in her column.

She further goes on to explain that “both of these situations put a huge squeeze on hospitals’ long-term viability. One robs from their long-term assets to solve medium-term problems, while the other puts the hospitals at risk of being bled dry by investors who get spooked.”

Well, wouldn’t ya know? Yes, we are seeing a few challenges due to decreased electives, but not because we were living off of our investments. The other good news is that, because we froze our fixed pensions several years ago, we are seeing very little impact upon them from the huge drop in those investments as well. Unlike many of our larger peers, neither of these issues is similar. Between the drops in the market, the loss of pension funds, the decrease in electives, and the down-grading of their viability by the bond markets, their challenges look galactic in size compared to ours.

Sometimes smaller is just safer.

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In Their Own Words: Patients, staff and physicians on their experiences at Nick’s Planetree hospital

October 5th, 2008

View SlideShare presentation or Upload your own. (tags: hospital medical)
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