Sunday, March 27, 2005

All Offense

That’s right it's county budget time again. The battle of the bureaucrats: the Sheriff and Dave Kears have started staking out positions, the lobbying and bullying has begun. Local politicians have already started poor mouthing and blaming the medical center, the governor, the religious right, the mediocre middle and the apathetic left for the current state of financial affairs.

The sups plan to cut cut cut healthcare, but ask them about the prison budget, they’ll tell you, “You know the Sheriff is very popular.” Poppycock they’re scared of the dude.

This is not just another year, this year the public plans to weigh in on the budget. That’s right we’re fed up with county budgets that don’t reflect our values and priorities. This budget will not be balanced on the backs of the elderly and sick. This time we all get a say, stay tuned, it's pressure and accountability time, this is gonna be fun!

Postscript: In spite of ongoing problems and leadership deficits the medical center has a nearly balanced budget.

Just Unplug Me

In writing on the record, “I do not want to outlive my brain. I do not want to persist in a vegetative state.”

Brain injury or cognitive problems don’t get discussed. We talk in terms of lists of deficits, level of consciousness, attention problems, and memory and language deficits, movement disorders. We have a whole lexicon of terms to describe “cognitive deficits” we try to take it apart and track and describe the differences. We like to fix and improve things, better diet, better joints better boobs, medicine fixes and improves.

With brain injuries we watch and see, we teach compensations and we coach the family to accept the changes caused whatever happened inside their loved one’s head. When you work with the families of brain-injured clients they often say to you, “they are not the same person.” That’s when you know they have started not just to understand but also to accept what has happened. Sometimes families never accept the changes in their brain injured relatives and loved ones and they keep waiting for the person they remember to come back.

That’s why we don’t like to talk about brain damage, it begs big questions, where is our soul? Which parts can you take away, replace or enhance and still have the same person? Americans can spend hours discussing makeovers and surgical improvement, they can tell you which movie stars have had work done, but could they tell you the man talking too loud in the restaurant with the scar above his eye had a brain injury? No, they would tell you he’s just a jerk.

There is something terrifying about the thought of loosing part of one’s self and still having one’s body inhabiting your life. Can the soul be changed and rearranged and at what point are we gone but still here. We would rather not think about it.

So instead of a national dialog about brain injury we have the Schiavo case: court room drama, political posturing, fear, ignorance, denial, and righteousness. Never has so much been said and so little learned.

Thursday, March 17, 2005

Cambio Healthcare Solution’s Twelve-Steps to Quality Care

When policy makers use the term “quality healthcare” what they are really talking about is the absence of bad outcomes, deaths, dismemberments, lawsuits or citation provoking mistakes. So has Cambio’s management caused a crisis of quality at the medical center? Yes. So how did they make the medical center dangerous? Well, actually they used a twelve-step approach.

The first step was to cut staff, and to replace highly skilled clinicians with temps in critical care areas. You want the nurse in the intensive care area to know where the “crash cart” is. If half of the ICU staff flew in from the red states the night before, not only do they not know where things are, they don’t have anyone to ask. The medical center doesn’t have enough oncology nurses, chemotherapy treatments are being delayed, this is a big no no, and will definitely get the hospital cited.

The second step: ignore maintenance in important areas, while spending extravagantly in others. Like why spend money on things like computers for doctors orders, telephones for nursing stations and patient’s rooms and elevators when you could blow millions on time clocks and PR. So under Cambio’s tenure, elevators have actually crashed down the shafts, when telephones break they don’t get replaced and computers, which generate physician’s orders for whole departments, are broken for weeks at a time. What is the point of clocking employees in if they don’t have any work because the computer broke?

The third step, keep executives away from all patient care areas, don’t articulate any long term vision for the hospital and blame employees and indigent patients for the hospital's financial problems. “Cambio doesn’t want these people in the hospital.”

So, while Cambio Healthcare Solutions failed to articulate a vision for the medical center, they have hurt patient care through cuts, bad staffing strategies, failure to maintain essential equipment and a negative attitude toward our clients. Once a consulting company causes this kind of damage what do they do? They claim victory having reined in cost and moved the facility toward “fiscal responsibility.” At the end of a consultant contract not much gets done. The Tennessee temps are busy keeping their chairs warm and trying to hire their buddy’s into high paid management spots before they fly home.

In the interest of getting a decent night’s sleep, I will skip the last nine steps of Cambio’s twelve-steps to getting blood from a stone or a public hospital. Still these consultants will be leaving on a high note; doctors, unions, managers, politicians and board members all express giddy optimism about the consultant’s departure. Everyone wants a real CEO. Awareness about healthcare has changed as well; people expect a functional public hospital. Medical center employees enjoy a new level of support and respect in the community and employees, patients and Alameda county residents expect the board of supervisors to make good on the promises of Measure A.

Friday, March 04, 2005

Belt Tightening and IOU’s

Cambio Healthcare Solutions wants to look good to the politicians, lower costs at any price. They have given up on revenue enhancement and fixing the broken billing department. They are focusing instead on more cost cutting: squeezing budgets, running off more staff, and not paying bills. Who knew you could run a hospital on IOU’s?

Cambio’s brain trust is going department-by-department chopping fat and waste. Physical therapy lost its wheel chair budget, respiratory therapy its equipment budget (those ventilators are a real excess). We fully expect that they’ll just fire all the discharge planners and replace them with new technology: the hospital ejecto-bed (which will propel patients off the roof and back into the streets of Oakland).

Actually, the consultant’s high-risk management schemes have begun melting down. Cambio Healthcare Solutions thinks unions are icky, so they have replaced many permanent staff with travelers and temps. They outsourced about half the nurses in the emergency department and the critical care areas.

Whenever a highly qualified specialist nurse tries to get hired on at the medical center, their resume gets lost. “You can teach the traveler from Virginia how to give chemotherapy. She has ten years of experience in labor and delivery it can’t be that different.”

So aside from frightening patient care scenarios this passion for outsourcing has now created a financial crisis. You see temp agencies are ruthless negotiators and when they supply a huge percentage of your staff, they can pretty much name their price. That’s just what the agency that supplies one third of the medical center’s respiratory therapists did. The raised the hourly rate from $ 38 to $54 dollars an hour. Oops, there goes your cost savings.

Cambio showed them, they cancelled the contract. Starting Saturday they’re gone, no more travelers. So now they will be paying the regular staff tons of overtime. Actually the department maybe able to run with less respiratory therapists if the ventilators get repossessed, that will really cut the work down.

Any day now, the nursing outsourcers (who provide half of the critical care nurses) will decide to gouge the medical center and raise their rates; this will catapult the medical center back into big debt. Cambio’s betting they can ride on temps, IOUs and service cuts until their contract is up. They run a lean mean healthcare machine and they’re running the medical center right into the ground.

Thursday, March 03, 2005

Measure A Giveaway

The Oakland Tribune is keeping an eye on the cash. The Sups are going to give millions to Saint Rose Hospital to cover the cost of treating the uninsured. Oh, poor private hospital.

Look, I'm all for supporting hospitals who reach out to the poor and the uninsured, but Saint Rose is not known for its soft touch with needy. Hospitals who get these funds should have to demonstrate that they don't discriminate or dump patients.

If an accident victim gets discharged from Saint Rose with an unfixed broken hip, and they still need an orthopedic surgery at Highland, why should our tax dollars go to the hospital that gave the poor patient expensive advice and Vicodin.

I'm guessing there's no strings attached to this public funds giveaway and Saint Rose doesn't plan to use the funds to develop substance abuse program for all the meth addicts who live within commuting distance of their hospital.

Oh, well at least the Tribune's on the job, to read Karen Holzmeister's piece click here: