My Motivation to Pursue a Leadership Role in Healthcare

St. Joseph’s HA511 Course, Leadership in Health Administration, encourages students to reflect on their personal leadership journey, leadership effectiveness and the transformation of healthcare.  During week 2 students engage in a dialog on the discussion board sharing with one another leadership quotes that inspire them. The following is a post from Aaron Strout:

My Motivation to Pursue a Leadership Role in Healthcare

“You can’t lead the people if you don’t love the people.” Cornel West

Leadership is not a subject I have studied in depth.  It is not a subject I have been interested in studying until recently.  The concept of leadership may even be one that I viewed with contempt for many years, viewing leaders as shameless self-promoting bullies, hawking their snake oil to mindless masses.  But I am older now, not as interested in “sticking it to the man” or “fighting the power”, as I am in modeling a life and creating a future that my children and others can be proud of and benefit from.  This adjusted paradigm has allowed room to value the concept of leadership, and even myself as a leader. 

Working in healthcare has allowed me to see my role develop as an advocate.  This advocacy unfolds in different aspects, but it’s primary motivation stems from perceived areas of injustice and wrongs that should be made right.  Healthcare is not a perfect environment.  Healthcare related mistakes cost too many lives every year.  These can include clinical mistakes as well as system injustices that omit access to certain populations of people. 

I also feel a sense of responsibility to fellow healthcare workers.  My primary role over the past 10 years has been as a nurse, but I see other disciplines and departments as equally important in creating a functional healthcare environment.  Too often healthcare does not do a good enough job taking care of the people who take care of others.  For example, while the consensus is to debrief and process after a traumatic event happens at a hospital, long term care facility or an office, my experience is that this does not happen in practice.  Consequently, employees are left to process death, blood, suffering, pain, and chaos independently without the formal support of their peers.  These events are often discussed informally amongst co-workers, but little follow up is done from an employer perspective.  Many daily events are not as traumatic, but still deserve to be followed up on, so that employees can focus the majority of their time and energy on creating a positive environment for patients and families. 

Herein lies my motivation to pursue a leadership role in healthcare.  As an industry, we need to do a better job at caring for those we work with.  I am convinced this is the only way to improve the healthcare experience and industry.  When we start caring for each other, we will do a better job caring for our patients and families. 

Healthcare needs leaders who are developing their worldviews and growing their inner capacity to, “…love the people.”  Instructor: Danine Casper, MHA

Risk, Fear, and Failure

Risk, Fear, and Failure

Friday, April 19, 2019

8:12 AM

In his book, "Fail More", author Bill Wooditch explores the human trait of "fear" and ow this has been ingrained in our culture, education system, and other institutions of society.  He cites numerous individuals who have overcome failures and fear but went on to greater accomplishments.

When I was reading the book, I thought about how the urge to be perfect and to always win creates the an environment to quit or not even try a hobby, sport or other activity.  I recall the comment from a movie that second place was really "first loser".  During the NCAA Basketball Tourney, I saw a young boy outfitted in his teams colors emotionally distraught over the loss of his team and wonder what might be the impact on his willingness to play the sport in the future.

All of this drive for winning and perfection lead me to some thoughts about the regulatory oversight and quality improvement  systems used in the LTC/PAC sector.  Public policy has driven providers to be mandated to seek care without errors or mistakes and compliance with subjective regulations needing perfection.  Is this really feasible given the challenges in financial resources and support from governmental funders?  Has this public policy direction for perfection created a culture that avoids risk and innovation?

The basis for quality improvement is to identify goals to achieve, evaluate performance data, create plans to achieve better outcomes and assess performance and progress or the classic "Plan, Do, Check, Act" mantra.  Does that fear of failure or a less than optima outcomes destroy attempts for innovation in the quality improvement cycle? 

In earlier blogs I have suggested the need to change how the LTC/PAC sector is regulated.  The ability to create innovative, quality driven organizations is stifled by the overzealous and subjective actions by the current survey system.  LTC/PAC providers are closest to the patient, have the ability to make evidence-based judgments on their needs.  The sector should be encouraged to work on innovation and not judged merely on observations taken from a database and based on opinions of documentation provided in a healthcare record.

Steven Chies, MHA, LNHA (MN) FACHCA, HSE

Program Manager, Long-term Care Administration

Instructor

HA 214

HIM 214

LTC 448

LTC 352

LTC 462

Medicare for All

As we move forward toward the 2020 elections, one of the things being proposed is a “Medicare for All” plan to replace the Affordable Care Act.  Medicare for All was originally proposed by presidential candidate Bernie Sanders in 2017.   This has also been championed by Alexandria Ocasio-Cortez, a freshman representative from New York City.  This plan lowers the age to qualify for Medicare to age 50.  The reasoning behind this is people ages 50-65 are older, not as healthy and require more care; therefore, they are more expensive for employers to insure.  Ultimately, the goal of the Medicare for All, as it has been undergoing metamorphosis, is to eventually eliminate health insurance companies (as the age where people were covered is continually decreased to age 40, etc.) until eventually all were covered.  In addition, drug company profits would fall considerably because the government would control health insurance and, in theory, have more bargaining power.  In addition, doctors and hospitals would have to take pay cuts.

In 2018, Kenneth Thorpe at Emory University estimated this plan (just to lower Medicare to age 50) would cost $2.4 trillion per year, while the Urban Institute calculated $2.5 trillion a year.  The Committee for a Responsible Federal Budget estimated an annual cost of $2.8 trillion which is 20% of the gross national product of the U.S.  This is twice the health care portion of the GNP of other nations (although the US has a much larger population (Ghilarducci, 2018) and about 2-3% higher than the current rate.

Essentially, Medicare for All is a single payer system where the government controls health care and consumers ultimately have no choice; what is available to them is controlled by the government.  Additional information about this plan indicates that all private insurance plans would be eliminated under some proposed versions.

It is important to note that other nations such as Australia, the United Kingdom (UK) and even China who tried to institute a “universal” single payer option all went back to also offering a private insurance option.  Even Germany, who is touted as a model for health care, used a multi-payer system and has both public and private options.

When the government controls health care and there are no other options, there is a potential capacity problem.  This is experienced in the UK and other health care systems where instead of waiting three days to three weeks to see a specialist, the patient may wait three months or more.  In a universal public system only, certain procedures and care are not available because the benefit of all outweighs the benefit of the many.  This may be fine in theory, but when it directly affects a loved one who cannot get a specific cancer treatment or a transplant because it is not authorized, this presents a very different perspective.

On April 1, 2019 Forbes reported that the UK’s system which is essentially like Medicare for All is collapsing.  Over 250,000 British patients are waiting more than 6 months for planned treatment and over 36,000 have been waiting for treatment 9 months of more in the public system. In addition, 25% of cancer patients in the US did not start their cancer treatment on time even though their physician submitted an urgent referral.  This is further reflected in cancer survival rates: in Britain the five year breast cancer rate is 81% compared to 89% in the US, while the five year survival rate for prostate cancer in the US is 83% compared to 97% in the U.S. (Pipes, 2019).  There is another aspect this this; the UK population was 66 million in 2017, while the U.S population is 326 million or 5.3 times that of the UK.  This also means more taxpayers; however, according to the Tax Policy Institute (2019) only slightly more than half of American pay taxes.  This is compounded by the aging of the Baby Boomers and underemployment of younger generations who now live with parents and become adults at age 27 or older.

It is important that U.S Citizens educate themselves about the potential effects of health policy since it directly affects them and their families.  Medicare for All may sound wonderful at first blush, but citizens need to realize it could result in a much different level of care, increased waiting times, and higher taxes.  These potential ramifications are not emphasized in the popular media.  However, more conservative organizations such as the Heritage Foundation have addressed potential issues that could occur.  This issues may be something citizens are willing to accept, but they should not blindly accept what they are told without examining it for themselves. As this proposal continues to be evaluated by health policy experts, American citizens owe it to themselves and their fellow citizens to examine the potential ramifications objectively and realistically, rather than emotionally and idealistically.

References

Ghilarducci, T. (2018, July 16).  What is Medicare for All?  Forbes.  Retrieved from https://www.forbes.com/sites/teresaghilarducci/2018/07/16/what-is-medicare-for-all/#9c75d0dbd0be

Pipes, S. (2019, April 1).  Britain’s version of “Medicare for All” is collapsing.  Forbes.  Retrieved from https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/#5e365bdb36b8

Tax Policy Center. (2019). TaxVox:  Federal Budget and Economy.  Urban Institute and Brookings Institution. Retrieved from https://www.taxpolicycenter.org/taxvox/tcja-increasing-share-households-paying-no-federal-income-tax