Today it’s hard to find a health care professional who doesn’t want to “put the patient first,” practice “patient centered care,” or make the patient “part, or even the center, of the healthcare team.” Bring up current problems with clinical practice (be they managerial, insurance company, or regulatory) and you will inevitably hear health care professionals talk about the importance of the doctor/patient, nurse/patient relationship.
Nurses, in particular, are adamant that they are members of THE Caring Profession and that their fundamental role is to be THE patient advocate. (This formulation does nothing enhance teamwork since it drives physicians, PTS, OTs and other non- RNs crazy. “What does that make me?” they may retort, “The patient’s enemy?”) Patient-centeredness, and the sanctity of the patient/clinician relationship is the talk everyone is talking.
When you start actually probing and physicians and nurses (as well as others in health care) describe the real life patient (rather than the patient as abstraction), things start to get a bit more complicated. It’s amazing how quickly so many of these patients – who were absolutely revered a few minutes earlier — suddenly become “difficult,” when clinicians start discussing actual patient encounters. Read more >>
Anyone interested in transparency in healthcare should check out the Sugar Bowl website under chairlift safety program, under inspiration. So right on the website of this famous ski area in California is the story of an accident that killed seven-year-old John Marco Henderson.
As the article explains, “Last December our community suffered a great loss. John Marco Henderson, age 7, died after falling from the Mt. Lincoln chairlift while skiing with the Sugar Bowl Ski Team. Over the past 10 months, Sugar Bowl Corporation and Sugar Bowl Ski Team have worked with John’s parents to investigate how this accident occurred and determine what steps could be taken to prevent a similar tragedy. At Sugar Bowl, safety remains our highest priority.”
The article then goes on to detail what could be pieced together about what happened to the boy and, in great detail, discusses what the ski area is doing in response. The website acknowledges that there were problems with the lifts and the ski area does not in any way try to shirk its responsibility — both in the accident and in fixing the problems that may have caused it. “Ultimately our safety practices were insufficient to prevent this tragedy,” the article reads. Although the article acknowledges problems, it does so without apportioning blame or scapegoating anyone.
“As a result of this tragedy,” the resort explains, “we reviewed existing policies, procedures and best practices relating to the loading, riding and unloading of the chairlifts at Sugar Bowl. We have implemented a comprehensive Safety Program that includes the following changes: restraining bars will be lowered for all minors under 51 inches in height (including equipment); increased adult supervision of children in the ski school and on ski team; and installation of cameras to continuously monitor and improve chairlift loading practices. The Safety Program will be distributed widely and is available on the Sugar Bowl website.”
Imagine seeing something like this on a hospital website. How remarkable would that be?
Reading this people might think, Suzanne has lost it. Does she really imagine that any hospital or health care professional would actually publicly post an acknowledgment of safety problems and how they are being remedied? But no, I have not lost my mind. This kind of behavior is common in high reliability organizations (HROs). In our book Beyond the Checklist: What Else Health Care Can Learn from Aviation Safety and Teamwork, we describe the kinds of reporting programs and information sharing that have made flying safer than it has ever been. These kinds of programs can be adapted to healthcare. Patients know healthcare isn’t safe. They know hospitals are dangerous places. What they cannot do is protect themselves if they don’t know what to do and don’t have guidance and assistance from professionals as they try to protect themselves.
Right now, too much of patient safety is being outsourced on to patients themselves. We are asked to check our meds, to make sure no one gives us the wrong dose, a more — rather than less — invasive operation. We are asked to ask professionals if they have washed their hands. And everyone expects us to do this — even when we’re unconscious — and some actually blame us if experience a medical error or injury because, according to the outsourcing logic, we have not been vigilant enough. It was our own fault. It’s kind of like asking an airplane passenger not only to listen in to the air traffic control channel but to make sure the captain has, in fact, descended to 25,000 feet.
Patients — like child skiers — can only do so much to protect themselves. Yes, we should do what we can. We should be vigilant. But when we are most vulnerable, we also the most unable to act to protect ourselves, and if we’re lucky enough to have family and friends nearby, they too may be unable to effectively advocate for us. One has only to read the last two Narrative Matters selections in the journal Health Affairs by Beth Swan and Jonathan R. Welch to discover how difficult it is for even seasoned professionals to protect their loved-ones.
Although I will write more on these two stories later, the take home message is, without the kind of high level committment exhibited by those who lead (the kind of high-level commitment exhibited by Sugar Bowl) institutions as well as efforts to involve staff at every level, patients will never be safe.
This is an excellent story my husband just wrote about the defeat of a major public health initiative to fight obesity.
From Beyond Chron and The Huffington Post, Nov. 8, 2012
Getting Into Bed With Big Soda: How Labor Helped Win A Vote For More Obesity
by Steve Early,
RICHMOND, CA.–As one-half of a dedicated (if contrarian) union household, I received multiple copies of the California Labor Federation’s official voting guide before trooping to the polls on November 6. “Take a Stand for Working Families,” this CLF brochure commanded. “Your union conducted the research, now you decide…” Eager to know what helpful “research” the CWA-Newspaper Guild (my union) or the UAW-affiliated National Writers Union (my wife’s preferred labor organization) might have conducted to assist electoral decision-making in our new home state, I proceeded to read further.
Most of the CLF piece explained, quite persuasively, why trade unionists should “Vote Yes” on Propositions 30 and 39 to fund schools, public safety, and other government programs and “Vote No” on Proposition 32, a measure restricting labor participation in politics.
But this “special union message” didn’t stop there. In the customized “local voter guide” on the back cover, there was a cryptic and, for us, quite troubling recommendation. As Richmond residents and good trade unionists, we were urged to oppose “Measure N,” described only as a “business license fee.”
Winning on Corporate Coattails?
When the polls closed Tuesday night, California labor had fortunately prevailed on Propositions 30, 32, and 39, two of which involved tax increases. In Richmond, the CLF and its local affiliate, the Contra Costa Central Labor Council (CCCLC), could also claim victory on Measure N, a proposed penny-per-ounce tax on soda pop and other sugary drinks (that would have indeed been collected as part of Richmond’s “business license fee.”)
Unfortunately, labor wasn’t on the right side of this critically important referendum question, defeated by a 2 to 1 margin. Instead, those CLF brochures piling up in our mailbox were just supplementing a $2.5 million direct mail and advertising blitz orchestrated by the American Beverage Association (ABA). The ABA’s leading sponsors—Coke, Pepsi, et al–succeeded in thwarting a public health initiative widely hailed as a potential model for the rest of the nation.
In working class El Monte, CA., a similar measure, placed on the ballot by that city’s brave 37-year old Latino mayor, Andre Qunitero, was torched 4 to 1 on Tuesday. Beverage industry ad spending there totaled $1.3 million vs. the paltry $57,000 raised by the pro- soda tax forces. As Quintero told The Los Angeles Times before the outcome was confirmed: “What they’re trying to do is not just defeat this measure, they’re trying to obliterate it, so that no elected official ever again considers putting something like this on the ballot.”
New East Bay Vanguard?
Richmond, of course, is not some southern California political outlier. Our blue-collar city of 100,000 is the largest in America with a Green mayor. According to The New York Times, Richmond is even upstaging the usual suspects–neighboring Berkeley and San Francisco–as the new “vanguard for anti-corporate left-wing activism” in the Bay Area.
That’s elite company, for sure. But, when the experienced labor and community organizers involved in Richmond Progressive Alliance (RPA) developed an innovative local response to our national epidemic of obesity—backed by the city council last May–they already had much prior experience jousting with big business. In Richmond, “corporate America” is mainly represented by Chevron, which operates a (sometimes explosive) century-old refinery and always spends heavily on local politicians eager to do its anti-environmental bidding.
Unfortunately, this year’s corporate tag team combination—Big Soda wrestling together with Big Oil (with Little Labor cheering them on)—proved hard to beat, in city council races and the controversial Measure N campaign. As of Wednesday morning, RPA’s two council candidates were placing fourth and fifth in the race for three open seats.
Combined corporate spending, to defeat them and Measure N, amounted to an estimated $100 per Richmond voter. The CLF’s “working families” in Contra Costa County were not well served by organized labor’s almost unanimous failure to back the pro-worker, independent political campaigning of the RPA and its highly educational advocacy of less soda drinking.
As RPA activist and former Kaiser physician Jeff Ritterman pointed out in countless public appearances on behalf of the soda tax, weight-related ailments are undermining health and shortening lifespans in working class Richmond.
A Working Class Affliction
Increased U.S. consumption of sugar-sweetened beverages is a major factor in the development of obesity, Type-2 diabetes, hypertension, heart attacks, strokes, and some forms of cancer. If current trends continue, nearly half of all Americans will be obese by 2030, putting a huge additional strain on U.S. medical spending and guaranteeing a life of pain, misery, and disability for many.
According to a group of academic researchers who presented their findings to the American Public Health Association in San Francisco late last month, a tax on soda, to discourage its consumption, would produce the greatest health benefits among black and Latino Californians. In Richmond, where 85 percent of the population is non-white, they are currently most at risk for diabetes and heart disease. A recent survey found that half the city’s children are growing up overweight or obese.
Measure N would have raised $3 million or more annually. According to Ritterman, who is stepping down from his city council seat, the new tax revenue could have financed “programs that prevent childhood obesity, like healthy school gardens and nutrition and cooking classes in the schools. We also wanted to provide adequate sports fields and teams for Richmond children.”
Helping Coke Instead
So how did state and local labor organizations, which have many black and Latino members, end up in the pro-obesity camp?
According to California Labor Federation Media Relations Director Steve Smith, “the state fed doesn’t take positions on local ballot measures.” As new union members in Contra Costa county, my wife and I had just “received a state mailer that we paid for that includes the [county] labor council’s recommendations on local measures,” Smith explained. He referred me to the Contra Costa Central Labor Council (CCCLC).
When I contacted its political action coordinator Tony Tiscareno, he helpfully described a labor endorsement process, at the county-level, which begins when a sixteen-union committee “schedules candidate and ballot measures for endorsement interviews.” That committee then makes recommendations to an executive board that includes 16 more unions, including the Teamsters, which represents beer and soda delivery drivers.
A national expert on the Teamsters speculates that IBT Local 315, a CCCLC affiliate in Martinez, “wanted to help the companies and feared that attacks on soda pop would decrease sales, which is after all the stated goal of the proposal.”
This source doubted that “the union would actually lose any members” as a result of Richmond’s plan but, like the beverage industry, didn’t want the soda tax idea to spread. When labor council delegates met to vote on the executive board’s 2012 political endorsements, Tiscarano says he heard no arguments against the recommendation for Measure N. (A call to Teamsters Local 315 on election day, seeking further details, was not returned, as promised.)
Jeff Ritterman contends he was never given the opportunity to present the pro-soda tax side before the CCCLC took its position. “The main opposition, I’m aware of, came from the Teamsters,” he told me. But the retired cardiologist questioned whether labor officials were really factoring in “the additional health care cost and loss of wages suffered by every union family member with a preventable chronic condition related to sugary drinks.”
To their credit, two local unions—Service Employees International Union Local 1021 (which shares office space with the RPA) and ATU Local 1555, which represents BART workers–urged their members to vote “yes” on Measure N.
A Management House Call
If we needed any reminder of who most of labor was partnering with on Measure N, two Coca Cola managers knocked on our door just one day before the election. These gentleman were part of a well organized, company-paid canvass of our Pt. Richmond neighborhood. To aid such efforts, their employer has published a report, called “Our Position on Obesity,” which disputes claims by doctors and scientists that soda is a leading cause of Americans being so dangerously overweight.
Perhaps in deference to the “Yes on N” sign on our lawn, the men from Coke didn’t try to pick a fight about the science. Instead, they tried to convince me that, if I voted for the soda tax, the Richmond City Council would never spend the money raised on new sports programs or health education for kids.
Ten years from now, taxing soda will probably be about as controversial as putting health warnings on cigarette packages and levying extra taxes on tobacco users to help defray the future cost of their medical treatment for smoking-related ailments. Let’s hope that long before then, labor gets its head out of the sand about America’s epidemic of obesity and what needs to be done to stem it.
In the meantime, unions will continue to face pressure from major employers—including Pepsi Cola and leading California health care chains—to make medical plan changes that penalize their own members financially for being overweight and having related health problems. From the east coast to the west, labor is agreeing to costly “sin taxes” under the guise of workplace “wellness” programs.
This individualized cost-shifting will leave millions of workers on the hook for bigger healthcare premiums, co-payments, or deductibles because they can’t or won’t meet new employer standards for weight, blood pressure, body mass index, cholesterol levels, and other health indicators.
A cent-per-ounce tax on soda will look like small change in comparison. So wouldn’t it be better for labor to address the obesity problem—its own and the nation’s— before it produces another wave of collective bargaining defeat?
(Steve Early became a Richmond resident in January of this year, after working for nearly three decades as a union organizer and negotiator for the Communications Workers of America in the northeast. He has been active in labor causes and campaigns since 1972. He is the author most recently of The Civil Wars in U.S. Labor from Haymarket Books and can be reached at Lsupport@aol.com)
The New York Times Well blog just posted an article on physicians who refuse to take any insurance payments. The article is entitled When Doctors Stop Taking Insurance
Please look at my facebook page. I took a series of photos yesterday in the large, 1000 bed hospital in Utrecht, the Netherlands. Many Americans think that national health care systems in Europe deliver substandard care in a terrible environment. Nothing could be further from the truth. Since a picture is worth a thousand words, these pictures document what can happen when money in the healthcare system is devoted to care not profit.