Saturday, October 25, 2008
By Joseph L. Galloway
This is an autumn of great discontent as not just the United States, but
the entire world trembles on the brink of an economic recession that may
bring the kind of pain that's known only to the oldest among us.
With days to go before Election Day, the country watches as a
presidential candidate and his political party unravel, frantically
dragging every ugly ghost out of the closet in an attempt not only to
fool everyone, but also to scare everyone.
They appeal to the worst remnants of racism that cling like kudzu to a
dying magnolia. Their robot phone dialers intrude on millions of uneasy
citizens with messages of hate and fear and envy and greed.
They try to paper their opponent with guilt by association: He
associated with a man who, decades before they ever met, belonged to a
group of wild-eyed student revolutionaries.
They and their forces of darkness falsely claim that he is a Muslim at
the same time they attack him for belonging to a Christian church whose
black minister aimed angry sermons at white America.
They have presided for the last eight years over a stunning
redistribution of wealth: They've turned Robin Hood upside down, taking
from the poor and the middle class and giving to the very rich.
Yet they tar their opponent for daring to suggest that it's time to turn
the tables and redirect some of that wealth to those who are jobless,
homeless and hopeless, and to the millions of other hard-working
Americans who are likely to join those growing ranks in the months and
years to come.
They call him a socialist for embracing a principle that's rooted deeply
in the teachings of the Christianity that they wear on their sleeves but
cannot find room for in their hearts.
They promise to "correct the mistakes" of their own president, their own
members of Congress, their own appointed overseers and regulators, if
only we give them another chance.
They promise to punish the Wall Street tycoons and the big bankers who
in their greed built this house of cards that's crashing down onto Main
Street. Yes they will. Surely they will smite the robber barons who
brushed a few crumbs from their groaning tables of riches into the laps
of the very people who now say they'll punish these malefactors of great
They say this even as the barons, bulging with bonuses and commissions,
pick over the carcass of a fallen economy gouging out a tasty morsel or
two more for themselves.
Is it any wonder that Sen. John McCain and Gov. Sarah Palin and the
Republican Party are sinking like the Titanic? Do they take us all for
complete morons? Granted, they may have reason to think that. After all,
we not only elected George W. Bush our president, we also re-elected him
to a second term. In so doing, we sowed the wind, and now we are reaping
Fooled us twice, they think, so maybe the third time is charmed.
That, however, doesn't seem likely as a cold, hard winter looms this
November. Not likely at all.
Here's a prediction for you, for them: McCain and Palin will go down to
defeat by 15 to 20 points, and they'll take a heap of Republicans down
with them to ignominious defeat.
The financial collapse and the painful fallout that's stalking the
nation won't be righted overnight. Putting Barack Obama in the White
House and giving the Democrats a veto-proof majority in Congress won't
mean that happy days are here again.
Hard work, sacrifice and suffering lie ahead. It could take a decade or
two to repair all the damage that Bush, Dick Cheney and all those
Republican congressmen in prison, out of prison and en route to prison
have done to our economy, our military, our standing in the world, our
Constitution and to civil discourse and competent governance.
In the meantime, we Americans would do well to try to remember all those
things that our grandmothers told us about getting by in hard times.
How to get by on a lot less. How to grow a vegetable garden.
How to squeeze a nickel till the buffalo bellows.
How to appreciate the small joys of family and friends.
How to share what you have, no matter how little you have, with those
who have nothing...
Saturday, October 11, 2008
Thursday, September 25, 2008
Life is more simple than we realize, why we must ignore the simple mathematical formulas that promote success is beyond me. Let's see if you agree with this simple formula:
I'm against the $85,000,000,000 bailout of AIG. Instead, I'm in favor of giving $85,000,000.000 to America in a 'We Deserve It Dividend'. To make the math simple, let's assume there are 200,000,000 bonafide U.S. Citizens 18+.
Our population is about 301,000,000 +/- counting every man, woman and child. So 200,000,000 might be a fair stab at adults 18 and up.. So divide 200 million adults 18+ into $85 billon that equals $425,000.
My plan is to give $425,000 to every person 18+ as a 'We Deserve It Dividend'.
Of course, it would NOT be tax-free. So let's assume a tax rate of 30%. Every individual 18+ has to pay $127,500 in taxes.
That sends $25,500,000, 000 right back to Uncle Sam. But it means that every adult 18+ has $297,500 in their pocket.
A husband and wife has $595,000 00.
What would you do with $297,500.00 to $595,000.00 in your family?
Pay off your mortgage - housing crisis solved.
Repay college loans - what a great boost to new grads
Put away money for college - it'll be there
Save in a bank - create money to loan to entrepreneurs.
Buy a new car - create jobs
Invest in the market - capital drives growth
Pay for your parent's medical insurance - health care improves
Enable Deadbeat Dads to come clean - or else
Remember this is for every adult U S Citizen 18+ including the folks who lost their jobs at Lehman Brothers and every other company that is cutting back. And of course, for those serving in our Armed Forces. If we're going to re-distribute wealth let's really do it...instead of trickling out a puny $1000.00 ( 'vote buy' ) economic incentive that is being proposed by one of our candidates for President. If we're going to do an $85 billion bailout, let's bail out every adult U S Citizen 18+! As for AIG - liquidate it. Sell off its parts.
Let American General go back to being American General. Sell off the real estate. Let the private sector bargain hunters cut it up and clean it up. We deserve it and AIG doesn't.
Sunday, September 21, 2008
Thursday, July 24, 2008
congratulations Anita, job well done!
Monday, March 31, 2008
In Wichita, Kan., 38-year-old Deedra Tolson bled to death after an emergency hysterectomy when her nurse, busy caring for 12 other patients, failed to hear her feeble cries for help.
In Alliance, Ohio, 30-year-old Lisa Vitale was waiting to give birth when she felt searing pain rip through her abdomen. An overworked nurse misread Vitale's fetal monitoring strip and failed to notice that her baby was in serious distress. Born hours after an emergency cesarean section could have saved his health, Vitale's son suffered severe brain damage that left him unable to drink from a bottle and required round-the-clock medical care.
In Florida, William T. Fain, 80, fell, hit his head, suffered brain damage and died two weeks later, an autopsy report said all while under the care of an agency nurse at Westside Regional Medical Center. Fain came to the ER after a seizure on Super Bowl Sunday in 2006, his family said in a negligence suit filed last month. Doctors ordered nurses to send Fain to the ICU and, in the interim, take steps to prevent him from falling from his bed, the suit said. They were to put up bedrails, lower the bed and check him more often. The agency nurse on his case did none of those steps, the suit said. After he spent 12 hours in the ER, and shortly after his family left for the evening, nurses found Fain on the floor. He fell, hit his head, suffered brain damage and died two weeks later, an autopsy report said.
Realizing all of these incidents were Acute Care related, how long can we dodge this National Nursing Shortage in the Ambulatory Care setting?
• No matter what your historical staffing vacancy rates have been, it is time we all begin to plan for the inevitable. There is fewer nursing students entering the field than there are vacant positions needing filled. According to the Nurses Coalition, only one position out of ten vacancies are being filled by nursing graduates, leaving a 90% vacancy on the books to be filled by other means than a permanent full time nurse.
• Some argue that the Ambulatory Care setting is one of several culprits to this shortage that hazardously impacts the inpatient/acute care settings. This highly debatable theory is relatively squashed knowing of the nursing shortage we have in the ambulatory environment.
• One could speculate that many nurses could not argue the fact that patients do receive better quality care when the care is delivered by familiar staff, staff well trained in the facilities’ systems and protocols.
Ambulatory Surgery Centers deliver more cost effective care to the patient than that care of the hospital setting. We realize this to be true; our patient satisfaction scores validate this as a fact. The lower vacancy rates that the ASC industry presumes has a direct correlation to the scores of our patient’s satisfaction. What are we doing to safeguard this within our own industry? How do we work harder today at our retention rates to dodge the sting of the shortage needle?
A quick guide to consider as action items you and your surgery centers can employ to withstand the outbreak of this epidemic, infecting your surgical centers:
> Provide new hires with the appropriate number of hours towards a secure, documented, and effective training schedule under the direction of a preceptor.
> Ensure that any new hire is paid according to your salary scale with years of experience comparable to those other nursing staff members.
> Ensure that no newly hired staff nurse is walking into the position at a higher rate of pay than those presently employed.
> Provide a formal structure whereby the nursing staff meet regularly, with pay, to look at opportunities for streamlining processes that l reduce their workload, providing them more hours at the bedside.
> Ensure that all members of management provide positive feedback frequently, and constructive critism at the time of the event while maintaining their privacy.
> Provide timely evaluations to the staff and ensure raises are paid annually, if not more frequently.
> Participate in frequent and employee observed salary scale validation.
> Strive towards self-directed nursing staff groups, reducing the need for management hours.
> Adopt and Implement a nursing friendly charting program that invites the nursing staff to chart only the exception and what actions were taken to resolve.
> Insist that the nursing staff take their yearly vacations and not allow the organization to demerit the importance.
If employing outside agencies to meet your nurse to patient ratios dictated by state regulations, then try to minimize any adverse events or effects by:
> Hiring staff for long term assignments, i.e. travelers or local nurses
> Contacting with an agency that prides’ itself in their retention rates of their registry staff
> Require the agency to provide you data on the nurse that comes to work for you in your facility, i.e. performance evaluations, references to the last assignment worked, etc.
> Require the registry staff to take and pass the competency skills assessment test you and your governing board has adopted as the organizations’ minimum expectation for the interim position.
> Ensure that the registry contract is without the nuisance of a large buy out clause if you and your registry nurse would want to be placed as a permanent staff member, employed by the center.
The time has come for each of us to participate in objectively looking at our staff and the vacancy of any open positions. We must work just as hard at retaining those that do deliver quality care so that we might dodge the need to subject our surgical patients to the dangers of placing those registry nurses that do not.
Sunday, March 16, 2008
This morning's news reported that the State of Missouri is considering legislation that will require existing abortion clinics (there are four of them) to conform to standards of 'ambulatory surgical centers' in order to continue offering their services. Proponents of the law call it 'common sense' and necessary for safety while abortion rights advocates decry it as a backdoor attempt to shut down abortion clinics.
Regardless of how you personally feel about the issue of abortion, this situation vividly shows how political architectural space can become. 'Ambulatory surgical centers' require 6 foot corridors and 12 x 12 examination rooms. One of the existing abortion clinics in Missouri has 5 foot corridors and 10 x 10 foot examination rooms. The new law would require the facility to essentially gut the majority of their spaces in order to comply-- about $650,000 of changes including plumbing, ventilation and other systems. The governor calls it one of the strongest pro-life laws ever put in place. Three of the four abortion clinics will have to make changes in order to comply with the new law. One doctor describes this will make it "difficult if not impossible to get abortions in this state".
Again, I bring up this issue not to necessarily spark a debate about abortion, but to point out that what we do as surgery center designers for space and patient flow for processes sometimes becomes a larger issue than first meets the eye. It is said that architecture is the manifestation of intention, and this intention embraces functional, spiritual and philosophical goals in addition to budgetary and tangible space issues. Oh, what tangled webs humans can weave.
Source: National Public Radio Morning Edition, March 14, 2008 · "Missouri Pro-Life and Anti-Choice Square Off" by Kathy Lohr. A federal judge is reviewing a Missouri law that requires abortion providers to become licensed as Ambulatory Surgical Centers. To do so requires retrofitting offices to meet codes. The new law is criticized as a bid by anti-choice legislators to make it difficult for women to get abortions.
Thursday, February 28, 2008
Most administrative personnel anticipate the onset of PAJ months in advance. The pre-accreditation jitters can have a devastating impact on workplace stress, staff morale, employee health, and productivity.
While the folks in IT departments have no trouble understanding the classic GIGO formula (garbage in, garbage out), the risk management committees, administrators, physicians doing the peer review seem to suffer from an occupational blind spot. If medical transcribers can easily identify the chronic conditions, which provoke PAJ, why can’t those of us so close to the core do the same? Why can’t the pre-accreditation jitters be avoided?
Come April 15th, will the news media have their cameras out as taxpayers rush to the post office to file their returns before the midnight deadline? Planning a story about people who wait until the last minute to do their taxes is a no-brainer for news editors. What about the millions of people who file their tax returns on time because they were doing what they should have done all along?
Whether running a surgery center or a restaurant, they pay their employer’s taxes on time. Their W-2 forms are delivered to employees and their 1099 forms appear in contractor’s mailboxes on time. Not only do these people understand the responsibility to store and maintain data so that they are ready to print W-2 and 1099 forms by mid-January, they also know that other people are expecting these forms to arrive on time in order to prepare their taxes and avoid any penalties for late filings.
Suppose we compare maintaining a patient’s medical record to handling a company’s accounting functions? In the financial world, data has to be clean. How can you plan a budget without sufficiently solid data to forecast income and expenses? How many people in your accounts payable department are allowed to issue blank checks? There isn’t an ASC in this country that doesn’t have at least one doctor whose dictated reports contain enough blanks to look like a piece of Swiss cheese. Or, a handful of surgery center staff that is notorious procrastinators. When people don’t know how much of a mess has been made – or don’t care – there’s good reason for the person in the hot seat (usually the Administrator and/or the Medical Director of the ASC) to get a bad case of the pre-accreditation jitters. Suddenly, there is a heightened awareness of the need for quality control in transcription.
As the pressure starts to build and employees are asked to work longer hours, management’s expectations become more and more unreasonable. While working in the outpatient arena, my friends and I used to compare the long-term health of large dysfunctional nonprofit institutions to that of problem drinkers. Is there a corollary between a surgery center’s pre-accreditation jitters and an alcoholic’s delirium tremens? The people at the bottom of the ladder are not fools. Nurses know which doctors make sloppy, illegible entries into patients’ charts or simply don’t chart a post-op note at all. But, as PAJ sets in suddenly on the eleventh hour before accreditation, miraculously dictated then transcribed reports appear. Medical transcribers know which doctors are continually contradicting themselves while dictating because they’re lost in space, dictating so fast that they can’t help but make errors, or are simply too exhausted to pay attention to what they’re doing or saying. Accountants know who’s been doing a responsible job of tracking expenses. It is unheard of for someone to address the physician or staff about their sloppiness in work habits and force them to sober up and learn the proper technique in documenting coherent entries into the medical record. That might require people to risk losing their jobs by accusing a doctor/alcoholic figure of not doing his work properly and being a hazard to those around him. Even worse, it might mean that in a medical peer review, doctors might actually have to accuse their colleagues of being incompetent and whose poor work habits continually jeopardize the accuracy of their patients’ medical records.
Surgery Center Administrators decide that by outsourcing transcription to India they can get faster turnaround with a lower price per line. With new advances in Internet technology, entrepreneurs trumpet claims that they have solved all the problems of creating and maintaining an electronic medical record. Larry Abernathy, the President of Digital Voice, Incorporated, claims that “Philips speech recognition technology is being married to our dictation system, to give birth to DVI Speech Power. Without changing physicians’ dictation behavior, we can run their DVI Voice Power dictations through the speech engine, produce a draft text report, and then provide this text – along with a synchronized voice playback – to a ‘medical editor.’ We anticipate dramatic improvements in productivity since correcting a small number of mistakes will be considerably faster for your transcriptionists than transcribing the entire document. Abernathy’s statement blithely ignores the fact that fast key stroking is not the issue, which keeps bringing medical transcriptionists to their knees. The problem is the incoherent statements spewing forth from the mouths of the dictators with absolutely no intention of improving the quality of their dictation. When was the last time the medical staff at your ASC diagnosed with the PAJ? Isn’t it about time, we join forces to construct a unity in legibility, quality, and consistency?
Don’t let your ASC be subjected to the infectiousness of PAJ, insistently ensure that all participants of your ASC is up on all their vaccines and that any Antibiotics needed are given way in advance to prevent this industry wide break-out of the Pre-Accreditation Jitters.
“Assisting the clients at doing it right from the very beginning” is our mission statement. Troy Lair, CEO and Principal Consultant of The Compliance Doctor, LLC. A Los Angeles Based Consulting Company that serves the nation in accreditation and licensure.
Sunday, January 20, 2008
Dr. Yamini Survives another Medicare Survey, The Compliance Doctor, LLC takes him through it with flying colors of success!
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