Know your healthcare waste

It’s important to know the facts about healthcare waste when discussing sustainability.

Types of Waste in Healthcare

Waste in healthcare can be divided into four categories:

General waste: The most common type. This is the same waste produced residentially and commercially, which can be subdivided into recyclable and/or compostable waste. This waste is the most common reason for exorbitant waste management costs as general waste should always be segregated from regulated medical waste, as the costs of treatment are high. General waste does not have to be treated.

Infectious waste: Waste that can be infectious should be segregated and kept separate in proper red bag receptacles. This waste must be treated, requires special storage, transport, and disposal (“Understanding waste”, 2019).  This waste includes: Sharps, PPE, Pathological waste, Surgical waste, Anything contaminated by bodily fluids.

Hazardous waste: This waste must also be discarded/ stored correctly as it can harm the environment. This waste can include (“Understanding waste”, 2019): Chemicals, Pharmaceuticals, Aerosol containers, Batteries

Radioactive waste: Proper disposal of any radioactive materials from treatments and/or tests is vital to the environment and public health.

 How Much Waste is Generated

Hospitals produce more than 5 million tons of waste each year- averaging over 29 lbs of waste per bed per day (Practice Greenhealth, 2020).

According to WHO (2018), 85% of healthcare waste is your run-of-the-mill non-hazardous waste, and the remaining 15% is regulated medical waste- waste that may be infectious, toxic, or radioactive.

How is Waste Disposed

Regulated medical waste must be treated before it is disposed of. Some places incinerate this waste; however, this can result in harmful emissions. According to WHO (2018):

Only modern incinerators operating at 850-1100 °C and fitted with special gas-cleaning equipment can comply with the international emission standards for dioxins and furans.

Safer alternatives to incineration such as autoclaving, microwaving, and steam treatment should be used where available. They minimize the formation and release of chemicals or hazardous emissions while properly treating the waste.

Waste Reduction

Proper training and education on waste management strategies in all healthcare facilities.

Oversight and auditing of waste

Prioritizing safe and environmentally sound treatment of hazardous waste

 Consideration of greening the supply chain is a good start

 References

Practice Greenhealth. (2020). Waste: Understand hospital waste streams, how to measure them, and reduce waste at your facility. Practice Greenhealth Official Website. Retrieved from: https://practicegreenhealth.org/topics/waste/waste-0#:~:text=Waste%20is%20a%20common%20challenge,waste%20per%20bed%20per%20day.

Understanding waste management: What are the 4 types of medical waste? (2019, Dec 18). Choice Med Waste. Retrieved from: https://www.choicemedwaste.com/understanding-waste-management-what-are-the-4-types-of-medical-waste/

World Health Organization (WHO). (2018, Feb 8). Health-Care Waste. World Health Organization Fact Sheets. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/health-care-waste

The Proof is in the Pudding...or Money

Reducing red bag waste is good for the environment, yes. It’s also good for public health- right. But did you know that you could be saving hundreds of thousands by reducing your red bag waste?

Don’t believe me? Take a look at these success stories:

Inova Fairfax launched their red bag waste initiative in 2008. By 2014, they saved more than 300K (McKinney, 2014). 

Sacred Heart Hospital of Euc Claire, WI switched to reusable sharps containers and reduced waste by 40,000 lbs annually. This was a 5% decrease in annual operating expenses (Mello, 2019).

A study published by Susan Kaplan at the University of Illinois- Chicago says the healthcare industry as a whole could save $5.4B in five years and up to $15B in 10 years if it adopts sustainable practices, such as waste reduction (Carroll, 2012).

There is so much evidence out there to suggest the benefits of sustainability initiatives in healthcare. If you don’t believe me, go out and look for yourself!

Sources for this post- you can start here:

Carroll, J. (2012, Dec 11). Study sees huge savings in hospital sustainability. Modern Healthcare. Retrieved from: https://www.modernhealthcare.com/article/20121211/INFO/312119994/study-sees-huge-savings-in-hospital-sustainability

McKinney, M. (2014, Sept. 27). Inova launches red-bag waste reduction initiative. Modern Healthcare. Retrieved from: https://www.modernhealthcare.com/article/20140927/MAGAZINE/309279984/inova-launches-red-bag-waste-reduction-initiative

Mello, J. (2019). Sustainability in Health Care Organizations: Successes, Challenges, and Opportunities. Journal of Strategic Innovation and Sustainability; West Palm Beach Vol. 14, Iss. 2, pp. 123-128.

How can my organization act to reduce red bag waste?

I am so glad you asked!

•  Establish a “Green Team.”: Neither one person nor one department should be responsible for initiating these changes. It is recommended that an interdepartmental team be instated in order to ensure that the organization(s) can be successful system-wide.

•  Education is a top priority: All staff must be educated in proper waste separation and waste disposal practices. It is every employee’s responsibility to follow proper waste disposal practices to both ensure patient safety and do their part in easing their organization’s financial burden. Signage should be posted to help employees, patients, and guests understand proper waste disposal.

•  Waste segregation: It is the responsibility of the organization that waste bins are properly labeled and segregated. As we cannot ensure every visitor is properly educated, we should not make regulated waste bins large and too publicly available. Other sources have suggested color-coding waste containers with proper signage as well, which can be easily understood by anyone passing by.

•  Recycling: Every organization should be doing their part to reuse and recycle as well. During a global pandemic, it is understandable that recycling is not as easily done in the healthcare setting. However, recycling should still be a top priority in public areas and with recyclable non-infectious materials.

•  Purchasing: Responsible purchasing is an important part of sustainability practices in waste reduction. When items are over purchased, they tend to be more widely and inefficiently disposed of. This is fiscally and environmentally irresponsible and should be addressed as a part of this initiative.

•  Waste audits: Each organization should be regularly auditing its waste management areas and practices. In areas where audits results are poor, re-education should occur, extra signage should be considered, as well as the necessity and location of any containers that are available for public and staff use. It is so important to hold areas accountable for their waste management.

More to come on this initiative!

Did you know that hospitals produce more than 5 million tons of waste each year- averaging over 29 lbs of waste per bed per day (Practice Greenhealth, 2020)? Medical waste can be costly to treat and dispose of if it is not properly separated. An important sustainability initiative for any healthcare organization is waste segregation. It can save the environment, the health of our communities, and save our organizations lots of money! More info to come. 

What Hospitals Can Learn from the Hospitality Industry

Most people look forward to a visit to a decent hotel, however, not many can say the same about a trip to the hospital. However, when you visit a hotel and when you visit a hospital, you need many of the same things. It is therefore logical that the two industries have begun to intersect. Healthcare has recently become more patient-centric, placing emphasis on patient satisfaction, and developing business models that cater more to the patient experience. Patients have indicated that they want more than just expert care when they visit the hospital. In 2016, a Boston University survey indicated that patients would be willing to pay 38% more for a hospital experience with hotel-style upgrades (“How and Why”, 2017). The hospitality industry is uniquely capable of helping the healthcare industry put patients first. This article will discuss how healthcare can learn from hospitality by going beyond making the patient well, as well as analyze hospitality’s use of technology, the importance of employee attitude, and the development of these hospitality behaviors.

Going Beyond Making the Patient Well

Healthcare is currently in the practice of treating illness- taking patients from sick to well and then sending them on their way. Hospitals can create a niche market by incorporating principals of hospitality to better satisfy patients and create loyal customers. Recently, healthcare is shifting to a more consumeristic model, where healthcare organizations are competing for patients and business. By proactively marketing their services, specialties, awards, and accommodations, they can attract and obtain patients the way that the hospitality industry does customers- and then it’s time to work the patient experience. Healthcare would still start with treating illness but would also focus on providing a pleasant experience for patients and families. Using hospitality principles, the medical community can shift focus from a model of illness to a model of wellness (“How and Why”, 2017). Being sure that the patient is not only healthy but well aligns with a value-based care model, in which healthcare organizations are paid bonuses for high-quality care, patient satisfaction, and patient wellness.  

The Importance of Employee Attitude

Understandably, many hospitals cannot afford high thread count linens, spa services, and other hospital amenities, however, hospitality is what is most important. Front-facing employees like your schedulers, registrars, and the like, should be highly trained in hospitality and customer service. According to Rice (2014), a higher emphasis should be placed on personality and attitude when hiring than on professional medical experience when it comes to your patient-facing non-clinical staff, as taking care of people is the bottom line- the rest can be taught.  According to medical staff in the same article, attitude is often overlooked when hiring in healthcare as it is a hard quality to measure (Rice, 2014). However, organizational culture is important to any hospital, and ones’ personality and how it fits in with organizational quality must always be considered for clinical and non-clinical staff. In the hospitality model, the hospitality experts are simply indicating that healthcare management goes a step beyond this and put more of an emphasis on these personalities than on professional background or experience.

Another aspect that must be emphasized is the importance of the comeback after a bad experience. Most people, patients especially, will let you know when they are unhappy. The hospitality industry empowers its employees to do whatever it takes to keep the customer happy, which can include perks, complimentary stays, and refunds (Rice, 2014). This is a big change to how patient dissatisfaction is treated- usually, patients are frequently dissatisfied, and employees are not empowered to remedy the situation. Healthcare is often a “you get what you get" industry, and this needs to change. Patient-centric models of care should mean that patients are front and center, and unfortunately, that is frequently not the case.  

Hospitality’s Use of Technology

Not only are employees not empowered to take on patient dissatisfaction, but the healthcare system as a whole is not measuring it or analyzing it efficiently or correctly. Currently, customer (or patient) satisfaction, employee engagement, and staff scheduling are largely unrelated entities in healthcare management, analyzed separately, and even falling under the auspices of different departments. These three factors are interdependent, however, and the hospitality industry has used new technology to control these areas and help drive business results accordingly. Healthcare largely relies on HCAHPS patient experience scores to measure patient satisfaction to drive the development of practices and operations accordingly. According to Vlahakis (2017), a 2015 McKinsey & Company article revealed the top eleven factors that patients cite impact their satisfaction with inpatient providers, and only four of these eleven factors are measured by HCAHPS surveys. Hospitals are inherently working with incomplete measures when evaluating their performance with patients.

Hospitality is currently utilizing technology to measure and improve customer satisfaction, measure and increase employee engagement, and optimize staff scheduling. As stated previously, these three areas are interdependent and very important to positive business results. Employee engagement is important to customer satisfaction, as employee attitudes and turnover greatly affect patient experience and business operations. In the same manner, efficient scheduling is important to employee engagement, and then patient satisfaction. When technology is utilized to optimize staff scheduling, as in the hospitality industry, technology ensures that staffing is adjusted to real-time demands and provides more flexibility, which also ensures lower labor costs in addition to the employee and patient satisfaction mentioned above (Vlahakis, 2017).  

The Development of Hospitality Behaviors in Healthcare

To work backward with what we discussed in this article, the first aspect which would need to be developed is the organization’s measurement of patient satisfaction, employee engagement, and staff scheduling and optimizing technology to capture and analyze this information. This is an important starting place that would allow a healthcare organization to know where to start when strategically planning for process changes and incorporation of hospitality behaviors and practices. Staff development should also be a priority during this time, as patient-centric, customer service, and hospitality behaviors can be fostered in existing employees first before hiring any to fill the gaps. According to Mclaughlin (2012), the key to good hospitality is the way that you implement it. Many in the hospitality industry charge a particular person or department with the development of hospitality behaviors, calling it a “hospitality ambassador” (Mclaughlin, 2012). This is a great idea in healthcare, as many who are in healthcare are not familiar with these behaviors. By hiring someone well versed in hospitality (or consulting), the development of hospitality behaviors would likely be more successful.  

The organization should focus on ethical hiring and hire those candidates with personalities who can fit in with the new hospitality model. The organization should also focus on employee friendliness, showing its employees the same hospitality that they expect employees to show to their patient customers. Any healthcare organization should focus on employee engagement and employee retention simply due to the high cost of employee turnover, however, a healthcare organization striving for high patient satisfaction should especially focus on employee engagement and attitude. As discussed previously, employee satisfaction and patient satisfaction are interrelated factors.

Conclusion

Making a hospital stay feel more like a hotel stay may not make the patient feel like they are on vacation, but it does make them feel better about being ill, and help them feel better more quickly by reducing their stress level.  Most people get into healthcare because they want to help those that may be ill, and they are natural caregivers at heart. It should not be a stretch to foster these behaviors in healthcare personnel. The process of change will most likely be the hardest, but starting with the technology and the analytics it can provide can be a start to help hospital systems connect the dots between patient satisfaction, employee engagement, and business results to provide a complete perspective on the employee-customer relationship (Vlahakis, 2017).  After the data is obtained, the change is a matter of overcoming a transactional state of mind and moving on to taking great care of the patient in the present in order to keep taking care of them in the future. A simple yet substantial change, which can do good for the hearts of patients and employees alike.

References

How and why hospitals are looking and feeling more like hotels today. (2017, Dec. 12). Mower Insights: Healthcare. Retrieved from: https://www.mower.com/healthcare/insights/how-and-why-hospitals-are-looking-and-feeling-more-like-hotels-today/

Mclaughlin, A. (2012, Sept 20). Hospitality to patients: A must at your medical practice. Physician's Practice. Retrieved from: https://www.physicianspractice.com/view/hospitality-patients-must-your-medical-practice

Rice, S. (2014, Dec. 09). The hotel business can teach hospitals how to put the customer first. Modern Healthcare. Retrieved from: https://www.modernhealthcare.com/article/20141209/BLOG/312099976/the-hotel-business-can-teach-hospitals-how-to-put-the-customer-first

Vlahakis, L. (2017, Jun 20). Tech's evolving role in a consumer-driven healthcare industry. Mower Insights: Healthcare. Retrieved from: https://www.mower.com/healthcare/insights/techs-evolving-role-in-a-consumer-driven-healthcare-industry/

Mitigating Soaring Healthcare Labor Costs

Within the last few decades, there have been substantial changes in the delivery of healthcare in the United States. From the inception of HIPAA and HITECH, the national implementation of the Electronic Medical Record, the Affordable Care Act and healthcare reform, America's Healthcare System is in a constantly changing state. The healthcare workforce is therefore required to pivot and adjust to these new changes quickly. Healthcare organizations, such as hospitals, are required to compensate labor accordingly, and with new roles and new skills in addition to clinical competencies, the workforce is becoming more costly. As we are amid the COVID-19 pandemic, 2020 promises to bring even more change to healthcare, invariably affecting the workforce and costs even more. Healthcare organizations must be able to adjust to changes with mitigating strategies. This article will delve into some drivers of hospital labor costs, evaluate mitigation strategies to address the soaring labor costs, and look at future projections of labor costs in healthcare.

Labor Costs

As stated previously, substantial change in the healthcare field has accounted for substantial change in the healthcare workforce. Since 2009, 586,500 new hospital positions have been created, causing a 13% increase in hospital employment and a shift in labor’s share of total hospital expenses from 2008 to 2018 (Daly, 2019). Hospital labor costs can remain manageable when they remain at around 50% of operating costs, however, this ratio continues to rise nationwide. Daly (2019) indicates a rising trend, where labor accounted for 50.6% of hospital operating expenses in 2008, and in 2018, labor accounted for 54.9% of hospital operating expenses. LaPointe (2018) goes so far as to estimate labor costs at 60% of operating expenses. Either way, labor costs are the single greatest driver of hospital operating expenses and must be analyzed and mitigated regularly in these tumultuous times.

Drivers of Increasing Labor Costs

America has experienced increased healthcare jobs since 2009, which would certainly account for increased labor costs, however, this is not the only driver of the increased costs. According to Daly (2019), other factors that drove labor cost increases include:

The growing elderly population and its requirement of more healthcare services: The huge baby boomer population is accounting for the highest Medicare population in Medicare’s history. This causes an increase in demand for healthcare services, and also a decrease in reimbursement.

Increased patient access points through newer services, such as urgent care, ambulatory and outpatient centers: Many new healthcare jobs created this decade went to these newer services, which were created in response to the demand for healthcare consumerism. With many new services in their infancy, they are essentially in a trial-and-error period both fiscally and operationally, which may lead to financial inefficiencies at least in the short term.

Response required to healthcare consumerism: As mentioned briefly in the previous bullet, healthcare consumerism has created some new positions and facilities. The American healthcare model is now inherently consumeristic which has caused healthcare organizations to adjust to pleasing a consumer and take care of a patient. Clinical roles are no longer solely clinical or transactional. Many healthcare organizations are adopting concierge-like models, requiring clinicians to wear many hats to please the consumer.

Shortages in the clinical labor market: Recent shortages in available nurses and physicians has resulted in increasingly competitive compensation and benefits to attract talent in a small market. This subject will be discussed more thoroughly later in the article.

High employee turnover: As with any market, high employee turnover is exceedingly expensive. However, in healthcare, the education and training of new employees are exceedingly lengthy and expensive.

Mitigating Strategies

Employee Retention

As stated previously, the costs associated with employee turnover are staggering in healthcare. Bryant and Allen (2013) estimate that the costs associated with losing an employee, then recruiting and training a replacement often exceeds 100% of the annual salary for the position. For that reason, once an employee is onboarded, leadership must focus on the retention and engagement of their healthcare workforce. Bryant and Allen (2013) suggest paying close attention to the three primary categories of predictors that are related to employee turnover in order to retain the employee:

The withdrawal process: Psychological or behavioral withdrawal from the organization happens when an employee decides they no longer want to work with an organization and begin their job search. A leader can usually sense the withdrawal and may be able to step in here before the employee finds a new position or quits.

Key job attitudes: Job satisfaction and organizational commitment can inform leadership of intentions of turnover or withdrawal. Organizations should not try to measure employee engagement only once a year- it should be worked on year-round in order to retain talent.

The work environment: According to Bryant and Allen (2013), aspects of leadership, work design, and relationship with others are the most important factors within the work environment which influence an employee to leave. Leadership must work on positive relationships with their team to foster a productive work environment. There should be clear role expectations and minimal role conflict as well (Bryant & Allen, 2013). Lastly, leadership should provide opportunities for positive interaction between departments and employees and help newcomers feel welcome and fit in.

If leadership can keep a constant eye on these three factors, they may be able to keep employees engaged, retaining talent and avoiding the high cost of employee turnover.

Automation/ AI

Both Daly (2019) and Bryant (2018) suggest utilizing automation and AI technology to control costs. By using AI in the revenue cycle, revenue cycle staff can be shifted to allow for more efficient AI automation. As AI is not fool-proof and often not a complete solution, human job loss can be minimized by shifting staff from production to auditing the AI’s work and owning the workflow. Utilization of this type of technology also allows for the leveraging of global talent (Daly, 2019). Lastly, the technology can allow for work-from-home administrative positions, which estimates to save around $3700 per employee annually in real estate and overhead costs alone (Wilson Pecci, 2019). Bryant (2018) goes the next step and also suggests predictive analytics and mapped workflow processes to increase productivity in the revenue cycle, as well as in staffing and related budgets.

Utilization of Midlevel Providers

Lastly, a newer strategy of employing more mid-level providers in the hospital and physician practice setting, as opposed to a traditional physician model, proves to cut labor costs efficiently in states that allow mid-level providers sufficient privileges. As a physician's salary is roughly double (sometimes triple) the salary of a Nurse Practitioner or Physician Assistant, it is simply fiscally smarter to include mid-level providers as often as possible while still utilizing a few (but less) physician supervisors. Again, this may not be a possibility in some states, but in states like Ohio which allow ample privileges to nurse practitioners and physician assistants in the hospital setting with a physician supervisor, this is already being widely rolled out in staffing models.

The Future of Labor Costs in Healthcare

A recent Healthcare Financial Management Association survey analyzed the worries of top executives about the financial future of Healthcare. Of 101 CFOs and operations executives who participated in the survey, 78% expect their organizations' labor budget to increase over the next year, with nearly one in five predicting increases of 5% or more (Bryant, 2018). This surety of labor cost increases is widely attributed to growing provider shortages. Quite simply, clinical providers are needed much quicker than they can be provided. Education and development are more costly, time-consuming, and selective in the medical field, which is attributing to a staggering shortage of clinicians. The physician shortage is projected to reach up to 104,000 physicians by 2030 (LaPointe, 2018). Nurse shortages are predicted to be even worse. By 2025, it is expected that the US will need over 3 million nurses, but researchers estimate only 2.8 million nurses will be available for employment (LaPointe, 2018). Labor costs are already a major burden for hospitals. With a shortage of clinicians, not only will access to services be decreased resulting in less revenue to hospitals, but hospitals will also be forced to pay more for clinicians in an increasingly competitive market for a limited pool of talent (Bryant, 2018). Healthcare leadership must act proactively to (a) retain their talent now for the long run, (b) shift around costs to allow more money in the budget for future clinician labor costs, and (c) more effectively manage labor and staffing to improve productivity and workflow efficiency as patient volumes will soon need to be handled by a smaller number of clinicians.

Conclusion

Labor costs in healthcare have steadily been on the rise in America within the past few decades, and more notably since the early 2000s. This is of no surprise when you consider the influx of changes in the field during this time. The healthcare workforce has adjusted to a new consumer-driven system and leadership must also adjust to not only retain consumers and patients but to retain their talent as well. The future of the healthcare workforce includes a remarkable shortage of clinicians, which will no doubt cause more increase in labor costs. Leadership must act now to mitigate labor costs and prepare for increases in labor costs in the future. By focusing on employee retention, utilizing technology like automation and AI, and utilizing more midlevel providers in lieu of multiple physicians, healthcare leadership can mitigate labor costs and prepare for the uptick in the future. Most importantly, the shortage is coming, so new workflows and increased efficiencies must be high priority for leadership in the next few years.

References

Bryant, M. (2018, Aug 24). Hospitals see labor costs rising amid ongoing doctor, nurse shortages. Healthcare Dive. Retrieved from: https://www.healthcaredive.com/news/hospitals-see-labor-costs-rising-amid-ongoing-doctor-nurse-shortages/530850/

Bryant, P. Allen, D. (2013). Compensation, benefits, and employee turnover: HR Strategies for retaining top talent. Compensation & Benefits Review, 45(3) 171–175. DOI: 10.1177/0886368713494342

Daly, R. (2019, Oct 1). Hospitals innovate to control labor costs. Healthcare Financial Management Association. Retrieved from: https://www.hfma.org/topics/hfm/2019/october/hospitals-innovate-to-control-labor-costs.html

LaPointe, J. (2018, Mar 2). Hospitals Target Labor Costs, Layoffs to Reduce Healthcare Costs. RevCycle Intelligence. Retrieved from: https://revcycleintelligence.com/news/hospitals-target-labor-costs-layoffs-to-reduce-healthcare-costs#:~:text=Labor%20costs%20may%20also%20grow,demand%20by%20growing%20their%20staff.

Wilson Pecci, A. (2019, July 23). 4 myths about revenue cycle telecommuting. Health Leaders Media. Retrieved from: https://www.healthleadersmedia.com/finance/4-myths-about-revenue-cycle-telecommuting.

Authentic Leadership & Fostering Its Development in the Workplace

         Leadership is a concept that most believe they understand but few can clearly define. Leadership does not depend on your position in a company, your salary, or whether you have people reporting directly to you. A leader motivates people and helps bring a vision to fruition. A leader engages and interacts with people, building relationships, and fostering teamwork. A leader is not only a manager who sits on the outside and barks orders, a leader is a part of the team. With their actions, they inspire their team to work hard, work smart, set goals, and achieve those goals. Kruse (2013) emphasizes the social aspect of leadership in being one of the most important factors of effective leadership. In their social interactions and relationships, effective leaders motivate others to see their vision and help guide them to the destination- their collective goal. Kruse (2013) also highlights the idea that an effective leader maximizes the efforts of those that they influence, therefore not only managing or guiding, but they are also contributing to and affecting the quality and outcome of the team's work. In working this way, an effective leader is not only delivering results today, they are ensuring that tomorrow’s results are delivered as well. They have learned in the process and mastering today’s vision makes for an easier and more productive tomorrow.

Learning from the Past & Personal Experiences

           Learning from the past is an important notion in all facets of life. Consider leadership, however. Up until recently, servant leadership and exuding power in management were the norm in the workplace. The ideas surrounding good and ethical leadership are fairly recent, therefore many who are early in their career have difficulty with ascertaining good leadership skills by looking at their predecessors. I include myself in this category. I have had many managers in the past, however, none that ever considered leading from down in the trenches, and none that considered socializing with me and getting to know me as a person. Working in healthcare administration, management’s values and ethics are not widely discussed, nor are employee-management relationships. Numbers and productivity weigh heavily on one's success, therefore ethics, values, and relationships are not at the forefront of the mind of many employees, like myself, who are regularly reaching their numerical goals and thus secure in their position. However, one relationship with a leader within the hospital- who I did not even work with- made me begin to think about leadership and the idea that it was being done all wrong.

A Doctor and An Authentic Leader

           About two years ago, when I began working in the hospital setting, I met a physician that made me think about leadership in a whole new way. Although I did not work directly with him, Dr. Issa was always friendly and willing to help anyone and everyone. He is remarkably young for the position he holds- at the age of 39 he is chief of internal medicine at University Hospitals Elyria Medical Center. He has held this position for the last 8 of the 11 years at this hospital. I began to take notice not only of his friendliness and his early success but in the way he truly and honestly wished to help people. I saw him offer to help physicians he worked alongside, and administrative staff when they needed it. When someone had a question, be it about hospital protocol or filling in paperwork, if he heard your question and knew the answer, he would shout it out. This caused him to be a "go-to" for staff, and instead of being overwhelmed by this, he thrived. He would help those he could or send them in the right direction if he could not. He never said no, asked who you were, or got upset by a question. Luckily, a position opened for office manager of Dr. Issa's hospitalist practice. I seized the opportunity and grasped at my opportunity to lead- all because Dr. Issa made me see that it was possible to enjoy working and enjoy being a leader. Dr. Issa’s exceptional leadership style caused me to question leadership in healthcare. His authentic leadership style is exactly the kind of leadership I aspire to.

Authentic Leadership

           Leaders like Dr. Issa are a new breed. Authentic leaders are self-aware, they are genuine, they are fair, and they do the right thing (Riggio, 2014). These four traits of authentic leadership are consistent in every definition of authentic leadership.

Self-Awareness: Self-awareness and self-reflection are vital as an authentic leader knows their strengths, limitations, morals, and values (Riggio, 2014).  They stick to their morals and values and are always reflecting on honing their skills, strengths, and on the betterment of the team.

Relational Transparency: Authentic leaders are genuine in the way they build relationships with others. They are honest and straightforward with no hidden agendas (Riggio, 2014). This is where teamwork comes so easy to an authentic leader, and coaching is an important strength and way that an authentic leader can give honest feedback to team members.

Balanced Processing: Authentic leaders are fair in considering opposing viewpoints and open to accepting feedback in planning and strategies (Riggio, 2014). Authentic leaders also accept and welcome creativity and controlled risk in order to foster innovation.

Moral Perspective: Authentic leaders are ethical to their core (Riggio, 2014). They always advocate for doing the right thing, for ethics and fairness in the workplace.

Developing the Skills and Habits of Authentic Leadership

           In developing the skills and habits of authentic leadership, the four traits of an authentic leader should be the focus. Baron and Parent (2014) conducted an interesting study on developing authentic leadership skills for the workplace which suggested self-reflection of habits at its core. “Leadership development training programs should foster changes at the cognitive, attitudinal, and behavioral levels in the participants” (Baron & Parent, 2014). This program asked participants to choose some behavior that they wished to work on, indicate how and why they would change it, act on the change, and report its benefit. If the change did not benefit them in the way that they hoped, it was back to square one in identifying a new behavior or change. This program, therefore, fosters self-awareness and self-reflection, balanced processing, relational transparency (as their change needs to be enacted and work, therefore, they need to seek feedback), and as always, considers their moral perspective in their betterment. This program can be done in the workplace, but for the sake of the study, it was done at a leadership retreat. The program was a two-phase, five-step program which considered the traits of authentic leadership along the way (Baron & Parent, 2014):

Phase 1: Exploration

Step 1: Developing self-awareness: Recognizing ways of acting, emotional awareness, their needs and values, past dynamics, and awareness in relation to others are all considered in this step.

Step 2: Identifying possible behaviors to adopt: Formulating the development issues, setting goals, and trying out new behaviors comprise this step.

Phase 2: Integration

Step 4: The trigger- recognizing the benefits of change: In this step, participants found their opportunity to enact the change in the organizational setting.

Step 5: Transferring behaviors and attitudes to the workplace: In the final step, the new behavior has proven beneficial, become commonplace, and is now being adopted by the organization or team.

The activities of the program foster gradual, progressive development of leaders, aiding real personality and skill development, constant self-reflection, and self-evaluation being key (Baron & Parent, 2014). The progressive nature of this program offers the benefit of lasting personal and professional growth, development of self-awareness, self-esteem, and awareness of others.

Conclusion

           Most people spend their lives trying to attain power and success in their careers. These people may believe that being a leader means that you have authority over others and can control their duties and outputs in order to achieve success. However, as we discussed, a leader is a part of the team. Leaders help themselves and others build and achieve an inspiring vision and, in that, they find success (“What is leadership?”, nd). Authentic leaders are especially ethical, honest, and make you want to follow them and succeed alongside them. Like Dr. Issa, they inspire those around them to reach for greatness- their esteem and positivity drive those around them straight toward success. Although ethical and moral values cannot be taught in the workplace, ethical hires can be sought, and authentic leadership traits can be fostered and developed in the workplace. The gradual and progressive development of the four traits of an authentic leader is key to developing the skills and habits of an authentic leader in healthcare. I hope to count myself in this category and continue to constantly prioritize my personal and professional development in authenticity.

References

Baron, L. Parent, E. (2014). Developing Authentic Leadership Within a Training Context: Three Phenomena Supporting the Individual Development Process. Journal of Leadership & Organizational Studies, 2015(22):1. DOI: 10.1177/1548051813519501

Kruse, K. (2013). What is leadership? Forbes. Retrieved from: https://www.forbes.com/sites/kevinkruse/2013/04/09/what-is-leadership/#671ac6355b90

Riggio, R. (2014). What Is Authentic Leadership? Do You Have It? Psychology Today. Retrieved from: https://www.psychologytoday.com/us/blog/cutting-edge-leadership/201401/what-is-authentic-leadership-do-you-have-it

What is leadership? (nd). Mind Tools. Retrieved from: https://www.mindtools.com/pages/article/newldr_41.htm

Where and How to Build Your Network While Working in a Hospital

     Networking can help you determine your career goals by helping you assess where you are, where you are going, and where you want to be (Siemasko, 2016). Networking can also foster a more effective leader and team. Networking behavior can facilitate collaboration on projects across groups and organizations and improve team performance (Hassan et al, 2018). By building cooperative relationships with people outside of the work unit (either in the community or within the organization), leaders can create connections for gathering information and making sense of projects and organizational priorities. These connections can act as resources and support for team performance. When working in a hospital, external networking can help tie your organization to your community, which can benefit the organization both financially and collaboratively. The right connections can contribute expertise, innovative ideas, and support the growth of an individual or an organization. So how does a leader effectively network within the healthcare sector? Let’s discuss.

Where You Should Consider Networking Opportunities

     Making meaningful connections depends on the circumstances in which you are meeting a potential connection. According to Siemasko (2016), you should consider actively networking in these locations:

Conferences: Whether your organization sends you to a professional conference, or you voluntarily travel to one through a professional association, conferences are great venues for establishing networking connections. Walker (2019) suggests pursuing smaller conferences to allow easier and more meaningful conversation.

Associations: Membership to professional organizations provides an avenue to peer networking. Take advantage of these types of memberships by maintaining connections over time and reaching out when you encounter a problem that needs an external and unbiased opinion.

Online: Social networking can help you find contacts, but try to build relationships offline. Make sure you get meetings on the books and stay in touch offline.

Colleagues: As mentioned previously, an effective leader has contacts throughout the organization that can help support the function of the team. A hospital is a functioning system in itself and siloed departments create problems. Effective leaders must always think of the big picture when managing a hospital or any healthcare organization.

Other Avenues: Social gatherings and events (both professional and community events) can help you building connections. According to Daggett (2018), you should make the most of informal opportunities for their capacity to build lasting connections.

What You Should Be Doing

     Now that you have an idea of where you can start, it is important to know how to make these connections. Here are some tips from Merritt Hawkins (“How to Build,” 2018):

First, map your professional goals and consider how you may help others.

Identify possible connections: starting with people you know in your organization or your community, identify people who are likely to have the connections and knowledge to help you reach your goals.

Prepare your introduction and try to convey who you are and your professional goals in 30 seconds or less.

Regularly attending meetings and conferences in your professional association of choice.

Build meaningful relationships with new contacts by getting to know them. Have genuine conversation, remain interested, and learn about their career aspirations, goals, etc. Again, this is a two-way street.

Participate in online discussions and forums and if you click with someone, schedule a meeting. Give extra consideration to what you post and how you represent yourself online if you are going this route.  

Always follow up after you make a new contact by text, email, or even a hand-written note. This demonstrates your appreciation of their time and interest if you are pursuing a new opportunity.

Be charitable: Dagget (2018) reminds us that community events may offer volunteer opportunities, so if you cannot financially donate, you may be able to donate time. By doing this, you may meet more networking contacts.  

Conclusion

     No matter what sector of the workforce you are working in, at some point in your career you have probably received guidance from someone who made a lasting impression on you or your career. When you read this article and go forth to make connections, remember your journey and where you want to go. Think of those you are leading and may be able to learn from your wisdom. Think of the ways you may be able to benefit your community or involve your community with your organization. In healthcare, a sector where many pieces are contributing to the whole, it is not hard to find connections. Walker (2019) suggests a final thought of wisdom when you are considering building connections- make friends. The key to being good at your job is being happy at your job. “Success—however you define it—depends on building and sustaining a range of relationships” (Lenz, 2013).

References

Daggett, L. (2018). 6 networking strategies for healthcare providers. Weatherby Healthcare. Retrieved from: https://weatherbyhealthcare.com/blog/6-networking-strategies-healthcare-providers

Hassan, S. Prussia, G. Mahsud, R. Yukl, G. (2018). How leader networking, external monitoring, and representing are relevant for effective leadership. Leadership & Organization Development Journal, 39 (4), pp. 454-467. https://doi.org/10.1108/LODJ-02-2018-0064

How to Build a Professional Network- and Why You Should Start Now. (2018). Merritt Hawkins. Retrieved from: https://www.merritthawkins.com/news-and-insights/blog/job-search-advice/how-to-build-a-professional-network/

Lenz, T. (2013). Commentary: Networking as a Leadership Habit. Public Administration Review, 73(2), 364. https://doi.org/10.1111/puar.12035

Siemasko, E. (2016). How networking can improve your career in healthcare. Barton Associates. Retrieved from: https://www.bartonassociates.com/blog/how-networking-can-improve-your-career-in-healthcare

Walker, T. (2019). Seven networking tips for health execs. Managed Healthcare Executive. Retrieved from: https://www.managedhealthcareexecutive.com/view/seven-networking-tips-health-execs

This article was published by me on the LinkedIn platform on August 2, 2020.

Considering Key Stakeholders in Hospital Management

Purpose: The complexities of American Healthcare and its free-market business model makes hospital management a very dynamic and stressful undertaking. I continue to be fascinated by all that I am learning and look forward to my evolution as a leader in my field and my community. These are my insights on hospital stakeholder management and engagement

Considering Key Stakeholders in Hospital Management

Published on July 19, 2020 by me on the LinkedIn Platform

In the last decade, we have heard a lot about the business of healthcare, especially in America with its capitalistic healthcare model. Studying healthcare administration while working in a hospital has opened my eyes to the balancing act of community/ public health and business. Healthcare is one of the most dynamic industries in the world. Strict and ever-changing legal and political regulation, in addition to complicated reimbursement policies, and varying organizational models makes healthcare a complicated business to master. In the management of hospital operations, community and public health must also be considered. Business success cannot be at the forefront of hospital priorities as the quality of care and positive health outcomes are paramount to hospital success. According to Austen (2012), increased competition in hospitals, poor economic situation, and frequent changes in the sector imposes the necessity for regular strategic planning and process improvement. These processes are most successful by working with key hospital stakeholders to continue to build and tailor a hospital to fit the needs of the community, thus remaining successful and indispensable. This article will identify key hospital stakeholders and evaluate strategies used to develop relationships with these stakeholders in order to maintain constructive communication and strategic business operations.

Hospital Stakeholders

Any successful business requires collaboration and alliances between various actors with clear stakes in the work and operations within the business, such is the role stakeholders (Auvinen, 2017). In healthcare, stakeholders can be patients, caregivers, providers, organizations, researchers, policymakers, or anyone who has a vested interest in a clinical decision or healthcare service (DHHS, 2018). The dynamic nature of a hospital indicates the need for collaboration between various stakeholders in strategic management. Fottler et al (1989) indicate that hospital stakeholders can be categorized into three groups- internal, interface, and external stakeholders, which we will define below.

Internal: Operate entirely within the bounds of the organization, typically management, professional and nonprofessional staff.

Interface: Function both internally and externally, typically medical staff, hospital board of trustees, corporate office/ parent company, stockholders, taxpayers, other contributors. These tend to be the most powerful stakeholders.

External: Can be further divided into 3 categories according to their relationship with the hospital:

Provide input: Suppliers, patients, payers, financial community. Symbiotic relationship (hospital depends on these stakeholders to stay in business, the stakeholders depend on the hospital for service or to take their output)

Competitive: Seek to attract the organization’s dependents, being staff or patients. Do not depend on each other to survive.

Special interest: Concerned with the impact of the hospital's operations relative to their interests, like government regulatory bodies, accrediting associations, professional associations, labor unions, media, local community, political action groups. If a conflict arises, compromise rather than collaboration is usually the solution with these groups.

Communication with each of these groups is different. Each group also has its own relative importance to hospital management. This is where stakeholder analysis and management come in.

Stakeholder Analysis, Management, & Engagement

In hospital management, stakeholder analysis, management, and engagement are key. However, it is impossible to reach all stakeholders, consider their opinions, and keep them happy at all times. Therefore, stakeholder analysis and management are important parts of strategic hospital management. In stakeholder analysis, the aim is to determine the relevance of the stakeholder's perspective to the project or policy by identifying important stakeholders, assessing or mapping stakeholders as primary or secondary, and lastly assess the views of the stakeholders based on relative importance to the project or policy (Auvinen, 2017). In the classification of stakeholders, the primary stakeholder groups are those stakeholders that are necessary for the survival of the hospital; the secondary stakeholder groups may influence the hospital but are not essential to hospital business (Auvinen, 2017). In assessing a stakeholder's importance, this step is relative to the project. Some may consider the power of the stakeholder within the hospital, others may consider the legitimacy of their knowledge of the project or the urgency of the task at hand. These steps allow hospital management to identify key stakeholders, which leads to the next task- stakeholder engagement.

Once key stakeholders are identified, clear and up-front communication is vital to maintaining a trusting relationship with honest and constructive feedback. Leadership needs to properly manage stakeholder expectations in order to maintain engagement. According to Jahangirian et al (2015), lack of communication with stakeholder groups is the top factor contributing to poor stakeholder engagement, followed by poor management support, unrealistic workload expectations, and failure to produce quick or tangible results. When interacting with stakeholders, it is always important to remember who your audience is and what your message is (DHHS, 2014). The message and expectations for various stakeholders should be tailored appropriately to maintain engagement. Clear, concise, and vivid examples should be presented. Expectations for stakeholder actions should be clearly communicated, and follow-up should always be initiated by hospital leadership to ensure that stakeholders are satisfied and remain engaged.

Conclusion

Due to the dynamic nature of healthcare and hospital management, stakeholder engagement is an important part of business operations and strategic management. Once key stakeholders are identified, their relative importance to the task at hand should be determined, and the specific stakeholder or stakeholder group should be analyzed for effective communication and continued engagement reasons. Success in stakeholder management and engagement should be constantly evaluated and operations adjusted. According to Fottler et al (1989), “managers should recognize, who matters? and why do they matter? and [recognize] that these hierarchies may vary in different organizations and settings.” When hospital management and stakeholders work together cohesively, a hospital can not only thrive in business but provide high-quality care and improve community health throughout the life of its business operations.

References

Austen, A. (2012). Stakeholders in management in public hospitals in the context of resources. Management, 16(2). DOI: https://doi.org/10.2478/v10286-012-0067-8.

Auvinen, A. (2017). Understanding the Stakeholders as a Success Factor for Effective Occupational Health Care. Occupational Health. DOI: 10.5772/66479. Retrieved from: https://www.intechopen.com/books/occupational-health/understanding-the-stakeholders-as-a-success-factor-for-effective-occupational-health-care

Fottler, M. Blair, J. Whitehead, C. Laus, M. Savage, G. (1989). Assessing key stakeholders: Who matters to hospitals and why? Hospital & Health Services Administration, 34(4), pp 525- 546.

Jahangirian, M., Taylor, S. J. E., Eatock, J., Stergioulas, L. K., & Taylor, P. M. (2015). Causal study of low stakeholder engagement in healthcare simulation projects. The Journal of the Operational Research Society, 66(3), 369-379. DOI: http://dx.doi.org/10.1057/jors.2014.1

US Department of Health and Human Services (DHHS). (2014). Designing and Implementing Medicaid Disease and Care Management Programs. Section 2: Engaging Stakeholders in a Care Management Program. Agency for Research and Quality. Retrieved from: https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm2.html

US Department of Health and Human Services (DHHS). (2018). The Effective Health Care Program Stakeholder Guide. Agency for Research and Quality. Retrieved from: https://archive.ahrq.gov/research/findings/evidence-based-reports/stakeholderguide/chapter3.html

The Impact of Federal and State Healthcare Policies on Consumer Costs

            When it comes to Federal and State policies, many Americans, especially in low or middle America, choose not to keep up due to mundane policies, or (more likely of recent) the inflammatory political climate. Many middle or low-income Americans believe that the government policies will not affect them in their average daily life, however, that cannot be more wrong. Especially in health care. This decade has seen an explosive political climate surrounding healthcare, and even healthcare reform. 

           Since the inception of the Patient Protection and Affordable Care Act (ACA) in 2010, the way that we access health insurance and healthcare, as well as the way we pay for said insurance and healthcare, has completely changed. This reform of our healthcare system is a hot topic of debate even ten years later. The ACA aimed to expand access to insurance (thereby increasing one's access to healthcare), limit rising health costs, increase patient and consumer protections, emphasize wellness/ prevention, and improve the system as a whole (“The Affordable Care Act”, 2011). Though most agree with these provisions and the need for protections, many do not believe that the ACA’s radical changes were a step in the right direction fiscally. Workers and employers saw increased taxes, and some saw increased premiums or increased medical costs as a result of the new policies. On the other hand, many had access to insurance and life-saving treatment that would have normally not been possible (chronically ill, low wage workers, etc). Some now had help with insurance premiums or were newly qualified as low-income under Medicaid with very little to no medical costs ahead. No matter where your opinion lies on the subject of the ACA and healthcare reform, undoubtedly if you live in this country, your healthcare or your finances were affected by this policy- in a good way or a bad way. The purpose of this article is to talk about the ACA’s impact on the American citizen.  

Positive Impacts

           During the first 5 years of the ACA, more than 16 million Americans obtained health insurance coverage, which accomplished the first goal of the act by increasing access to health coverage and healthcare (Roland, 2019). Many Americans that were newly insured were people with pre-existing health conditions that were previously denied private payer coverage under a pre-existing clause. The patient protections under the ACA made this practice illegal. Many young college-aged Americans were newly covered as well, as one provision allowed coverage of children under their parents’ plan up to age 26. Along with keeping adult children healthier, the ACA provided full coverage of routine preventive services, aiming to get Americans in to see the doctor before a problem presented itself; thereby preventing the development of a chronic illness, or even providing early detection of one. This provision leads to decreased healthcare costs nationally, as preventive measures are much less costly than catastrophic services resulting from avoidance of regular screenings.

           The ACA is regularly referred to as Healthcare Reform, and the changes mentioned previously are not some of the more radical. One way that the ACA majorly reformed the way the average citizen approaches healthcare is through healthcare consumerism. As we are a highly capitalistic society with free-market healthcare, this is not a new idea. However, the inception of the ACA made the practice of consumerism in healthcare a necessity in many homes. Many people obtaining insurance through their employers or the healthcare marketplace had new High Deductible Health Plans (HDHP). With a HDHP, in exchange for tax breaks on health spending via a Health Savings Account, the subscriber has a high deductible in excess of $2500 that they are responsible for paying before insurance begins paying non-routine claims. This made the average American into a health consumer. As they were now responsible for paying a large portion of their healthcare, they needed to educate themselves on available services, providers, and “shop” for healthcare. Some think of this as a positive impact, as patients are empowered into taking ownership of their own healthcare. They are more active with their providers and in their treatment decisions. Some, however, think this is a negative, one of many criticisms against the ACA, some of which we will now delve into.

Negative Impacts

           Many Americans complain about the burden of healthcare consumerism and high costs due to high deductible health plans the most. In 2016, 39.3% of Americans had HDHPs as their primary insurance (Thorpe et al, 2019). Though those with this type of plan have the option to make tax free contributions to a Health Savings Account (HSA), many Americans cannot afford to contribute enough to cover the costs of their deductible. This causes many who are chronically ill and need a lot of non-routine care to limit or even forego care, risking severe long-term health consequences. As about 60% of Americans have at least one chronic condition, the odds are that many Americans that need consistent care are not following through due to the costs associated (Thorpe et al, 2019). Though they have insurance, they cannot use it unless they can afford to foot a large part of the bill.

           The cost of the ACA does not stop with high deductibles. Many Americans complain about new taxes that were passed into law to help pay for the ACA. Businesses are highly taxed and are also now obligated to cover 95% of their full-time employees and pay a larger portion of premiums (IRS, nd). Many of those opposed to the ACA believe that this decreases American jobs, as employers are cutting hours to avoid the obligation to pay for insurance for full-time employees. Employers are obligated to provide affordable coverage, which is defined as costing an employee no more than 9.78% of their household income in 2020 (“2020 Affordable Percentage”, 2020). If an employer does not comply with these two requirements, they must pay a penalty to the IRS, with an exception for some small businesses (IRS, nd).

           For the early years of the ACA, up to 2019, businesses were not the only ones that were penalized for not complying. As health insurance was now a requirement, Americans were penalized when filing taxes if they did not have coverage for the majority of the year. For many Americans who paid for their own coverage, their premiums went up as a result of the increased liability of insurance payers, as they were now required to cover those with chronic illness. Some Americans opted out of paying sky-high premium payments and instead paid a penalty on their taxes. For these Americans, it was a lose-lose situation. President Trump repealed this tax penalty and it was foregone in 2019.

Medicaid Expansion

            Each state had its own role in ACA roll out, and perhaps their largest and most controversial role included their responsibility in Medicaid expansion. Though the ACA was signed into law in 2010, Medicaid expansion was not required until January of 2014. Prior to the ACA, each state chose its own Medicaid eligibility requirements for the standard coverage categories of low-income families, children, pregnant women, the disabled, and the elderly (“Medicaid and the ACA”, 2011). The ACA’s Medicaid required expanded coverage to include anyone under 65 who falls at or below 133% of federal poverty guidelines ($14,484 for an individual and $29,726 for a family of four at its inception) (“Medicaid and the ACA”, 2011). The Federal Government would be fully financing those that fall under this expansion from 2014-2016, then federal assistance falls as time goes on- 95% in 2017, 94% in 2018, 93% in 2019, 90% in 2020- and then the State is responsible fully for funding their Medicaid program (“Medicaid and the ACA”, 2011).

           Many states went along with the Medicaid expansion with no issue, eager for reform. However, some states appealed to the Supreme Court to retain control of State Medicaid jurisdiction. In 2012, the Supreme Court ruled that states could opt out of the ACA Medicaid Expansion, as Federal Law should not mandate State Medicaid ("Where the States Stand", 2020). This Supreme Court decision left the decision in the Governor’s hands. As of this year, 14 states opted out of Medicaid expansion- WY, SD, KS, OK, TX, MO, WI, TN, MS, AL, GA, SC, NC, and FL refused to expand Medicaid, and NE opted to adopt Medicaid expansion at the inception of the ACA but still has not implemented it (“Status of State Medicaid Expansion”, 2020). The main reason for states opting out of Medicaid expansion is the fact that the state budget would be footing the bill, therefore requiring more taxpayer money. It is easily seen how State Medicaid expansion would also have positive and negative effects on State residents.

Conclusion

           The federal and state health care policies discussed above have an impact on consumer costs in more ways than one. First, both federal and state policies require tax payments for funding. Secondly, the success or failure of the policy may have a positive or negative impact financially on the consumer. As we discussed previously, the ACA aimed to reduce healthcare costs by promoting wellness and routine services. Expansion of coverage to less healthy persons had a negative effect on consumer costs, as in the pre-existing clause example. This article was written on very well known legislation, and many Americans can easily voice an opinion on the ACA and Medicaid expansion when asked; however, there is legislation that goes through routinely that is not so public that also affects consumer costs. It is important for all Americans to keep up with public policy and be active in voting to ensure that their opinion is considered. Legislation can change with changes in the field and changes in political administration, which makes it even more important that consumers stay current on healthcare policy.

References

2020 Affordable Percentage for Employer Health Coverage Shrinks. (2020). Mercer Law. Retrieved from: https://www.mercer.com/our-thinking/law-and-policy-group/affordable-percentage-for-employer-health-coverage-shrinks.html#:~:text=The%20Affordable%20Care%20Act%20(ACA,%25%2C%20according%20to%20IRS%20Rev.

Medicaid and the Affordable Care Act. (2011). National Conference of State Legislatures. Retrieved from: https://www.ncsl.org/research/health/states-implement-health-reform-medicaid-and-the.aspx

Roland, J. (2019). The Pros and Cons of Obamacare. Healthline. Retrieved from: https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare

Status of State Medicaid Expansion Decisions: Interactive Map. (2020). Kaiser Family Foundation. Retrieved from: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

The Affordable Care Act: A Brief Summary. (2011). National Conference of State Legislatures. Retrieved from: https://www.ncsl.org/research/health/the-affordable-care-act-brief-summary.aspx

Thorpe, K. Calder, K. Hyde, A. Weidner, L. (2019). The Challenges Of High-Deductible Plans For Chronically Ill People. Health Affairs. Retrieved from: https://www.healthaffairs.org/do/10.1377/hblog20190416.47741/full/

US Internal Revenue Service (IRS). (nd). Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act. IRS Official Website. Retrieved from: https://www.irs.gov/affordable-care-act/employers/questions-and-answers-on-employer-shared-responsibility-provisions-under-the-affordable-care-act#Affordability

Where the states stand on Medicaid expansion. (2020). Advisory Board Daily Briefing. Retrieved from: https://www.advisory.com/daily-briefing/resources/primers/medicaidmap?wt.ac=slideshow_spc_tool_revcycle__medicaidmap_2

The Impact of Raising Medicare’s Eligibility Age on a Hospital Facility

     Periodically, the Congressional Budget Office (CBO) issues an addendum to help inform lawmakers of the state of the deficit. The amount of federal debt held by the public has more than doubled relative to the size of the economy since 2007 (CBO, 2016). This makes these publications inherently important to the state of our government. The publication entitled, “Options for Reducing the Deficit” is available publicly and reports the estimated budgetary effects of various options including health-related and non-health-related options. The report that I reviewed included 115 options that would decrease federal spending or increase federal revenues from 2017 to 2026, dividing these options into health and non-health related options (CBO, 2016). As a hospital administrator, my interest is vested in the health-related options. In this article, I would like to discuss one option that may have a significant effect on this organization- changing the age of eligibility for Medicare coverage from 65 to 67 years of age.  

The proposal: Changing the age of eligibility for Medicare coverage from 65 to 67 years of age

           According to the CBO (2016), the average period that people are covered under Medicare has increased significantly since the program’s creation, due to a rise in life expectancy. The CBO advises a slow shift in the age of eligibility, raising it two months each year starting in 2020 until it reaches 67 in 2033 (CBO, 2016). The 67-year-old eligibility age would then align with social security's full retirement age, which will be 67 years within this decade. This proposal is indicated to reduce federal budget deficits between 2020 and 2026 by $18 billion, according to estimates by the CBO and the staff of the Joint Committee on Taxation. Total spending on Medicare as a result would be estimated to decrease by $55 billion between 2020 and 2026 (CBO, 2016). The CBO estimates that 3.7 million people would be affected by this change- approximately 45% of those would obtain insurance from an employer, 25% would purchase nongroup insurance, 25% would receive insurance through Medicaid, and about 5% are estimated to become uninsured (CBO, 2016).

     This would, therefore, leave approximately 185,000 elderly Americans uninsured. A recent study published by the National Bureau of Economic Research found that Hospitals are burdened with paying for uninsured uncompensated care, estimating costs of about $900 per patient (Evans, 2015). Disproportionate Share Hospital (DSH) payments are supposed to go to hospitals to help cover uncompensated care for the uninsured, however, the above estimate is after the government is making these payments. Upon the inception of the Affordable Care Act (ACA) in 2014, all states were supposed to expand Medicaid in order to reduce or eliminate the amount of uninsured and the undue burden on healthcare organizations and our system. However, this provision was contested and found unconstitutional by the Supreme Court, and only an estimated 37 states (including Washington, DC) have expanded Medicaid (Morse, 2019). According to Evans (2015):

That means hospitals in states that did not expand Medicaid under the Affordable Care Act will spend $6.4 billion in 2022 on uncompensated care, according to the study. That's roughly the cost of financing Medicaid that year for the 21 states that failed to do so as of May…The government is directly saving money, but the hospitals in the state have to pick up the slack. (Evans, 2015).

     My hospital system reported $47 million in charity care and $193 million in Medicaid shortfall, which equates to $240 million which was not covered by the government (censored). The burden of uninsured elderly patients will most certainly be significant, as the elderly spend much more on care with more chronic issues. Our organization cannot withstand that incumbrance as-is. If this proposal is enacted and our uninsured patient population rises, some changes must be enacted system-wide to cut costs and revisit the way we approach uncompensated care.

How can we reduce impending uncompensated care costs?

     First, many of the elderly may qualify for disability coverage through Medicaid. We must try to obtain coverage to reduce current and future uncompensated care costs from those who may now be uninsured. If they do not qualify for Medicaid but are still considered low-income, they may qualify for a federal subsidy and be able to enroll online through the federal healthcare marketplace. As advocates, we must make every effort to point our more unfortunate patients in the direction of obtaining insurance coverage and/or social services. For all of our patients that remain uninsured, we may have to alter the way we approach their charity care. Zimmerli, Craighead, and Gupta (2010) suggest a new method of reducing uncompensated care with the FAIR method. They suggest by urgency or necessity of care and making payment arrangements upon contact for scheduling (Zimmerli, Craighead, & Gupta, 2010). This would likely prioritize the newly uninsured elderly patients and push back our lower age indigent population. This re-prioritization may shift some of our charity care to other area hospitals, which would also help our costs.

Reducing hospital costs

     Lastly, if we are unable to reduce uncompensated care, we must reduce costs system-wide to adjust to a “new normal”. According to Gooch (2018), here are some areas that hospitals can best control costs:

1. Staffing and Administration: Staffing is the single greatest expense for hospitals, and innovation can lead to changing staffing needs. Regularly assess labor and nonlabor expenses by evaluating performance and actual costs, including contracts, labor, and overtime. Focus on quality patient care by automating repetitive administrative tasks – clinicians are spending up to 57% of their time on administrative work, leaving less time on patients. We need to automate and optimize workflows to increase productivity.

2. Regularly eliminate unnecessary expenses: We should expect our leaders to be able to identify and eliminate waste as a regular part of their everyday tasks. Waste should be monitored by all leadership, including variation in supplies, processes, and unnecessary duplication of effort throughout the company. In this manner, we can engage all employees to report waste or inefficient workflows to management, and management should be using regular budget reporting and management.

3. Care Management: Coupled with prevention, nutrition, and wellness services, the care management strategy enables us to monitor patients with acute and critical conditions to provide disease management support, help with medication coordination and compliance, and provide access to community resources. This leads to reduced costs through decreased inpatient and emergency department utilization for those with preventable and manageable chronic conditions.

Conclusion

     “When policymakers decide not to provide health insurance for a portion of the population that otherwise could not afford insurance, hospitals ultimately bear the cost of that decision” (Garthwaite, Gross, & Notowidigdo, 2018). Though our hospital has been fortunate to be able to be generous with our community care, we may not be in the same position if this proposal to reduce federal healthcare spending is enacted. We must prepare for the possibility of providing a lot more uncompensated care for the community’s uninsured population. If we prepare by cutting costs early, and stay on track, we can be successful in taking care of our community even in the absence of the federal funding being missed.

References

Congressional Budget Office (CBO). (2016). Options for reducing the deficit: 2017 to 2026. Congress of the United States. Publication 52142. Retrieved from: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52142-budgetoptions2.pdf

Evans, M. (2015). Hospital cost of uninsured: $900 per patient, per year. Modern Healthcare. Retrieved from: https://www.modernhealthcare.com/article/20150623/NEWS/150629964/hospital-cost-of-uninsured-900-per-patient-per-year

Garthwaite, C., Gross, T., & Notowidigdo, M. J. (2018). Hospitals as Insurers of Last Resort. American Economic Journal: Applied Economics, 10(1), 1–39. https://doi.org/http://www.aeaweb.org/aej-applied/

Gooch, K. (2018). Healthcare finance leaders share 7 cost-cutting strategies. Becker's Hospital Review. https://www.beckershospitalreview.com/finance/healthcare-finance-leaders-share-7-cost-cutting-strategies.html

Morse, S. (2019). Hospitals are fighting DSH payment cuts. Healthcare Finance. Retrieved from: https://www.healthcarefinancenews.com/news/hospitals-are-fighting-dsh-payment-cuts

[EMPLOYER REFERENCE CENSORED]

Zimmerli, B., Craghead, T., & Gupta, N. (2010). A FAIR way to reduce uncompensated care. Healthcare Financial Management : Journal of the Healthcare Financial Management Association, 64(5), 92–97.

Healthcare technology should have a regular place in every household and on every smartphone

     As almost every household in America has internet or smartphone access, every household in America should also have access to quality healthcare and some of the latest healthcare technology. According to the US Census Bureau (2018), only 14.5 million of 128 million households were without any type of internet. With the availability of wearable devices, mobile apps, chatbots, and telemedicine, more Americans should be readily able to connect to their medical providers on a more regular basis. However, a 2019 survey showed that numbers declined by 4% in the last year for usage of the internet to access health information and health tools (Mikulic, 2020). As the internet is the most used tool in America (and worldwide), this is puzzling data. It could be due to the complexity of health data. Health literacy has a large role in the use and understanding of data provided to informed patients. It could simply be the lack of promotion or advertisement of these available technologies. Regardless of the reason, this article aims to provide a brief introduction to the most useful healthcare technology that has recently been made available to the public and discuss its current and prospective impact on the system.

 Wearables

           Wearables like the Fitbit, smartwatch, and prescribed medical devices are being more widely used and commonplace to promote wellness and avoid chronic illness. Those that are chronically ill can also use these commonplace devices to manage their illnesses. According to Loncar-Turkalo et al (2019), wearables and nearables (neighboring devices that interact with wearables) are considered the most likely technologies to transform future healthcare and lifestyles. Whether you are tracking your jogging route and calories burned during your workout, reviewing your blood glucose trends,  or monitoring your heart rate while you work, wearable technology has become widely integrated into many American households even without connecting to your physician or sending your data to be analyzed. Common devices like the apple watch can be integrated with your electronic medical record app (via your local health system) and send your data directly to your physician in order to facilitate care. Don’t want to send your data to your healthcare provider? You don’t have to. Many wearable devices can be monitored through a plethora of available smartphone apps.  These apps can provide advice and assistance with analyzing your own health data and assisting and altering wellness behaviors. Which leads us to apps.  

Apps

     There are now 318,000 mobile health apps available for download globally (“11 Surprising Mobile Health Statistics”, 2019). Though Over 60 percent of people have downloaded one of these apps, 85% of these downloads were for wellness reasons, and only 15% for medical reasons (“11 Surprising Mobile Health Statistics”, 2019). A 2016 survey showed that 40% of health app users have discussed or shared information with their doctor so that their health concerns and conditions are better understood (Vincze, 2017). Health apps are uniquely capable of providing that health literacy that is needed to fully take advantage of available health technologies and improve access to healthcare as a result. In addition to sharing information with your provider, educating the user on their health condition and/or wellness, health apps can also provide online support communities for every type of app user, including those who are chronically ill, suffer from mental health disorders, or are looking for fitness support. There also exist apps that provide health alerts and reminders, such as doctor’s appointment reminders, medication reminders, menstrual period and ovulation tracking, etc (Vincze, 2017).

According to Vincze (2017), some apps users can consider downloading include:

·         Asthma MD: Created by a physician at USCF, this asthma management app allows asthmatics and/or their parents to log/ graph asthma activity, track medication, track asthma triggers and map PFM to severity zones. All of this information can be sent/ shared with your doctor.

·         Diabetes apps for blood sugar control, glucose trackers, and food planning/ trackers. Diabetes apps can help monitor blood sugar fluctuations and help plan ahead and share data with your doctor.

·         First Aid App by the American Red Cross: Provides information to handle the most common emergency situations for the average untrained person. They have sections that allow users to learn about emergency situations, prepare for emergencies, and sign up for emergency courses through the Red Cross.

·         Heal: Lets users sign up for on-demand home doctor's visits for a flat rate of $99. Includes sick and well visits, and will work with your insurance.

·         MedCoach: Medication tracker and reminder.

·         Medwatcher: Shares news about new drugs, vaccines, and medical devices

·         Prodigy Patient: Information provided by doctors and pharmacists in the UK- this app gives advice on managing hundreds of the most common illnesses and medical conditions.

·         Managing addictions: QuitGuide Smoking Cessation and Recovery Record for eating disorder management.

·         SickWeather: Local Illness Tracker which provides maps and alerts.

As stated before, apps can educate the average person and help them take an active leading role in their health. Information can empower those that seek information to improve their health and help medical professionals to manage their health more easily, leading to better, higher quality care.

Chatbots

           Some, including the older aged Americans, believe that some apps are not user friendly or do not have the time to navigate the available education on their condition or wellness. They may fare better with the newly developed AI, medical chatbots. As long as they can text, they can use these chatbots, for medical advice regarding new or existing ailments. Chatbots have found significant success in the UK, where they use the app Babylon with the UK National Health System (NHS) in order to release the burden on their over-worked physicians. In 2017, a hospital in London conducted a trial with Babylon's AI via its emergency advice line. The automated system asks callers to wait on the line or advises them to download the app instead. 40,000 opted for the app and 40% of those that used the app were directed to self-treatment options rather than a doctor (Heaven, 2018). The proportion of people referred to emergency were the same as those who were previously referred to emergency by human staff- 21% (Heaven, 2018). This app allows human doctors or emergency rooms to become your last resort instead of your first. It eases stress and anxiety from the patient and controls health care costs by avoiding costly non-emergency care in the emergency or urgent care setting. When users seek medical advice for chronic illnesses, this is another opportunity for health literacy and another opportunity to empower the patient to take their health into their own hands. Other Medical Chatbot apps available include Ada, Your.MD, and Dr. AI (Heaven, 2018).

Telemedicine

           Perhaps the easiest option of all is the route of Telemedicine. If you have ever had a video chat with a family or friend, you can participate in Telehealth. However, until recent months, it has not been widely available as insurance payers have been reluctant to cover or pay for telehealth visits as it is newly available and considered unproven. With the current COVID-19 pandemic, it has become more widely available and accepted as people across the world are asked to socially distance from others. Now, hospital systems and even private practices everywhere have been offering telemedicine visits for routine and less complicated physician appointments, where your provider has a video encounter scheduled with you. Most providers will utilize apps for video conferencing like ZOOM, or hospital proprietary systems, which are encrypted and protected. If your provider needs to physically assess you, they will schedule a follow-up in-person appointment. Just like a regular appointment, providers can prescribe medications or testing as indicated.              

Impact & Conclusion

           Ultimately these technologies are available to the layman to empower patients and turn them into consumers and advocates in their own healthcare. In the last few months, this has been increasingly important in light of the COVID-19 pandemic. People everywhere are being told to self-sustain, and this has proved to be a scary and unprecedented thought, especially to those that need regular healthcare to manage everyday chronic conditions. According to Bard Levine & Guidry, 2020:

The U.S. health care system is at a critical inflection point. For the approximately 100 million Americans who are uninsured or underinsured, access to comprehensive care continues to be a barrier to health and well-being. Many of these patients rely on free or low-cost community health centers (CHCs) for vital primary care. But too often, CHCs are not equipped to care for patients with complex or chronic conditions… that require the expertise of a highly trained physician specialist. Though clinics can offer referrals, patients frequently face barriers including long wait times, out-of-pocket costs, travel distance, and more—leading to patients going without the vital specialty care they need. This vicious cycle leads to worsening conditions, hospitalizations, increased emergency room visits, decreased quality of life, and even death—all of which could be avoided with timely access to the right care at the right time. (Bard Levine & Guidry, 2020)

The healthcare technologies mentioned in this article proved that any American with a smartphone or an internet connection can have access to the medical advice and care they need without having to wait for specialist referral or a costly doctor’s appointment. Wearables are efficient at promoting a healthy lifestyle and keeping the user informed on their wellness. They can even help track biometrics for chronic conditions. Apps can help manage chronic conditions as well, and even share information with your doctor without you having to visit a clinic or doctor's office. Chatbots can help in the same respect and get a little closer to physician advice in the way that they can “chat” with you about your health concerns. Lastly, telehealth is available in your home and many times with your actual doctor (in the wake of COVID-19 and in the immediate future). In the last two decades, technology has fundamentally altered the way that people do business and communicate with each other- so why not let it revolutionize the way you communicate with your doctor and your healthcare team. It has been proved that technology has the power to make healthcare more accessible everywhere, making it easier to reach and easier to understand, in a time when many Americans’ continued access to healthcare is uncertain, it is paramount to utilize any available resources to get quality healthcare to more people. “A robust telehealth infrastructure could protect vulnerable patients by keeping them out of clinics and emergency rooms, triage patients virtually to assess for COVID-19, and treat patients with non-COVID-19 chronic or complex conditions virtually and locally to preserve limited hospital beds and health resources” (Bard Levine & Guidry, 2020).

References:

11 Surprising Mobile Health Statistics. (2019). Mobius MD. Retrieved from: https://www.mobius.md/blog/2019/03/11-mobile-health-statistics/

Bard Levine, L. Guidry, M. (2020). Telehealth and COVID-19. EP-Magazine, May 2020, 26-28.

Heaven, D. (2018). Dr. Bot will see you now. MIT Technology Review, 121(6), 22.

Loncar-Turukalo, T., Zdravevski, E. Machado da Silva, J. Chouvarda, I. Trajkovik, V. (2019). Literature on Wearable Technology for Connected Health: Scoping Review of Research Trends, Advances, and Barriers. Journal of Medical Internet Research, 21(9), 1438-1471.

Mikulic, M. (2020). Use of digital health tools by type in US adults 2015-2019. Statista. Retrieved from: https://www.statista.com/statistics/1102227/adoption-of-digital-health-tools-by-type-us-adults/

US Census Bureau. (2018). Presence and Types of Internet Subscriptions in the Household. Retrieved from: https://data.census.gov/cedsci/table?hidePreview=true&q=B28002%3A%20PRESENCE%20AND%20TYPES%20OF%20INTERNET%20SUBSCRIPTIONS%20IN%20HOUSEHOLD&table=B28002&tid=ACSDT1Y2018.B28002&lastDisplayedRow=12&moe=false&t=Telephone,%20Computer,%20and%20Internet%20Access&g=0100000US

Vincze, J. (2017). 25 healthcare mobile apps for consumers. Library Hi Tech News, Vol. 34 No. 7, pp. 16-23. https://doi.org/10.1108/LHTN-07-2017-0052. Retrieved from: https://www.emerald.com/insight/content/doi/10.1108/LHTN-07-2017-0052/full/html

How Henrietta Lacks’ Story Taught Me How to be a More Compassionate Leader in Healthcare

The story of Henrietta Lacks is both a story of miracles and of tragedy. The history of the HeLa cell is truly the stuff of scientific miracles. However, the story of Henrietta Lacks, the patient who unwittingly donated the cells, and whose family has suffered as a result, is heartbreaking. In reading Rebecca Skloot’s best-selling book, I admit that I read the story through the eyes of a leader in healthcare. I was ready to defend my field and my peers in the field. However, as I read both the personal story of Henrietta Lacks and the Lacks family, as well as the story of the HeLa cell, I was astonished at the amount of betrayal I felt as a warrior of science. Many criticize Skloot’s book as reminiscent of a novel, and problematic in the way that she reports it like she sees it- from sexually transmitted diseases, child abuse, abusive marriage, child molestation- Rebecca leaves no stone unturned in her ten-year mission to learn about Henrietta Lacks and her contribution to science.

Christoph Lengauer, the first scientist that was willing to speak with the Lacks children, said it best by stating, “Whenever we read books about science, it’s always HeLa this and HeLa that. Some people know those are the initials of a person, but they don’t know who that person is. That’s important history” (Skloot, 2011, p. 266). Rebecca Skloot’s book was successful in uniting the person, Henrietta, with the cells. The cells were not the only important discovery in science. The story of the person was important for healthcare and could teach us a lesson about being a compassionate caregiver in healthcare.

Critics state there are problematic elements in Skloot’s portrayal

In a poetic analysis of the book, Lantos (2016) reinforces the idea that Skloot’s book further exploits the Lacks family in its overshare of private details of their lives, namely Deborah’s abusive marriage and divorce, the imprisonment of her children and details of the crimes, and even the amount of Deborah’s social security check. Daniel Podgorski, a literature reviewer for the Gemsbok, comments on Skloot’s exploitative position relative to the Lacks family, stating that she, however, tells an important and even story (Podgorski, 2016). Podgorski (2016) states:

Skloot adopts a neutral tone throughout her book and presents the facts of the cases and lives involved evenly, and, in doing so apolitically, manages to expose the inextricable story of racial segregation operating above and with scientific progress in the twentieth century without sacrificing journalistic integrity…she presents all people in her book as part of this one grand narrative of humanity, each a character as in a novel, susceptible to moral and critical judgments by the reader, and a human being, and so representative of a faction of reality (Podgorski, 2016).

While most of the Lacks family disagrees, two Lacks men have come forward regarding their feelings of contempt toward Rebecca Skloot, and HBO, who produced the film portrayal of Skloot’s book. Bustle reports that Lawrence and Ron Lacks (Henrietta’s son and grandson) feel exploited by Rebecca in the same way that they felt exploited by Johns Hopkins. “Skloot portrayed the Lacks family as falsely uneducated and poor. ‘She made us stereotypes…people think we’re dirt poor’” (Truffaut-Wong, 2017). Lawrence Lacks even goes on to tell the Bustle reporter, “It’s bad enough Johns Hopkins took advantage of us. Now Oprah, Rebecca, and HBO are doing the same thing. They’re no better than the people they say they hate” (Truffaut-Wong, 2017). However, the article goes on to give a comment by HBO, stating that the film had overwhelming support from many Lacks family members.

In my reading of the book, I found a number of details cringe-worthy in their honest horror, and I admit that they horrified me as a woman and as a mother. First, there was Day’s character as a young husband and father. Early on in the book, in Chapter 1, Day is painted as an adulterer (Skloot, 2011, p 13) and later on, it is explained that the sexually transmitted diseases he passes on to his wife, Henrietta, are the reason why her cervical cancer is so aggressive. Later, in Chapter 15, Deborah’s physical and sexual abuse by her uncle, Galen, is another one of those details that breaks your heart and keeps you up at night. You wonder if you can do without hearing these atrocities suffered by this family. Then you keep reading on and get to the part where Day, her father, did not protect her from this incestuous monster (Skloot, 2011, p. 113) and you want to both kill Day again and embrace Deborah in all her suffering. This rollercoaster of emotion keeps you reading voraciously and really humanizes this family.

While I do agree that these details are of a very private nature, they served their intended purpose in conveying the message that Henrietta was a real person. She is not just a cell. She is a real woman who had a real family- who are still alive today- and still suffering from the aftermath of the notoriety of the HeLa cells, which were taken without Henrietta or her family’s consent, and have changed the face of medicine (and made millions since their theft). What makes a person or a family more human than the reality of their flaws?

How the story helped me in my role as a leader in healthcare

This story is not only an exposé of all of the skeletons in the Lacks family closet, but it was a discussion on racial disparity and medical mistrust in the African American community, and of informed consent, or the lack thereof, for Henrietta and the Lacks family. It was the story of any and all of the above. As an African American woman visiting a public ward in the 1950s, Henrietta had no choice when it came to research, as was the same with all the black patients at Johns’ Hopkins’ public colored ward (Skloot, 2011, p. 29). This was the era of racism, segregation, and Jim Crow laws. Black patients had no choice but to trust the word of their doctors, and not many words came from these doctors. They weren’t informed of many details of the treatment for Henrietta’s cervical cancer, nor were they informed of the cells they took from her in research, nor were they informed of the fruit of those cells- a medical revolution.

These cells crossed the world. In 1952, they were the first living cells shipped via postal mail. They helped develop the polio vaccine, the cervical cancer vaccine, and many drugs. They were the first cells ever cloned and were also the first cells ever hybridized with the cells of an animal- a human-mouse hybrid. The discoveries were endless and are still being made. The fruit of the research of the HeLa cell was ample, and the financial gain was enormous. However, this was all unbeknownst to the Lacks family. In fact, they were unaware of the existence of these cells until 1973- more than 20 years later! It wasn’t until 1975 that the Lacks family knew of the immense contribution to science and the commercialization of the cells after a reporter for Rolling Stone interviewed them and published a story about Henrietta Lacks. Their mother’s cells now had a name, and a family, and her medical history was out for the world to read about.

This is what pulled on my heartstrings. As a medical professional, I am a bleeding heart. I regularly encounter some of the most vulnerable sick people who just need someone to take care of them and often to advocate for them. Here was this woman- a poor and educated minority who just wanted to trust her caregivers- who died at the age of 31. She left behind a family of many small children, one of whom was disabled. That family defined struggle. They were uneducated, poor, and struggled into adulthood. Henrietta needed a caregiver, an advocate. Her children needed this, too. When they learned of their mother’s cells and notoriety, they felt deceived and rightfully so. Here they were struggling from health issues of their own and could barely get medical insurance- yet their mother’s cells created much of what we think of when we think of modern-day healthcare. Where were the Lacks’ caregivers? Why did no one in the medical field feel that they needed to be taken care of, in their vulnerability?

 With this lesson of bioethics and medical mistrust: How do we prevent this from happening again?

Though Henrietta’s contribution to science was immense, it was done without her consent or the consent of her family. When Henrietta was identified and her family was made aware of the enormity of this situation, the Lacks family was still kept in the dark. The scientific and medical community continued to take advantage of the Lacks’ by deceiving them into giving blood to further their research into Henrietta’s genome and disguised this as “cancer testing” (Skloot, 2001, pp. 183-189). There were so many opportunities for the medical community to make this right, but no one stepped up to bat.

So how do we make sure that this never happens again? First, we need to remember why we went into this field- to help others, to save lives. Some of those that I have worked with in healthcare are caregivers in every sense of the word- they are bleeding hearts and some of the most moral and ethical people that I have ever met. Physicians down to nurse’s aides, almost everyone I have worked with have come into this field to make this world a better place by helping those that we can. As a leader in the field, this is an important trait that I look for in all members and prospective members of my team. In order to prevent this from ever happening again, we must convey a culture of ethics and compassion. By selecting and hiring ethical employees and fostering ethical decisions by acting ethically and helping your employees act ethically, you instill a compassionate and compliant environment (“How Managers”, nd). Talking through decision-making and being seen as a moral authority are important to convey an ethical and compliant culture in your organization.

As a caregiver in healthcare, it is always important to put yourself into the patient’s shoes. What if this were you? What if this were your mother? Always treat the patient as you would like for your family to be treated- or like you would like to be treated, yourself. Always be an advocate- just because you understand doesn’t mean they do. Informed consent was a big deal in this book, and it is a big part of the mistake that we do not want to be duplicated. It is important to talk through every diagnosis, every treatment, every procedure, until they understand. It is good practice to make sure that they can reiterate and explain it back to you. Informed consent is not only a form to be signed- it is peace of mind for both the caregiver and the patient.

Conclusion

In The Immortal Life of Henrietta Lacks, Rebecca Skloot goes into detail regarding Henrietta and her family’s life in order to tell a story apart from the story that was currently understood as conveyed by science- the story of the HeLa cell. By separating the story of the HeLa cell from the story of the Lacks family, Skloot effectively conveys the ramifications of the HeLa cells’ scientific contributions and commercialization on the Lacks family. Rebecca Skloot’s portrayal of Henrietta Lacks and her family may have been intense, but that intensity was key in conveying the central idea of the abhorrent treatment of the Lacks family by the medical and scientific community. This book was meant as a lesson, and I hope that the whole field hears it loud and clear.

    References

How Managers Can Encourage Ethical Behavior. (nd). Lumen Learning: Principles of Management. Retrieved March 8, 2020 from: https://courses.lumenlearning.com/wm-principlesofmanagement/chapter/how-managers-can-encourage-ethical-behavior/

Lantos, J. D. (2016). Thirteen Ways of Looking at Henrietta Lacks. Perspectives in Biology and Medicine, 59(2), 228-233. Retrieved from https://search-proquest-com.contentproxy.phoenix.edu/docview/1876059666?accountid=35812

Podgorski, D. (2016). Creative Journalism: American Race Politics, Perspective, and Shifting Culture in The Immortal Life of Henrietta Lacks. The Gemsbok. Retrieved from: https://thegemsbok.com/art-reviews-and-articles/tuesday-tome-immortal-life-henrietta-lacks-rebecca-skloot/

Skloot, R (2011.) The Immortal Life of Henrietta Lacks. New York, NY: Broadway Books

Truffaut-Wong, O. (2017). What Does the Lacks Family Think Of 'The Immortal Life Of Henrietta Lacks'? The Movie Portrays Their Heartbreaking Story. Bustle. Retrieved from: https://www.bustle.com/p/what-does-the-lacks-family-think-of-the-immortal-life-of-henrietta-lacks-the-movie-portrays-their-heartbreaking-story-51712