Posts Tagged ‘NYT’

Fracking, Beiber Fever…and Bedbugs

May 12th, 2011

Every once in a while, it’s important to write about things that are hot. (It keeps the blog numbers up.) Well, hydraulic fracking, Justin Beiber and bedbugs… yes, bedbugs are all very hot and in the news again. While the D’s and the R’s sort out the nuances of cutting $14 trillion or so from the U.S. federal budget over the next few centuries, we still have to deal with the day to day challenges of living on this planet. In Pennsylvania and New York at least, the hot news — according to the New York Times — is the radioactive water that is reportedly being forced from deep below the surface of the earth as a means of releasing natural gas reserves:

“The relatively new drilling method — known as high-volume horizontal hydraulic fracturing, or hydrofracking — carries significant environmental risks. It involves injecting huge amounts of water, mixed with sand and chemicals, at high pressures to break up rock formations and release the gas.”

“With hydrofracking, a well can produce over a million gallons of wastewater that is often laced with highly corrosive salts, carcinogens like benzene and radioactive elements like radium, all of which can occur naturally thousands of feet underground. Other carcinogenic materials can be added to the wastewater by the chemicals used in the hydrofracking itself.”

Of course, the essence of those two paragraphs will be the source of numerous heated discussions between environmentalists and the gas and oil lobbyists until this issue can be sorted out. In the meantime?  Well, that’s the question du jour.

On a lighter note, my five year old grandchild, Nina, is madly in love with Justin Beiber. She knows every lyric from every one of his songs and regularly either dances or does gymnastic flips to his music. On Saturday, she, her brother, sister and I worked to clean up their two car garage sized playroom. She turned on the Karaoke Machine and let it rip. We were all dancing and singing to the Bieb as we put the toys away, cleaned up the miniature kitchen, folded baby doll clothes and stacked their books.

Justin Bieber - photo credit: celebrity-gossip.net - Nick Jacobs FACHE - Healing HospitalsImagine my shock when one of my Google news alerts appeared spouting the fact that young Justin suddenly had become violently ill at one of his concerts in Manila, then quickly returned to the stage. He had been diagnosed with a bad chest infection prior to the show, but insisted on performing, having tweeted before the show, “Sick as a a dog… But the show must go on.” As a non-medical/non-science healthcare guy, the diagnosis made me a little curious, (remember, I’m a musician, too), but Yahoo Answers cleared things up for me with this patient testimonial: “I’ve spent so many years of my life convincing myself that I have emetophobia, because when I was about 11, I was sick from a chest infection and I threw up…” So, there you have it:  Justin is not the only person who gets sick from being sick. So, relax, Nina, he’s going to be okay.

Now, some additional disconcerting news. After having  personally survived a bedbug attack at a top-notch hotel in a major U.S. city last year,  I read with trepidation that it has recently been discovered that MRSA infection has now been associated with the scratching that comes after the bed bug bites.  This dangerous, antibiotic-resistant bacteria (usually acquired from hospital visits or things like high school wrestling mats), is a strain of the bacteria Staphylococcus aureus which is called Community Associated MRSA or CA-MRSA.  Because it is resistant to oxacillin, penicillin, amoxicillin and other antibiotics, it is not to be ignored.  My medical friends tell me that the best treatment for bed bug bites is to keep the area clean, use antibiotic ointments or gel and keep a close eye on the bite to ensure that it doesn’t become infected.

So, all of you frackers, Bieberbots and bedbug-dreaders …should have a sip of some Grey Goose or Courvoisier.  They’re not radioactive, may calm your fear of tossing your cookies, and would probably – in the right quantities – kill bedbugs…or at least make you stop caring if  they didn’t.  And, if you still want to learn more…well, there’s an app for that.

Bedbugs 101 mobile app - Nick Jacobs, FACHE - health 2.0 - healthcare

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Excerpts and Opinions on “What Makes a Hospital Great?”

March 17th, 2011

Dr. Pauline W. Chen’s March 17th New York Times article answers the question, “What Makes a Hospital Great?” In this article, Dr. Chen finds:

Dr. Pauline W. Chen - surgeon & New York Times contributor - Nick Jacobs, FACHE

Pauline W. Chen, MD | Blog: paulinechen.typepad.com

“Hospitals have long vied for the greatest clinical reputation. Recent efforts to increase public accountability by publishing hospital results have added a statistical dimension to this battle of the health care titans. Information from most hospitals on mortality rates, readmissions and patient satisfaction is readily available on the Internet. A quick click of the green ‘compare’ button on the ‘Hospital Compare’ Web site operated by the Department of Health and Human Services gives any potential patient, or competitor, side-by-side lists of statistics from rival institutions that leaves little to the imagination. The upside of such transparency is that hospitals all over the country are eager to improve their patient outcomes. The downside is that no one really knows how.”

I’ve written often about the failed promise of technology alone, and this is reaffirmed in Dr. Chen’s findings:

“…hospitals have made huge investments in the latest and greatest in clinical care — efficient electronic medical records systems, ‘superstar’ physicians and world-class rehabilitation services. Nonetheless, large discrepancies persist between the highest and lowest-performing institutions, even with one of the starkest of the available statistics: patient deaths from heart attacks.”

As she asks why this is,  the answers have become relatively clear from a study that was released in the Annals of Internal Medicine this very week. This research indicated that it was not the expensive equipment, the evidence-based protocols, or the beautiful Ritz Carlton-like buildings. It was, instead, the culture of the organization.

Hosptials in both the top and bottom five  percent in heart attack mortality rates were queried by the study team. One hundred fifty interviews with administrators, doctors and other health care workers found that the key to good (or bad) care was “a cohesive organizational vision that focused on communication and support of all efforts to improve care.”

Elizabeth H. Bradley, Phd, Yale School of Public Health

Elizabeth H. Bradley, Phd, Yale Global Health Leadership Institute

“It’s how people communicate, the level of support and the organizational culture that trump any single intervention or any single strategy that hospitals frequently adopt,” said Elizabeth H. Bradley, Senior Author and Faculty Director of Yale University’s Global Health Leadership Institute.

So, it wasn’t the affiliation with an academic medical center, whether patients were wealthy or indigent, bed size, or rural vs. urban settings that mattered in hospital mortality rates. Rather, it was the way that patient care issues were challenged that made the difference. The physicians and leaders at top-performing hospitals aggressively go after errors. They acknowledge them, and do not criticize each other. Instead, they work together to identify the sources of problems, and to fix them.

One of the most telling findings in this study was that relationships inside the hospital are primary, and the physicians and staff must be committed to making things work. Dr. Bradley said. “It isn’t expensive and it isn’t rocket science, but it requires a real commitment from everyone.”

So, the next time that you select a hospital, look up its statistics, and I guarantee you that you will be surprised. When it comes to outcomes, to nurturing or even competent care, the biggest is not always the best.

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Creating Functional Healing Hospitals

November 8th, 2009

Why Healing Hospitals?  Transparency.  Human Dignity.  Patient Advocacy. All of these represent a new way of administering health care in this country.  Our industrialized model of care in the mirror image of factory-like settings is no longer acceptable, viable, or an alternative.  We, as a country, as a society –as a culture, need to step up and do what is right.  Love, kindness, nurturing, and a commitment to patient advocacy are the correct ways to interact with our patients.

healing_mosaicMany organizations who embrace the various human dignity monikers such as Planetree and Eden Alternative do so for marketing clout, for positive press, or for hoped-for financial gains.  Upon meeting some of these leaders, transparency becomes a very recognizable trait because they themselves are transparent –and not in the good  sense.  Rather, they are transparently “takers” in an environment that is much better served by “givers.”

For a country that is so obsessed with standardized tests, our healthcare delivery scores are abysmal, astonishing, and asinine. Not unlike our appetite for Biggie fast food meals and Biggie drinks, our appetite for beautiful trappings without substance, for corporate jets, for the power of millions and in some cases billions of dollars in reserves has resulted in a dysfunctional health delivery system that looks at patients as widgets.

Nicholas D. Kristof - NYT photo Nicholas D. Kristof  NYT photo

Nicholas Kristof, New York Times Op-Ed columnist has written another compelling article about the  U.S. health system, in which he quotes the latest World Health Organization figures. (Download the .pdf file.) According to the WHO report, the United States ranks 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the U.S. is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland. He then quoted another study, a recent report by the Robert Wood Johnson Foundation and the Urban Institute that looked at how well 19 developed countries succeeded in avoiding “preventable deaths,” such as those where a disease could be cured or forestalled. The U.S. ranked in last place. Dead last.

He did find one health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare, he writes. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.

Learning how to convert your hospital to the standards of  Healing Hospitals is not rocket science.  It is, however, not without tough decisions, aggressive doses of nonconformity, a passion and commitment to patient advocacy, and a strong desire to improve infection, readmission, restraint, and mortality rates.  It can be done, but it takes guts, a break from the conventional, unconventional wisdom, and a willingness to do what is not only right …but also what is very, very smart.

WHO Report – Primary Health Care: Now More Than Ever

View more documents from Nick Jacobs.

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