UCSF: The most beautiful hospital complex I’ve ever seen!

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Readers of my blogs know that the state of the American healthcare system is a decades-long interest of mine, facilitated by the company, Healing Healthcare Systems, that Susan and I founded 23 years ago.  Earlier this year, I attended and … Continue reading

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Reflections on 9/11 and a significant birthday

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September 11, 2015, Denver, Colorado Our parents’ generation all remembered where they were when Pearl Harbor was attacked in 1941. I was in high school in Columbus, Georgia, when Kennedy was assassinated in 1963…at Florida State University when Martin Luther … Continue reading

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Four Mini-Blogs with Photos

Detroit Municipal Garden

Detroit Municipal Garden 

Detroit

The short tragic history of Detroit is that race riots in the late sixties caused “white flight”, drastically lowering the tax base and precipitating the relocation of major industries away from Detroit. The lack of jobs led to a reduction in Detroit’s total population from over two million to the current 700 thousand. At its worst there were approximately thirty thousand empty, burned out houses. Many have been torn down enabling the establishment of municipal gardens, which supply many of the new upscale restaurants with fresh organic vegetables.

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One wall of the Diego Rivera murals filling the atrium of the Detroit Institute of the Arts

Kahlo/Rivera exhibit

The Detroit Institute of the Arts is a unique world class museum. Besides its extensive and varied collections, perhaps the most striking single feature is the large room which houses the Diego Rivera murals commissioned by Edsel Ford at the height of the auto industry’s position in Detroit high society.

Rivera’s wife, Frida Kahlo has gotten increased attention of late. Her expression through her art reflective of her personal crises foreshadowed today’s selfie culture. She also foreshadowed feminist art in the sense that she presented realist feminine characters of all ages.

Diego Rivera was an avowed communist. His magnificent murals in the DIA provoked some critics to propose painting over them. In fact, at another of his murals commissioned in New York, Rivera painted Lenin’s likeness in the “peace” section of the mural. Hisenemies succeeded in having Rivera’s artistic masterpiece destroyed. This is exactly the American counterpart to ISIS destroying cultural treasure in Syria.

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More classical art displayed within the DIA

Detroit Symphony

Music is almost always best heard live as opposed to in recordings. The Detroit Symphony made its program of Britten, Mozart, and Schumann sound better than I had previously ever heard these pieces either in recorded form or live. This is the sign of a great symphony. I love all my friends in the Reno Philharmonic. But I am very sensitive to imperfections in orchestral tuning and execution. I can never fully relax while listening to the Reno Philharmonic, because I am distracted all too often by individual errors and ensemble inconsistencies. I could totally relax and bath in the sound of the orchestra while listening to the Detroit Symphony in its magnificent old concert hall.

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Getting ready to play Robert Shumann’s Spring Symphony

Mayo Clinic

Mayo Clinic is a fantastic integrated medical system. It doctors work on salary in what is effectively a large group practice. Due to the close integration and cooperation across specialties and departments, comprehensive diagnosis testing can be completed in a much shorter time than the usual fragmented situation on the open healthcare market, where separate appointments must be made for different tests from which results are often very slow in coming.

I’m proud that Mayo Clinic has had our CARE Channel for a number of years. Its broadcast extends into the neighboring institutions such as Charter House, the eldercare facility which is home to our friend Bani. Susan and I really enjoyed watching it in our guest room. We left it on for hours, just like patients in the medical center do.

Mayo Clinic seems modern and progressive in every way. There are regular concerts in one of the clinic’s large atriums. There is an abundance of art in the long hallways, including a series of Andy Warhol’s reproductions.

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Andy Warhol within the Mayo Clinic

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This house is located opposite the municipal garden

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Symphony Hall, home of the Detroit Symphony

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Chihuly glass artworks hanging above an escalator in the Mayo Clinic

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We are all the Patient Experience

The Dallas, Texas skyline from our hotel room

The Dallas, Texas skyline from our hotel room

Inflated Prices for Rice and Healthcare

Rice is a staple of the Japanese diet. Japanese-grown rice costs twice as much in Japan as the same rice sold in other countries. This is because of a convoluted system of distribution and middlemen, which raises the price far beyond the actual and reasonably expected price of rice.

The price of healthcare in America is similarly inflated. Americans spend on a per-capita basis twice as much for healthcare service as the same healthcare services in other modern industrial nations. This would be okay if American healthcare were twice as good as that of other nations. Unfortunately, we do not receive the outstanding healthcare that its high price would imply. Indeed, in comparative measures, such as child mortality, hospital-born infections, re-admissions, and patient satisfaction, the US comes in the middle of comparative ratings, far behind nations who spend much less per capita for their healthcare delivery.

Like rice in Japan, Americans don’t pay anything close to the actual cost of healthcare services received. A quick trip to the emergency room for a relatively simple injury, such as a broken bone, results in a bill for many thousands of dollars. Hopefully, the injured person has health insurance to cover the high cost (after the patient-obligated deductible has been paid). While the ACA, known colloquially as Obamacare, seeks to require all Americans to pay into a general insurance pool, at the present time, the US leads the world in medically-caused bankruptcies. (Such bankruptcies are non-existent in countries that have universal healthcare.)

The end of “fee for service”?

While a large cause of America’s high healthcare cost can be attributed to the insurance industry’s profits removing a large percentage of healthcare dollars to cover their operations, promotions, and profits, another important factor is the “fee for service” design in which doctors and hospitals are paid more when more procedures, tests, and treatments are prescribed, leading to ever-escalating costs. This basic flaw in our healthcare system is slowly being replaced by a new financial system called “outcome-based-reimbursement” (also called “value-based-purchasing”). Under this system, the hospital/doctor makes more profit when their treatments are successful, without complications or readmissions following the initial treatment. Personally, I think that a profit-based healthcare system is inherently wrong through and through, but this is a subject for another time.

ConfTitle

The Beryl Institute and the Patient Experience

In a refreshing contrast to the flawed system discussed above, I had the opportunity to attend a wonderful conference in Dallas, Texas, sponsored by The Beryl Institute, focusing on improving the “patient experience.” The general theme of philosophy of the conference (and the Beryl Institute) is that every person working in the hospital contributes, either positively or negatively, to the experience of the patient who passes through the healthcare system. Certainly, a positive healthcare outcome is facilitated when the patient feels that they have been well treated, receiving the best care possible. This can be summed up in the phrase: How one feels affects how one heals.

Consideration of the patient experience is familiar territory for Susan and me, since our career in healthcare producing the CARE Channel has always been directed toward improving the patient experience. Indeed, at the conference, we met many attendees from our CARE Channel client hospitals. This was gratifying. I’ve always said that we work with the best, most sensitive humane individuals in healthcare. The people who are attracted to the CARE Channel are the ones most sensitive to the potential of beautiful music and nature images to improve the patient experience.

Spanning two and a half days, the Beryl Institute conference consisted of large general sessions, as well as smaller group “break-out” sessions, covering many single issues being addressed by different hospital representatives from the US and Canada.

The Beryl Institute defines the patient experience as: The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.

Healthcare horror stories

Several conference speakers prefaced their appeal for a better patient experience by recounting their healthcare horror stories, such as denial of coverage by insurance companies, distracted physicians who would not inform the patient of their condition and prognosis, delayed or undelivered treatments despite clear medical orders, uncoordinated staff leading to incomplete fragmented care, etc. Bureaucratic requirements reduce the amount of time that nurses are able to deliver care. Financial pressures leading to increased work loads result in overworked staff and low morale. Obviously, there is more than enough money being spent within the US healthcare system. Yet, the US system fails in comparison with other countries’ universal systems that simply provide healthcare for all, just like education, water, electricity, roads, and other functions that have been recognized as being vital for the general welfare, and which suffer under competing companies seeking to maximize profits derived from delivering vital services only to those with enough money to afford them under the market-based model.

The grassroots response

Thus, we have a grass-roots movement to reform and improve patient care from the inside and from the bottom up, not through government regulations or financial incentives. Ultimately, groups such as The Beryl Institute (www.berylinstitute.org), Planetree (www.planetree.org), and the Center for Health Design (www.healthdesign.org) all seek a culture change in American healthcare, to humanize the environment of care for the benefit of patients and healthcare professionals, to lead with the values of caring, nurture, trust, and empowerment, separate from the politics and financial exploitation of the profit model that had given us our current system and its obvious flaws.

It is very uplifting to attend conferences such as this one in which the most progressive and enlightened individuals come together in the common purpose of improving our troubled healthcare system. Susan and I, together with our colleagues in Healing Healthcare Systems, are proud to participate in this work.

On the second day of the conference I played the morning invocation

On the second day of the conference I played the morning invocation

This sentiment is embodied in another key Beryl Institute catchphrase describing the patient experience:

All voices matter.

Every interaction matters.

You matter.

We are all the patient experience.

I am the Patient Experience

I am the Patient Experience

We are all the Patient Experience

We are all the Patient Experience

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Israel-Jordan Photo Exhibition

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Israeli and Palestinian Nurses Uniting in Human Caring

The official group photo.  I'm standing in the back row to the right.

The official group photo. I’m standing in the back row to the right.

For the third year in a row, Susan and I attended the conference Middle Eastern Nurses Uniting in Human Caring. This year’s title was Human Caring in a Time of World Crisis, a theme chosen almost a year ago, before the most recent war between Israel and Gaza, before the hideous executions by ISIS, most recently of a Jordanian pilot burned alive. Some Americans were afraid to attend the conference this year in Jordan (or indeed anywhere in the Middle East). Perhaps some Israelis were reticent to attend as well. But the conference was the largest yet, with approximately fifty attendees, half of them from Arab countries, (mostly Palestinian) nurses, one quarter Israeli nurses, and assorted foreigners including Americans and attendees from Dubai, Bahrain, the Philippines, and Iran.

Iranian nurse on the left; Palestinian nurse on the right

Iranian nurse on the left; Palestinian nurse on the right

With the second Iranian nurse

With the second Iranian nurse

It must be noted that it is risky for nurses from the Occupied Palestinian Territories (OPT) and those from Israel to collaborate because of the risk of political repercussions. So far these conferences have not been widely publicized in terms of their professional colleagues being aware of their attending the conference. Publicity about the conference could lead to some people being condemned by their colleagues and perhaps even losing their jobs. Indeed, some Palestinian nurses from Bethlehem and other areas were unable to attend precisely because of these professional hazards.

And yet, it is precisely such cross-national gatherings, bridges between the people as occurred with this one, that are critically needed in the region. Jordan has been the mutually agreed-upon meeting place because Jordan is the one country to which Palestinians are able to travel freely. Jordan is also at peace with Israel, so Israelis travel to Jordan to visit tourist sites, such as Petra, or in this case for this professional development conference.

It was necessary to state among attendees that the conference was not a political event. Rather, it was a gathering to promote professional development within the various nursing disciplines. The conference was planned by a committee comprised of Israeli and Palestinian nurses. In other words, those nurses most deeply involved with each other and concerned about promoting closer ties between Israelis and Palestinians are the ones who organized the conference.

Jean in mid-sentence

Dr. Jean Watson in mid-sentence

The unifying international force is the work of nursing pioneer Dr. Jean Watson. I call her the Florence Nightingale of the 21st century. Her vision is to acknowledge that all nurses share common values as healers. Therefore, nurses of every nationality are ready to work together toward their common healing goals, regardless of political and national conflicts. For example, the Israeli nurses proudly spoke about the fact that they gave equal care to wounded Israeli soldiers or captured Palestinian enemy soldiers. Everyone receives the same high quality compassionate care, a stated mission and policy of Hadassah Medical Center.

Jean Watson developed the nursing theory of Human Caring, outlined in her  Caristas Processes (Caritas is the Latin word for caring). She is internationally recognized and has hospitals in countries around the world that seek to implement her philosophy of caring among their nurses. She invited Susan and me to participate from the beginning of these conferences, seeing our environmental design work using music and nature as being totally in alignment with Caritas.

At the first gathering of the conference, all attendees introduced themselves, what they did, and where they were from. It was a confrontation with reality to hear so many nurses proudly state their work places in “Palestine,” a country that exists for them, where they have lived their whole lives, but is not recognized by the international community.  At this time, there is a news-blackout in the US press regarding life in the Palestinian Territories.

The first presentation was from the Palestinian head of their nurses’ association. In spite of our intention to avoid politics, this Palestinian man spoke to the “elephant in the room,” the fact that Palestinians live in a territory controlled and occupied by Israel. He spoke of his belief in the “two-state solution,” i.e. Israel and an independent Palestine. He spoke of the absolute necessity of cooperation and collaboration between the Israeli and Palestinian medical communities who confront the same issues: limited resources, the spread of antibiotic-resistant bacteria, the necessity of vaccinations, communicable and non-communicable diseases, poor health as a result of poverty, the necessity of treating refugees from the nearby Syrian civil war, etc.

Susan with the head of the Palestinian Nurses Association

Susan with the head of the Palestinian Nurses Association

An example of the political challenges creating health challenges is in the fact that there are six hundred Israeli checkpoints within the Palestinian territories. While Palestinians must pass through them every day to get from one place to another, for a women in labor or a cardiac patient in an emergency who needs care in Israel, the check points pose a dramatic risk. For Palestinian nurses that work in Jerusalem, their journey can take a couple of hours each way even though the distances are small. Ambulances that bring acute patients from Palestine into Israel are forced to exit the ambulances, be inspected, and then get into an Israeli ambulance, regardless of the condition of the patients. Women have been forced to give birth at the checkpoints because the Israeli guards would not expedite their passage through the checkpoints. These upsetting stories were told in a matter-of-fact way. It’s just a daily fact of life. Their Israeli nursing colleagues are equally dissatisfied with the decades-long impasse.

Nurses from the Palestinian Territories stated that they have not received pay for 7 months; the Hadassah facility in East Jerusalem went 4 months without pay and then the nurses themselves figured out how to generate revenue for the hospital by treating refugees from the UN-administered camps near the Syrian border. In spite of not being paid, the nurses continued to come to work every day to take care of their patients.

We heard that during the recent war with Gaza, air-raid sirens would sound in Jerusalem, at which point people were supposed to move into the bomb shelters. But the Israeli and Palestinian nurses in Hadassah Medical Center refused to abandon their patients and didn’t retreat into the bomb shelters. Their level of professional dedication is inspiring.

The bulk of the two-day conference was spent in 20-minute TED-style presentations of research projects conducted in Israel, Palestine, and elsewhere. Subjects included: confirming the effectiveness of mid-wives, application of genetic testing to discourage marriage among cousins in Palestine even though it is condoned in the Koran, promotion of palliative care, promotion of employment opportunities for disabled/challenged individuals. In short, medical workers everywhere confront similar issues and have done so ever since Florence Nightingale elevated the role of nurses as a profession.

Susan presented a talk entitled Space, Place, and Grace

Susan presented a talk entitled Space, Place, and Grace

Interestingly, one of the visiting Iranian nurses compared Caritas with Islamic philosophy, pointing out similarities in the injunctions for selflessly providing care wherever and to whomever it’s needed. After all, the Moslem world, particularly under the Ottoman Empire, was the world’s leader in medicine, mathematics, and science, at peace for centuries during the time that Europe was embroiled in its Catholic-Protestant religious wars. The presence of so many Moslem nurses, some of whom always wore head scarves (abayas), presented Islam as compassionate and caring. The sense of shared values among all nationalities of nurses was reinforced by the conference.

Invoking Islam as the foundation of delivering nursing care

Invoking Islam as the foundation of delivering compassionate nursing care

As individuals, we feel so powerless to effect any change the course of human events on a national or international level. Yet, there is a famous saying to the effect that a group of committed individuals is the only thing that has ever been capable of changing history. Thus, we will continue to attend and support future conferences of Middle Eastern Nurses Uniting in Human Caring. It embodies the sentiment of the saying: Let there be peace on earth, and let it begin with me.

Having fun at the end of the conference.  Jean Watson is in the back.

Having fun at the end of the conference. Jean Watson is in the back.

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Wadi Rum, Jordan’s spectacular desert nature reserve

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    Four years ago, Susan and I toured Jordan for the first time. Through the internet, I hired a driver/tour guide based on an ad from a Jordan tour company. This driver, Mazen, met us at the airport holding … Continue reading

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