On the one hand, to see the variety, pace, and sheer volume of issues that must be dealt with on any given day in any given legislators office is mind-boggling to say the least. Constantly shifting gears from issues ranging from education to labor to healthcare to energy to transportation to (you get the point) requires a level of study and preparation that no one person can possibly master in any significant way. Yet through the coordination of legislative aides, assistants, and directors our public officials manage to do a pretty good job of being knowledgeable not only about the issues, but also the pros/cons and political consequences of any decision that they must make or support. Specifically, I was impressed to see the level of understanding that our elected officials have about the activities taking place in our hospital ranging from our research efforts in spinal cord injury and composite tissue allotransplantation (hand transplants) to our local issues affecting patient volumes, insurance, and reimbursements just to name a few. We should be comforted by the fact that our legislators are very aware (in a positive way) of the excellent care we provide to the community and the reputation that we hold as we carry out our mission.
On the other hand, after spending some time in the Capitol and seeing the level of competing priorities, agendas, and partisan politics, you can't help but get a bit dismayed at how difficult it really is to get anything accomplished. I just happened to be in D.C. as Senator Jim Bunning was in the news for blocking legislation to increase federal spending by $10 billion. Nevermind the fact that the Senator was really not opposed to spending the money per se, all he was asking was that we be accountable and have a way to pay for the proposed new expenditures (just as we must be accountable in our business). The result is an avalanche of chaos and commotion as lobbyists, constituents, and the media all flood the office, phone lines and email boxes as they scramble to position their personal agendas and biases in order to put pressure in overturning the last vote needed to sway in their direction. After seeing that display, you can't help but wonder where our issues on healthcare stand and to what degree they evaluated on their merits versus simply how objectionable or valuable they might be to any single legislators portfolio that they must manage as they attempt to barter with their votes to make progress.
However, as one legislator said to us, it really isn't the people in Washington that are the problem, but rather the process and I think he was correct in his assessment. When you look at a problem as complex and controversial as healthcare, to expect meaningful reform to occur in a single session is highly unlikely if not impossible. The number of variables that must be addressed to achieve true transformation is simply to large to be accomplished at one time. In my opinion we need a deliberate process to address not only hospitals and insurance companies, but also physicians, pharmaceuticals and supply companies, technology, tort reform, education, and even our entitlement philosophy as a nation. Unfortunately though, our government does not partake in a true strategic planning process, but instead resorts to politics and reconciliation to try and make good on a worthy, yet overambitious campaign promise regardless of the fact that the "reform" now being discussed will no longer provide a solution to the real problems we face. There ought to be (and is) a smarter and more thoughtful approach to tackle something as important as the health and well being of our nation. Hopefully we will figure this out before our current healthcare system collapses and bankrupts the country.
(But in the words of Dennis Miller, one of my favorite comedians)...Of course that's just my opinion, I could be wrong.
4 comments:
Mr. Bonick, I have worked for the organization for 10 years. I currently work at JH, but have worked at MCE and MCS in the past. I was briefly in a management position during the whole Studer era. I was hopeful that we were moving in a positive direction. I love my job at JH, but I miss the inclusion and transparency that existed at MCE/ MCS. At those places, I felt like a "team" member. At JH, I feel like an employee, who isn't much appreciated. And, let me just say that it isn't my immediate manager who makes me feel under-appreciated.
Today, was a hard day for JHSMH with the lay off announcement. However, team members at MCE and MCS were hearing about this last week. JH employees were told about it today and just before it hit the air waves (not a great impression). I understand that bad news is never easy to give or receive, but this situation could have definitely been handled better.
Also, I generally keep my mouth shut, but besides the lay off news today, I just had a bad day at work. I was given what could have been a routine assignment, but things don't always go as planned in the ICU. Both of my patients were busy and I could only be in one place at a time. I don't even want to think about what would have happened if I didn't have a nursing assistant and a nurse who was precepting a new nurse that could provide care to one patient while was in my other patient's room. These two individuals managed a crisis for one patient, while I was receiving the other back from OR.
I like working at JH and I could care less about losing 2 vacation days per year. But I do care about losing support staff. What kind of red rules bracelets are we going to be wearing because of doing more with less. Yes, today was one busy day for me, and luckily there was someone there to help me out. But tomorrow another nurse will be overwhelmed; will they have someone to turn to for help? Is there a plan for this situation?
Michelle, I appreciate the candor and frustration that you share. Today was not an easy day for anyone. You raise several issues that each deserve attention, and I plan on addressing those in more detail in Team Member Forums next week.
To touch on a few points you raise though...transparency is something that I have been striving for since my arrival at JH two years ago. Through various formats I have tried to be as transparent as possible whether its in forums, hallway conversations, progress notes, or this blog as a few examples. That being said, I am fully aware that on a campus as big as ours downtown that we will never be able to replicate the feel of a campus like MCS where everyone literally is able to know everyone else and be able to openly communicate through face-to-face interactions.
With nearly 3,000 Team Members on the downtown campus, I have to be able to rely on multiple formats of communication to be able to try and stay in touch with what people are thinking and wanting to know. To today's announcement specifically, I'd welcome your feedback on how to communicate bad news more effectively. When dealing with something this sensitive, the message can take on a life of its own if left to the rumor-mill alone, and therefore requires a level of planning and preparation to be able to communicate quickly across the organization. The downside to that is that it makes the communication accessible to all, including the media.
To the more important point you raise about the issues on your unit, I will say that our goal has been and remains to ensure that the quality we provide to our patients remains our utmost importance. To that end, we have gone to great lengths to work with our units, your managers and our consultants to ensure that we have nurse-to-patient ratios that are dictated by the needs and acuity of our patients. From that, staffing grids are created to help ensure that we have the right people in the right place and the right time to take care of our patients. Will that ensure that you never encounter a situation that is less than optimal? The short answer is "no."
We cannot perfectly predict the number of patients we will have nor can we always immediately deal with last minute call-ins, codes/emergencies, and other events that disrupt that the normal flow that we would like to see. To that end, we have created opportunities for input and participation through our Nursing shared governance and other outlets to solicit your best ideas and feedback as to what we can do when these situations arise.
We all are going to have bad days, and if I could do something to prevent them I would for your sake and mine. Unfortunately that is not a reality within my span of control nor is it one of any other hospital administrator across the country. Every hospital I have worked in has these same types of issues to wrestle with. The only way to improve these situations is to work together constructively in efforts to better understand our mutual needs and to work in earnest to find realistic solutions to deal with the day-to-day challenges that we will continue to face. Thanks for the feedback and as always feel free to contact me directly if you'd like to discuss in more detail.
I like Dennis Miller, I never realized he was so well read...
Well said.
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