. . . because much of the content relates both to Washington, D.C., and "outside the beltway" -- the heartland, specifically Iowa -- and because after going from Iowa to Washington via Texas and California I subsequently returned, From DC 2 Iowa.
This morning's blog entry is a commentary about the School Board's most recent efforts at rethinking its elementary school attendance boundaries, at its meeting last evening, November 10.
But first, here are links to earlier entries on this topic and some of the other hot topics from the past week or so that are now getting the most direct hits, among which may be the entries you are looking for:
"Contributions from patients" proposal: "UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m. (with numerous updates through November 4, links to additional, related material -- and now with over 30 of the Press-Citizen readers' comments on B.A. Morelli's stories)
"the boundary committee will develop two to three scenarios while keeping in mind demographics, finances, keeping neighborhood schools and neighborhoods intact and projected enrollments and building uses. The demographics consideration also includes drawing boundaries in such a way that no school would be more than 20 percentage points higher than the district poverty average, which is currently about 28 percent, the board said. . . . Board member Mike Cooper said . . . 'The more flexibility, the better. I'm sure the committee will take all four of these (criteria) to heart.'"
The best good news is that this school district is blessed with the leadership of Lane Plugge. It's reminiscent of the line used in a number of songs, "If it weren't for bad luck, I'd have no luck at all." If it weren't for Lane the Board would have no leadership at all.
His is a perfect personality for the task before us -- and I say "us" because how this boundary business comes out will affect everyone for a few miles around, whether they happen to have children in the ICCSD schools or not. It is a rare superintendent who can work with the likes of me, on the one hand, trying to bring some clear articulation to Board governance and goals, and on the other, keep his calm, and make sure things don't fall too far off the track in the midst of the Board's present chaos, confusion and deliberately structured ambiguity.
He knows what a school board should do -- legally, managerially, financially, and in shaping policy and goals. He knows a superintendent should not be doing the Board's job. But he also has the patience and ability to work with, and around, the hand of cards the voters dealt him.
Having watched the Board's discussion of boundaries last evening, I've kind of reversed my position. As awful as the result may be, for reasons I'll explain in a moment, given the Board's lack of either the will or ability to do its job, the utilization of a consultant and a committee may have been a brilliant stroke on Lane's part. It gives the Board the opportunity it seems to want to be able to avoid responsibility for the ultimate decisions, provides them the assistance they seem to need to do anything at all -- while at the same time avoiding the otherwise awkward, but only available, alternative of having the superintendent to do their job for them.
So Lane's the best news.
Another bit of good news, for which Lane is also responsible, is the creation in advance of a schedule of meetings of the committee, public forums, and the presentation of its ultimate report.
Finally, there is the use of at least one metric in the midst of this sea of ambiguity. The disparity of the percentage of FRL students in elementary schools is to be kept between a 48 percent maximum (the 28% District average, plus 20%) and a minimum that is not specified. (Even if the minimum is also subject to the 20% variation, that would mean schools could have anything from 8% to 48% -- a 6-to-1 ratio.) That would not have been my choice, but I have never argued this is about my choice -- only that the Board arrive at, and announce, its choice, which it has now done and for which congratulations and appreciation are in order.
On this one the Board may actually be reflecting the plurality of community opinion -- though how would anyone know what that is? -- that a 6-to-1 disparity is just fine, especially if the parents in question can continue to send their kids to a school with the low percentage (and the ones who can't are free to transfer out to another school).
I should make unambiguously plain at the outset that I believe the seven Board members, as individuals, are obviously committed to public service, and otherwise worthy of our thanks. The problem comes with what happens to groups, as illustrated by this poster:
The mere fact that each is an outstanding individual -- knowledgeable, caring and bright -- does not mean that when they come together and act as a board that the results will resemble anything done by people who are caring, informed and bright. You may have seen this poster about "Meetings," with the caption: "None of us is as dumb as all of us." [Credit: Despair, Inc.] One of our nation's major gurus of governance, John Carver, puts it this way in defining boards: "boards are incompetent groups of competent individuals." Or you may have heard the definition of a camel, as "a horse built by a committee."
As for the Board's current chaos and ambiguity, I'm reminded of a story. Concerned about their community's lack of progress, a poll was commissioned to ask the question, "Which do you think is the worst problem in our community, ignorance or apathy?" The majority response came back, "I don't know, and I don't care."
Is there a point at which, notwithstanding "elections," so few people care to vote that it is only nostalgic nonsense to refer to a community as a "democracy"? I think the School District may be at that point when 10% or less of eligible voters even bother to vote for their School Board members. Or perhaps it is the case that the population really does follow and understand in great detail the Board's approach to this boundary business, and is so affirmatively in accord with its approach that it sees no need to question what the Board is doing. Whichever it may be, my sense is that mine is a lonely voice in the wilderness on these issues, and that the Board may very well be reflecting its constituents' desires.
Nonetheless, I'm going to continue to share my own view of the matter for whatever inherent persuasiveness it may present to any who care.
"[It] is the board's, and only the board's, legal, managerial, economic and political responsibility . . . [to] go beyond the vague 'prioritizing its top criteria' . . .. Telling a committee of 30 that it should keep in mind the board's 'priority of demographic considerations' is equivalent to Congress telling the FCC to regulate broadcasting 'in the public interest.' . . .
[T]he board . . . should start by calculating the percentage of "free-and-reduced-lunch" students in the District-wide student population. [It's now done so; the answer is 28 percent.]
It could then say, to state the extremes, that it wants:
• To specify precise percentages to maximize the FRL disparity, within the limits of the law: Some elementaries with a disproportionately high percentage of FRL students, and others disproportionately low (like now). [Of the three options I offered, this seems to be the one it has selected: no minimum FRL percentages specified, a 48 percent maximum (20% over 28%) -- producing conceivably as much as an 8-to-1 disparity from school to school (e.g., 6% vs. 48%).] . . .
Abdicating leadership
But for the board to delegate its responsibility for boundaries to a committee of unelected citizens in the form of a multiple-variable set of criteria with no algorithm, made up of vague categories with no metrics, is an abdication of its responsibility, a kicking the can down the road, a recipe for chaos and frustration, and an unconscionable imposition on the time, energy, good will and financial resources of 30 dedicated local citizens and the public at large. . . .
New data, physical impracticability, political or economic pressures may well call for some rational modifications occasionally.
But at any given point in time, everyone simply must have specific numbers to work with -- numbers not from the administration, a consultant or committees, but from the board.
Having done its job it is then possible, if the board desires, to delegate the task of creating specific, alternative line-drawing possibilities to the superintendent, a consultant or a committee -- but not before."
At that point in time I was only focusing on the ambiguity in the Board's use of language.
Having now watched the deliberations last evening [Nov. 10] I am even more concerned about the chaos involving the structure and process of its decision making.
It has taken what could be a rather unique clean structure and process -- the Iowa Code provides that the Board has the power, and the Board makes the decisions -- and turned it into the ambiguous chaos that prevails elsewhere in government.
o Consider Washington and health care. How's that been working for us? There are 435 folks in the House, almost half of whom have vowed to "break" the President by voting against anything he's for. Now that it's finally come up with a 1000-2000-page bill with something for everyone (at least some of which has nothing to do with health care) it goes to the Senate, where it has been declared to be "dead on arrival" and will require, for reasons best known to the Senate, 60 of 100 votes to pass rather than 50. If there's anything left in it for the American people after it comes out of the Senate, if it ever does, it must go to a "conference committee" for further watering down. Finally, if the President can hold his nose long enough to sign it, it will become law.
o There are similar problems within the Regents' university system. The UI faculty has some power, as do the college deans, president and other administrators -- although, as in Animal Farm, when it comes to the hospital and athletics "some are more equal than others." Nor is that the end of it, for the Regents have a kind of ultimate authority under the Iowa Code, as does the Legislature (or, more particularly, those legislators in the leadership and on the relevant committees).
Elected officials in Washington and Des Moines (at least those who would really like to get things done on the people's behalf) must envy school board members. As with any elected official, Board members have some responsibility to their constituents, and a significant number of stakeholder groups. But the legal authority stops with them; they need report to no one -- not the city council, not the legislature; only the courts can reign them in, and then only if they violate some federal or state law.
Given this rather uniquely clean bit of authority, what has our Board done? It has taken the smoothly working beauty of an Iowa City decision making machine and tried (and succeeded, alas) to turn it into something as chaotic and dysfunctional as the governance systems of Washington for health care and Des Moines for universities. Why would anyone want to do that?
It has, with a skill at ambiguity seldom if ever equaled, dispersed its power in all directions. There are the seven individual Board members. There is the Board acting (as it should) as a Board. There is the Superintendent. There is now a consultant. There are 30 (with promises of more) individuals on a committee. There is the committee acting as a committee (either unanimously, or with widely splintered views). Then there are two of the Board members (Mike Cooper and Tuyet Dorau) who will also hold the title of "ex officio" members of the committee (a wholly inappropriate role for individual Board members); and some imprecise role that will be played out by the consultant, Superintendent, and other District administrators at the committee meetings. All have some -- and often conflicting -- authority for this process and its ultimate decision; for none has that authority (and its limits) been defined.
Like "snatching defeat from the jaws of victory," in addition to creating "criteria" that provide no direction (with the exception of the 20% metric), the Board has now also deliberately created this blob of undefined roles and interwoven quasi-legal loci of power and will have to live with it.
As I listened to the exchange among Board members last evening my concerns were only heightened. Someone sought clarification on "what the consultant has told us we must do." Someone else commented that the 20% metric might be modified in some cases if one of the other "criteria" conflicted. There was some confusion about what "ex officio" would mean.
To end on a more positive note, here's a suggestion that I've written about before.
I believe in "the ratchet principle." You know, like a jack you put under a car. You start with something and then try to improve it. Writers may use it as an alternative to what some have described as the process of looking at a keyboard and waiting for little drops of blood to fall off of your forehead onto the keys.
Let's start with a map -- not one of the "two or three scenarios" the Board is delegating as an assignment to its committee; not as anything anyone thinks the Board would ever end up with. But as a place to start.
Nor need it be a multi-thousand-dollar precise map. Surely the administration can make pretty accurate estimates of many of these numbers.
1. Building occupancy. (a) Do with building occupancy what the Board has done with FRL. What is the total elementary school population for the District? (b) What is the maximum occupancy of each elementary (not counting "temporaries"), and what is that District total? (c) If students were assigned such that every elementary had the identical percentage of its maximum occupancy, what would that percentage occupancy be? (d) If every elementary student was assigned to the school closest to him or her, working outward from each school in all directions until that occupancy percentage is reached for each school, where would those boundary lines be drawn?
2. Free and reduced lunch. (a) Do the same exercise using only that nearly one-third (28%) of the elementary students who are FRL. (b) What is 28% of the student population of each elementary (using the optimum/average occupancy calculated above)? (c) If every FRL student was assigned to the school closest to him or her, working outward from each school in all directions until its 28% is reached, where would those boundary lines be drawn? (d) Do the same exercise as in 2 (a)-(c), above, forgetting about the percentages in each school; assign each FRL student to the closest elementary. What percentages of FRL would that produce in each school? You then have the data (with the visual of a map) to decide the most cost-effective way of reallocating FRL students to meet the 48% maximum.
Having done these, and similar, exercises there are some maps on the wall. All can, literally and figuratively, "see" what this is all about. Those involved, whether Board or committee, can then meaningfully talk about the modifications they want in the metrics that produced those visuals. They can "ratchet up" to ever increasing detailed modifications of those maps.
Ideally, as I've suggested before, there is no reason why these kind of "what if" games could not be played with software plus data made available by the District to the administration, Board, committee and any member of the public (presumably online). All kinds of maps could then be drawn by anyone with the time and inclination to do so. I can't believe the software isn't easily available, possibly even for free. (But no, I'm not going to volunteer to take the time to find it.)
Failing that, however, as least some early, fixed maps of the range of what various formulas would mean geographically would be a cheap, and very useful, compromise. _______________ * Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
That the UIHC administrators want a trip to Orlando, Florida's Disney World raises a number of issues: (1) the public relations, and legislative, backlash, (2) whether the UIHC needs improved "patient satisfaction," and if so (3) the appropriateness of, and alternatives to, the Disney program, and finally (4) emerging concerns about the judgment of UIHC management generally.
But first, here are links to entries on some of the other hot topics from the past week or so that are now getting the most direct hits, among which may be the entries you are looking for:
The UIHC's controversial "contributions from patients" proposal."UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m. (with links to additional, related material -- and now with over 30 of the Press-Citizen readers' comments on B.A. Morelli's stories).
A week ago last Saturday the Press-Citizen cleverly ridiculed into reality the School Board's "governance by clicker." Editorial, "Board Needs Civil Dialogue Not Clickers,"Iowa City Press-Citizen, October 31, 2009. Yesterday they did an equally creative job on the UIHC's latest Mickey Mouse proposal: a $130,000 edu-tainment trip to Disney World for some of the institution's top administrators. Editorial, "Time to cancel UIHC's trip to Disney Institute,"Iowa City Press-Citizen, November 7, 2009:
When Republican state legislators began complaining Thursday about the University of Iowa Hospitals and Clinics' plan to spend $130,000 to send hospital officials for a training session at Walt Disney World Resort, the only response from UI officials should have been: "You're right. That doesn't pass the common sense test. At a time when the state is slashing budgets and the hospital is facing budget cuts, this absolutely is the wrong time to implement this program."
Instead, UI officials actually have been trying to defend the decision as a necessary "small investment" that will reap big rewards in improving the hospital's low scores in patient satisfaction. In an e-mail sent throughout the UI community, the top hospital brass tried to spin the $130,000 as a good deal for the hospital. . . .
To make the case for why UIHC needs to be Disneyfied, the e-mail linked to three PR testimonials on how the Disney Institute has "partnered" with other hospitals on their "journey to excellence."
[Here's one example from the three the Press-Citizen quoted:]
• Back in 2001, the Arkansas Children's Hospital was struggling with the recruitment of critical staff, and its series of short-term fixes weren't correcting the problem. After the hospital took its senior management team for the Disney Institute's "Excellence in Healthcare Leadership" program -- which included visiting Disney sites and spending a short time as Disney "Cast Members" -- the management team was able to brainstorm ways to improve their retention efforts. (www.disneyinstitute.com/About_Us/PDFs/DI_CaseStudy_ArkansasChildrenHospital.pdf). . . .
But this isn't the 1990s . . . [or] even the start of the 21st century. This is the end of the first decade of the 21st century, when people are losing jobs left and right, and the so-called "small investment" of $130,000 represents nearly three times the annual salary of the average Iowa family.
We're all for UIHC changing its culture to improve patient care. But right now we can see only one benefit to UIHC officials visiting the happiest place while on Iowa is on budget-slashing roller-coaster ride: It will help bring together two normally at-odds groups, union leaders and Republican legislators, as they find common ground in how understandably appalled they are over this decision.
The paper earlier explained, "UI is planning a trip for 35 senior UI Health Care and UI Hospitals and Clinics administrators, doctors, nurses and other personnel . . . said Gordon Williams, UI Health Care chief of operations. The trip would include plane, hotel, meals, two and a half days' training and 'the Disney experience,'" he said. Williams and UI spokesman Tom Moore defended the plans on Thursday [Nov. 5] . . . “We haven’t though about putting it on hold because this initiative is so important,” Williams said. Moore said this plan has the support of UI President Sally Mason . . .." B.A. Morelli, "UI Officials Consider Disney Trip,"Iowa City Press-Citizen, November 5, 2009. And see, B.A. Morelli, "Politician questions UI Orlando trip; Officials say Disney Institute the best around,"Iowa City Press-Citizen, November 6, 2009, p. A1; B.A. Morelli, "2 lawmakers slam plans for U of I Disney trip,"Des Moines Register, November 7, 2009; Diane Heldt, "UI trip to Florida decried as wasteful; Lawmaker may push for more oversight of state regents," The Gazette, November 6, 2009, p. A1 (characterized as "part of an 'epidemic of arrogance' in the state regents system. Jeff Kaufmann, R-Wilton, said Thursday that the trip to Orlando, Fla., at an estimated cost of $130,000, is the latest in a string of poor fiscal decisions"); Sam Lane, "Legislators upset over UIHC’s trip to Disney World,"The Daily Iowan, November 6, 2009.
There are a number of issues here, summarized in the opening of this blog entry: "(1) the public relations, and legislative, backlash, (2) whether the UIHC needs improved 'patient satisfaction,' and if so (3) the appropriateness of, and alternatives to, the Disney program, and finally (4) emerging concerns about the judgment of UIHC management generally."
1. Public Relations. What will be the reaction of the public, media and Iowa Legislature to what many Iowans will understandably perceive as an all-expense-paid "vacation trip" for hospital administrators earning multiples of the average Iowa family income? It should have been easily predictable. Was that thought about at all by top UI and UIHC administrators? (As I noted in a comment about a DI editorial questioning the patient donation proposal, "Like the boy in The Emperor's New Clothes, our students can spot nakedness of which their adult administrators are either too blind or too frightened to speak." Editorial, "UIHC donation plan would inappropriately pressure patients,"The Daily Iowan, November 5, 2009.)
Even if at another time and place it would have been a wise use of $130,000, as its defenders insist it is now (a matter I would dispute), it should have been obvious that this was not the time. Iowans in general, and UI personnel in particular, are facing unemployment, mortgage foreclosures, and bankruptcy. Orlando is the farthest thing from their grasp. See the Nov. 10 story, B.A. Morelli, "Union head slams UIHC Disney trip; Officials: Trip essential to improving customer service,"Iowa City Press-Citizen, November 10, 2009 ("'It is completely unacceptable at this time, when state workers are facing layoffs and Iowans are looking at major cuts to services, for the UIHC to plan a trip to the Disney Institute in Orlando, Florida," AFSCME President Danny Homan said in a statement Monday. The decision 'shows the tone-deafness of the UI to the current situation the rest of state government is facing.'").
Iowa legislators' criticism of this trip necessarily reminds one that, "Lawmakers in Washington . . . criticized the $442,000 that an A.I.G. subsidiary spent on a weeklong resort retreat for top sales staff, within days of receiving government aid." Jonathan D. Glater and Vikas Bajaj, "Cuomo Seeks Recovery of Bonuses at A.I.G.,"New York Times, October 16, 2008, p. B1.
The Gazette adds more examples of public relations insensitivity by the privileged: "H1N1 vaccine was shipped to big Wall Street companies while public clinics . . . don’t have enough" and amidst "employee layoffs . . . Linn County supervisors . . . allow . . . pay increases . . . for about 140 management workers." "Gomers," The Gazette, November 9, 2009, p. A4.
But never mind that the UIHC isn't the only institution with public relations gaffs. Never mind that for UIHC a $130,000 expense is but a drop from its $1.4 billion gross revenues bucket (1/100th of 1%; see source, below). Never mind that an argument can be made the money isn't coming from taxes. Never mind that the idea's promoters argue it's the least-cost way to get some improvement in patient satisfaction (as A.I.G. executives undoubtedly argued the benefits in increased sales that would result from the resort retreat).
It's a public relations disaster, especially coming on the heels of last week's revelation of plans to ask new patients for financial contributions just as they are checking in at the hospital [see "UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009]. You want to improve "patient satisfaction"? You might start by not asking patients for donations at the very moment they are most vulnerable, and already concerned about how they are going to pay for the procedures they are about to receive.
Making predictions about the public's reaction, fashioning public relations and "strategic communications" programs, requires some capacity for empathy with the public. When you're traveling on a Gulfstream it's hard to imagine what it's like for those who can't afford to travel on a Greyhound (or what their trip is like when they can afford it). When you're paying $40,000 for your kid's college tuition it's hard to relate to those who are trying to support a family of four on $20,000 and who can't even dream of paying Iowa's tuition for their kids. When you think nothing of the cost of a meal at Iowa City's most expensive restaurants . . . ah, but hopefully you get my point (whether or not there is any UI administrator who has ever traveled on a Gulfstream or Greyhound, sent kids to $40,000 schools, or actually likes the food at those restaurants).
One gets the sense that there is a bit of a disconnect between those who are making these decisions, the worlds in which they live (both literally and figuratively), and the Iowans -- including many of the UIHC's employees as well -- who are reacting to them.
2. Patient Satisfaction. Given virtually all administrators' inclination to put the best light on institutional deficiencies, if UIHC executives are willing to acknowledge they have a "patient satisfaction" problem you can bet they probably do.
I have some affection for the UI Hospital. My younger sister and I were born there, I worked the cash register and serving line at its employees' cafeteria while in high school, have occasionally volunteered as a guinea pig for a clinical trial, and have returned many times over the intervening years as a patient. John Colloton's accomplishments during his leadership in building what the UIHC is today invoke awe. Many of the institution's doctors and departments are not simply "among the best" they are actually ranked number one in the nation. I certainly admire Gordon Williams' accomplishments as a hospital administrator at many institutions before we were lucky enough to get him here. And I must say, I thought UI Vice President for Medical Affairs Jean Robillard's remarks at the "Healthcare Reform: A Civil Discourse" forum last month were among the most informed, articulate, candid, compasionate and public spirited I've heard from anyone inside the health care industry during this past year [see, Kevin Hoffman, Locals Address Health Care,"The Daily Iowan, October 20, 2009].
I've had my own frustrating experiences with the hospital and heard the stories of friends over the years: lengthy waits well beyond the time of appointments, inaccuracies in billings, lost records and x-rays, a seeming lack of effective communication between departments, or a general sense of feeling lost in a vast, impersonal system. But this blog entry is motivated by neither personal anecdote nor animus. I simply take as a given, based on the UIHC administrators' representations, and press representations that the Disney World visit is supported by the UI President Sally Mason, that patient satisfaction at the UIHC is not just a collection of anecdotes but is a serious and systemic problem.
3. Disney Appropriateness and Alternatives. I have no personal experience with the Disney program, and am even willing to accept its advocates' representations that it is the best at what it does. I just question whether what it does is what the UIHC needs, or that even if it were, a day or two of exposure to Disney's wisdom and the Florida sun will cure what ails the UIHC.
Patient satisfaction is neither rocket, nor medical, science.
(a) The Walmart Standard. As a school board member visiting schools, I expressed concern to the superintendent at the number of times I would walk into a reception area, stand in front of a person behind a desk, and not be greeted by anyone, let alone with a smile. I suggested we hold our employees (some with PhDs and masters' degrees) to what I called "the Walmart standard." It was not intended to disparage either Walmart or the ICCSD, but to dramatically make the point. You may have had the experience: An employee is sitting on the floor, organizing stock. You ask where something is located. They look at you, smile, stop what they are doing, get up, and if necessary walk to the northwest quarter of the 40-acre store, with some friendly chat along the way, and then point to the spot on the shelf where what you're looking for is located. I figured if Walmart could train high school graduates and dropouts to that standard, we ought to be able to do as well with our school district employees. See, e.g., Nicholas Johnson, "Complaints Help Solve Problems,"Iowa City Press-Citizen, August 17, 1999, p. 13A.
(b) Hire for Attitude. “'We hire for attitude and train for skills,' says Dean Worker, recruiter for Southwest Airlines. At Southwest Airlines . . . maintaining the corporate culture is dependent upon the loyalty and devotion of its employees . . .. The key to fitting in . . . is not just how well you do the job, but how good your attitude is while you do it. As a result . . . Fortune has consistently ranked Southwest Airlines among the top five of Best Companies to Work for in America, and according to the April 2003 issue . . . Southwest is an employer of choice among college students." "Secrets from the Other Side: Working for Southwest Airlines," St. Louis University Career Chronicles, October 2003.
Almost everyone has some skill or talent that enables them to be as good or better than anyone at doing a specific task. Greeting, or working with, the public -- especially those members of the public suffering the anxiety or stress of some hospital patients -- is not a talent possessed by all. That doesn't mean those who neither enjoy nor do such work well are bad people, or that they wouldn't be well qualified for other tasks. It just means that institutions would be well advised, in filling positions that involve working with the public, to "hire for attitude and train for skills" -- rather than hoping that a trip to Disney World can turn around an attitude that has had decades to develop.
(c) Employee satisfaction. Job One for any administrator concerned about patient (or customer) satisfaction has to be employee satisfaction. Employees who are over-worked, under-paid and under-appreciated, who are scarcely noticed let alone thanked and praised, are not going to be at their best in creating patient satisfaction. And for administrators to merely follow the instruction to "be sincere, even if you don't mean it," isn't enough; employees can tell the difference. As an "Anonymous" put his or her example about life in Jessup (a comment on an earlier blog entry): "Every day, when they [President David Skorton and Provost Mike Hogan] came in they would stop and visit for a minute with each person in the offices around them. They'd ask about our families and our day." Nicholas Johnson, "A University's Strategic Communication; A Modest Proposal to the Regents' University Presidents," October 7, 2009, comment 10/09/2009 07:05:00 PM.
(d) The Fundamentals. A hospital is not a big box store or used car lot. Willy Loman's "shoeshine and a smile" (that is, just basic friendliness and attentiveness) can be a great place to start in improving patient satisfaction. But a hospital needs, among other things, smooth working integrated systems. Mayo Clinic (which I have never visited as a patient) seems to have such systems, based on what I've heard from those who have been there. Rather than taking 35 people to Disney World the UIHC might consider sending one person to Rochester, Minnesota, to: (1) observe their procedures, (2) take notes, (3) come back to Iowa City, and (4) do what they do. It is my impression, for example, that there is little or no waiting; clinics are not routinely overbooked. There are friendly greetings. Patients are not repeatedly required to fill out forms asking for the same information. Records arrive at each destination before the patient. Personnel are familiar with their contents, know why you're there, and where you're going next. Oh, and the first thing patients hear is not an appeal for financial contributions (talk about "patient satisfaction")!
I understand that UIHC is not Mayo. It must treat patients who could not afford or get into the Mayo Clinic. UIHC is a teaching hospital; training new doctors requires they be able to see patients. OK, so UIHC can't emulate everything Mayo does; it can at least copy what it can do.
The controversy surrounding this proposed Disney World trip has produced dozens of comments on newspapers' online editions from readers -- virtually all expressing something between outrage and ridicule. But I noticed three this morning (Nov. 10) that I thought consistent with and reinforcing of the points I'm making here, constructive, helpful and worth including in this blog entry. Coming as they do from people I do not know and have not talked to, they drive home the point that Iowans' values are widely shared: "patient satisfaction" is not rocket science, it's just common sense. They are attached to B.A. Morelli, "Union Head Slams UIHC Disney Trip; Officials: Trip Essential to Improving Customer Service,"Iowa City Press-Citizen, November 10, 2009:
"[E]ven I won't go to UIHC for care unless I need something really specialized, because I don't have a whole day to devote to a clinic appt that should take an hour--and I work there." Gilgamesh37, 11/10/2009 6:26:08 AM
"All UIHC needs to start doing is keeping the appointments THEY schedule with their patients. That would solve over 50% of their patients complaints." iowahawkeye, 11/10/2009 6:25:44 AM
And, for a testimonial that the "Mayo treatment" is widely available and easily achieved:
"[A]t at Mercy Hospital in Iowa City, I was immensely impressed with the sensitive, fast and personable good service I received in several departments. Persons at all serice levels seened dedicated to my comfort, my understanding of the procedures . . .. As I left last week they handed me a 1-page satisfaction survey with the request that I fill it out only if I wanted to. I did.These people haven't even had a free paid trip to Disneyland to my knowledge and still they did a great job -- just being courteous, professional and just plain nice." Harvey, 11/10/2009 6:24:17 AM
What a dramatic distinction there is between being handed a request for donations when you check in, and being handed a satisfaction survey when you check out! That pretty much sums it up.
(4) Management Judgment. The Disney World trip is UIHC's second public relations disaster in the last two weeks. The first was the proposal to cover financial shortfalls with appeals to patients for donations -- above and beyond the medical bills; see "UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009. This was problematical for at least three reasons: the proposal's substance (asking patients for donations at all, and worst of all when they're at their most vulnerable), responding to an avalanche of outrage and ridicule with a defensive effort to justify it, and in doing so to misrepresent the extent to which it was being done by other hospitals. As The Gazette reported on October 31, "[UIHC spokesperson] Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place. . . ." Of course other hospitals receive contributions from people who happen to have been patients in the past -- as a part of their general donor base -- as does the UI Foundation. That's not, and never was, the issue -- nor can it be the justification for fund raising efforts to be the first thing patients confront when they arrive at a clinic. The issue involves soliciting patients -- especially when they are checking into a clinic. As I wrote in a comment on a Daily Iowan editorial, "To tell reporters (as they did) that others do this, when they don't, is either sloppy investigation of details, insensitivity to ethical nuance, or (hopefully not) deliberate disingenuousness."
Either the patient donations proposal or the Disney World trip, taken alone, causes one pause. Taken together they prompt one to ask, "What else is being proposed by the folks who brought us those two great ideas, somewhere within that labyrinth of offices and hallways that is the UIHC, that we don't yet know about?"
For example, on October 19 I wrote:
Here we are, confronting a budget crisis. The Board of Regents has put a freeze on hiring, voted for a halt to construction (until they voted against it), is considering a mid-year tuition increase, layoffs, cuts in salaries and benefits, has at least nodded in the direction of fairness in all of this, and what does the UIHC do?
Morelli reports that it, "filled a newly created position of chief medical information officer last week -- the same day university officials were instructed to consider temporary and permanent layoffs and a tuition surcharge" (an emphasis in the Register's story and headline that doesn't appear in the Press-Citizen's version).
And why is this position necessary? Because it accompanies a $61 million investment in a new computer system -- an amount that exceeds the cuts being asked of all the Regents' institutions combined.
After reciting the UI's creation of four senior administrative positions and three new vice presidents, Iowa Representative Jeff Kaufmann, R-Wilton, expressed the same kind of concern about the "chief medical information officer" position as other legislators expressed about the patient donations and the Disney World trip: "I can't believe they've gone this long and they are adding it into a half-time position -- and that couldn't wait? Even if it is $45,000, I don't care if it is $5,000, it sends a message to people at the bottom of the organization. I just don't understand it right now."
A comment put up on that blog entry of mine, by "Anonymous," reads as follows:
UIHC administration decided to spend 60 million (probably more) to install a new buggy pathetic software system. It takes 18 clicks to write a prescription, which is often wrong.
The system -- EPIC -- was abandoned in a Calif hospital when after $160 million, the system determined it would take ONE BILLION $$ to make it work.
This system has been determined to increase morbidity and mortality, while adding huge costs.
Any other story is denial...and it is criminal that leadership and the press do not tell the honest truth on this one.
Obviously, I can't possibly know if these assertions are true, and I don't represent that they are. But what seem (to me) really serious errors of judgment over the past two weeks make it seem more worthwhile for some reporter to track this story down. And see the blog entry on which this comment appeared, Nicholas Johnson, "UI Budget: Waivers Waive Goodbye to Savings," October 19, 2009.
If I'm reading the auditors' report correctly, in 2006 (the latest report I could quickly find) the UIHC controled over $1 billion in assets (p. 9), had gross patient charges of $1.4 billion (p. 26), and investments (as in stocks and bonds) of nearly half of $1 billion (p. 16). KPMG Independent Auditors' Report, UIHC Financial Statements, June 30, 2006 and 2005.
When you compare numbers like that with, say, the UI's appropriation for the teaching of German (a program now abolished entirely, I believe) it makes the cuts being asked of the UIHC look pretty small -- though I doubt they look that way to those taking cuts in pay -- and the costs of the Orlando trip not even the equivalent of that for executives' coffee. B.A. Morelli, "UIHC must cut $17M from budget,"Iowa City Press-Citizen, November 5, 2009.
But that fact only makes more troublesome, not less, the $60 million acquisition, the new positions, the Disney World trip (and the proposal to exact donations from patients).
The Iowa Legislature, and the people of this state, simply must have confidence in the quality, common sense, and ethics, of those responsible for the decisions affecting this multi-billion-dollar medical operation for which all Iowans are rightfully appreciative and proud. _______________ * Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
There will be time enough in future blog entries to reflect upon the impoverished UIHC "leaders and staff," with their need to shake down patients for "voluntary" contributions to help make up for a $17 million shortfall, now heading off to an Orlando resort to think about it [B.A. Morelli, "Politician questions UI Orlando trip; Officials say Disney Institute the best around,"Iowa City Press-Citizen, November 6, 2009, p. A1], but meanwhile, this morning . . .
President Lyndon Johnson used to have a teletype in the oval office, so he could know about the latest AP news bulletins just as soon as they were "on the wire." My modern day equivalent is an iPhone with the AP "app," and a laptop, or desktop, with instant access to the New York Times and local papers' online editions.
As it happened I used the latter yesterday afternoon and saw the story that the Times said was then only one minute old: the shooting at Ft. Hood near Killeen, not that far north of my old stomping ground in Austin. This morning it's reported as Robert D. McFadden, "Army Doctor Held in Fort Hood Rampage,"New York Times, November 6, 2009, p. A1. During the night the story took up nearly one-half of each of the BBC's half-hour newscasts, and I suspect was reported by most of the world's major media.
But yesterday afternoon also brought me some better news that I'm going to reproduce for you in a moment.
The Times story notes that these seemingly unprovoked, mass, random killings are nothing new to America -- not that any of us needed to be informed of that fact: "The rampage recalled other mass shootings in the United States, including 13 killed at a center for immigrants in upstate New York last April, the deaths of 10 during a gunman’s rampage in Alabama in March and 32 people killed at Virginia Tech in 2007, the deadliest shooting in modern American history."
In fact, it's not the first in the Killeen area: "In 1991, Killeen was the scene of one of the worst mass killings in American history. A gunman drove his pickup truck through the window of a cafeteria, fatally shot 22 people with a handgun, then killed himself."
Look, I'm no psychiatrist -- though it appears yesterday's shooter was -- but it would seem to me that what's probably going on here is that he, what's the scientific psychiatric term? -- "snapped." So it's probably not a valid stretch to draw any "American character" conclusions from this single incident.
Still . . . we do tend to value, almost worship to the point of a mantra, the idea of "competition" -- competition on the playing field and competition in business and politics.
And while there are undoubted benefits from competition, there is also a downside, as when it leads to the conflict and verbal combat between the Democrats and Republicans in Washington. It seems pretty obvious that, at least for many of them, their single minded focus is, first, their own re-election, whatever it takes (including their taking of special interest money), and second, a "win" for their "team" (party) measured by which team has the majority, and therefore control, of the White House, Senate, and House of Representatives. And what "single minded focus" means is that if meaningful health care for the American people has to be sacrificed in the process, well, so be it. If it's necessary to handicap the domestic and international ability of the other party's president of the United States, well, that's just part of the "game."
(There is at least some speculation that an accumulation of the form of "verbal combat" we call "hate speech" may have played a role in triggering the action taken by the shooter yesterday.)
Even when the competition is in the relatively benign context of "sport," brawls occasionally break out -- regularly in hockey, occasionally in baseball -- and often among fans in the bars following the game.
Nor is it just verbal combat. We are at "war" in Afghanistan, with a vague and shifting mission (as was the case in Iraq), in a geographical area (it can't even be called "a country" in the way in which we think of that word) with challenges for which even the generals acknowledge there is no military solution. And yet we find it necessary to study for months, and debate, whether sending in even more troops will enable us to "win" (whatever that word might mean in this context). We're more comfortable with "combat," even when it is inappropriate and counterproductive, than the exploration of alternatives.
I'm not sure the case can be made that an exultation of competition leads inevitably to conflict and then to combat and finally to the kind of catastrophe that occurred at Fort Hood yesterday. But I do think there is some relationship, and I find it troubling.
We share the grief of the families of the 12 dead and 30 injured soldiers, innocent random bystanders all. And let us not forget the family and friends of the accused killer, and the other Muslims in and out of the American military who are as innocent as those who were shot, and yet may have to deal with some negative fallout from the incident.
And yet in the midst of the darkness brought on by competition, conflict, combat and catastrophe, there are those who light candles of hope as well as mourning.
There is another way.
You may be familiar with the training exercise in negotiation involving the "ugli [sic] orange." It's an effort to dramatize the difference between one's "position" and "interest" on the road to win-win solutions to conflict. There are many incarnations of the exercise. Here is one.
I don't think I can ever bring myself to believe, with Anne Frank, that "people are really good at heart." Many certainly are, but far from all, in my experience.
But what really helped me through the day yesterday was one example of the payback from "cooperation" as an alternative to competition, conflict, combat and catastrophe. It comes from, of all places, American business -- often seen as the most ruthlessly competitive institution in our society. Indeed, there are business leaders who would probably be tongue-tied if they could not draw upon sports analogies in heralding the virtues of competition.
It is an email received by a friend of mine from a Scott Westerman, a Comcast Area Vice President otherwise unknown to me, who is about to leave the position he currently occupies in order to apply for another. Here, with his permission, is the text of that email:
I got a call from a co-worker the other day. “Full disclosure,” he said. “I wanted you to know that we’re both competing for the same promotion.”
We’re friends. He said he didn’t want me to hear about it from someone else. I thought that was a classy thing to do.
Then I got a crazy idea.
“You know, both of us have strengths that could help the other during the interview process. Why don’t we prep each other so we can both can do our best?”
That sounds nuts on the surface. Why would you want to help a competitor win the job you desire? And why would anyone else who is competing with you even consider sharing his secrets?
My friend didn’t miss a beat. “That’s a terrific idea. Lets do it!”
We spent the next hour sharing nuggets from our areas of expertise, talking about how we would approach the job, sometimes debating the validity of an idea, but all the time trying to better understand the value that each of us brought to the table.
What followed was an email chain. I sent him the spreadsheets that helped me track progress, and explained sales strategies and my favorite management techniques. He sent me a blizzard of details on a section of the business where his expertise is nationally recognized.
We agreed that our joint goal was to help the company hire the best possible person for the gig and realized that, no matter how the chips fell, we would each enjoy working for the other.
I told my team members about the encounter. Some may have thought that their boss was crazy, but there was an interesting gleam in the eyes of others.
That gleam made sense to me two weeks later, when I learned that three of them were applying to succeed me in the role I was about to relinquish.
Naturally, I helped each of them prep for their first interview encounter. I know them well and shot tough questions their way, gave them feedback on their answers and tried to share the lessons I had learned in the role. It was enthralling to watch them work things through and gratifying to see that some of the ideas I had tried to teach them over our time together had taken root.
But the real surprise came later. I saw two of them heading out together at the lunch hour this week. When I asked what they were doing they said, “We’re sharing our knowledge with one another so that we can both be our best during the interview process.”
It turned out that all three of them had spontaneously agreed to help one another prepare.
Clearly, this approach only works if you’ve built a team who trust one another and are genuinely able to put the best interests of the group first. They have worked hard over time to build a unique bond. In our staff meetings, everyone pitches in to understand and assist with an individual’s challenge, even if its technically outside of their core competency. Sometimes, the best technical solutions came from our call center guy. And our marketing lead offered to off load some of the finance person’s work so that we could hit a forecast and customer communication deadline on time.
I can’t yet tell you who will get the two jobs that my buddy and I, and my three extraordinary team members are competing for. But my sense is that the likelihood of the right person being selected has gone up substantially.
Because we’re all in it together.
He got me to thinking -- about Senators John Kerry, D-Mass., Joseph Lieberman, I-Conn., and Lindsey Graham, R-S.C.,trying to fashion bi-partisan meaningful support for a climate change bill; that cluster of law students I saw who were studying together rather than competing,"Paper Chase" style; the football player I saw reach down and give an opponent a hand getting up; and those corporate executives helping each other face-to-face instead of placing knives in the backs of their "competitors."
Am I making too much of a single email? Maybe. But I don't think so. Because cooperation, working together for the benefit of all, is something that's possible every day in thousands of little as well as big ways. Whether it's the mission of our foreign and military policies, Comcast, health care reform, military units at Fort Hood and Afghanistan, politicians in Washington, or law students in Iowa City, we are, as Scott Westerman says, "all in it together." And the more often we behave as if we believed it the better off we all will be. _______________ * Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
This morning's blog entry is a reproduction of an op ed column of mine on school boundary line drawing that appears in this morning's Iowa City Press-Citizen, below.
But first, here are links to entries on some of the other hot topics from the past week or so that are now getting the most direct hits, among which may be the entries you are looking for:
The UIHC's controversial "contributions from patients" proposal."UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m. (with links to additional, related material -- and now with over 30 of the Press-Citizen readers' comments on B.A. Morelli's stories).
Asked how he felt after losing the presidency in 1952, Adlai Stevenson quipped, "It hurts too much to laugh, but I'm too old to cry."
Following the tragic farce of our school board's attempt last week to "prioritize its criteria" for school boundaries, apparently this paper's editorial board didn't hurt enough to prevent giving us a laugh Saturday ("Our View: District needs civil dialogue, not clickers" [Iowa City Press-Citizen, October 31, 2009]).
I, however, have never been too old to cry, and thought the matter too serious to laugh.
Nor am I too proud not to beg: "Board, please, please reconsider your approach."
Board flexibility
"Local control of schools" means that the board can do virtually anything with our schools not prohibited by federal or state law. It can decide to let some schools sit virtually empty while others are overcrowded.
It can push the disparity between schools' percentages of students in various socio-economic classes up to the limit of the law -- or try to make them more equal than the law requires. They can draw perfect circles around each school as its boundary, or vary them to achieve a variety of goals.
Leadership with metrics
The board simply must, however, go beyond the vague "prioritizing its top criteria," reported in Thursday's Press-Citizen [Josh O'Leary, "Board finalizes priorities; Not all members pleased with process,"Iowa City Press-Citizen, October 29, 2009], and provide metrics. This is the board's, and only the board's, legal, managerial, economic and political responsibility.
Example: Telling a committee of 30 that it should keep in mind the board's "priority of demographic considerations" is equivalent to Congress telling the FCC to regulate broadcasting "in the public interest."
Continuing with the "demographics" example, within the bounds of the law the board can choose from a range of metrics.
It should start by calculating the percentage of "free-and-reduced-lunch" students in the District-wide student population.
It could then say, to state the extremes, that it wants:
• To specify precise percentages to maximize the FRL disparity, within the limits of the law: Some elementaries with a disproportionately high percentage of FRL students, and others disproportionately low (like now).
• To use busing and boundaries to make the FRL percentages equal in all schools.
• To do it so that all schools' FRL percentage disparities are within some fixed percentage points of each other, specifically set by the board (say, 5 percent).
Abdicating leadership
But for the board to delegate its responsibility for boundaries to a committee of unelected citizens in the form of a multiple-variable set of criteria with no algorithm, made up of vague categories with no metrics, is an abdication of its responsibility, a kicking the can down the road, a recipe for chaos and frustration, and an unconscionable imposition on the time, energy, good will and financial resources of 30 dedicated local citizens and the public at large.
Ultimately, these metrics will emerge -- either because they finally have been declared by the board, or because they are evident "de facto" from the numbers that result from what it's done. That being the case, the earlier the board specifies specific numbers for, say, FRL or percentage occupancy of schools, the better.
Obviously, this is not to say that, having done so, the board should be forbidden to ever change its collective mind. Quite the contrary. New data, physical impracticability, political or economic pressures may well call for some rational modifications occasionally.
But at any given point in time, everyone simply must have specific numbers to work with -- numbers not from the administration, a consultant or committees, but from the board.
Having done its job it is then possible, if the board desires, to delegate the task of creating specific, alternative line-drawing possibilities to the superintendent, a consultant or a committee -- but not before. __________ Former Iowa City School Board member Nicholas Johnson's blog can be found at http://FromDC2Iowa.blogspot.com. _______________ * Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
Rather than killing off this idea as soon as it became buried under an avalanche of outrage, hostility and ridicule -- in my opinion, what would have been its wisest public relations strategy -- the UIHC spokespersons chose (or were instructed) to defend it as perfectly legitimate.
Unfortunately, in doing so, they chose to misrepresent (either unintentionally or deliberately) the practices of other hospitals. Not that other hospitals' practices would have justified UIHC's (a variation of the child's plea, "But Billy's mother lets him play with matches").
Do hospitals receive gifts from grateful patients? Of course. That's never been in issue. But there is a continuum in the medical ethics of how they go about it -- a continuum that finds the UIHC at the bottom of the cliff on the wrong end.
(1) The medical ethicist, quoted below, and I, believe the most ethical -- and possibly most effective and remunerative -- approach is to make community wide appeals through the media and mailings to all citizens. This could include mailings to all UI alumni, or all donors to the UI Foundation. Particularly in the Iowa City metropolitan area an enormous proportion of the population would be, in fact, present or former patients of the hospital. Those who wished to do so, and they are a significant number, will respond to such appeals. But no one is singled out as a patient.
(2) Somewhat worse is accompanying this with telemarketing. Yesterday a faculty member became increasingly agitated while relating to me the harassment of repeated phone calls during weekends and evenings, ending with the exclamation to the unrelenting pitch man that this once-very-generous UI contributor would never again give money to the University.
(3) Worse still, in my judgment (and that of the ethicist), are personal appeals to present and former patients as patients with mailings or phone calls. The delivery of health care by the UIHC is ethically distinct from the delivery of football tickets by the Athletic Department -- which also not only requests, but demands, "contributions" as a condition of granting permission to a fan to buy tickets -- not to mention getting a seat that will optimize the experience.
(4) More questionable, obviously, are person-to-person appeals to patients at any time, as they become even more coercive than a personal mailing.
(5) Personal appeals in the hospital, by hospital personnel are worst of all, for all the reasons discussed throughout this blog entry. Because patients cannot know when they may need to return to the hospital in the future for one reason or another -- and in some instances are involved in a known series of treatments requiring return visits over a period of weeks or months -- personal appeals for funds when they are leaving the hospital are only marginally, if that, any better ethically than personal appeals at check-in.
(6) Clearly what the UIHC chose to do -- requiring/requesting the patient to make information about his or her clinic visit available to the UI Foundation for purposes of future solicitations -- at the time of check-in is the worst of all possible unethical options.
What's additionally very troubling, as I noted this morning in a comment on the Press-Citizen's online version of its editorial and story, is the repeated insistence that other hospitals are doing what the UIHC was proposing to do. ("To tell reporters (as they did) that others do this, when they don't, is either sloppy investigation of details, insensitivity to ethical nuance, or (hopefully not) deliberate disingenuousness.") As The Gazette's Cindy Hadish has repeatedly reported, below, "Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place."
To equate a community-wide appeal, or a literature mailing, or a discovery that a high percentage of a hospital's donors have been, in fact, former patients, to equate that with a one-on-one discussion with a new clinic patient upon arrival, and cite it as justification for doing so, is shocking.
Nor has the UIHC yet offered an apology, or a mea culpa for this ethical embarrassment -- let alone stopped the idea cold. It's only willing to delay it a bit, to "listen" to the avalanche of concerns, to try to tweak it (presumably with the aid of public relations advisers) to make it acceptable to those with ethical sensitivity.
This sad, sad story is far from over.
_______________
Update: November 4, 2009, 6:15 a.m.; Nov. 3, Nov. 2, Nov. 1; first posted, October 31, 2009, 7:00 a.m.
"Once 'revenue is needed' is the Polestar for a university's financial decisions its moral compass begins to spin as if it was located on the North Pole."
And this afternoon Cindy Hadish, who deserves the credit for breaking this story last Friday [Oct. 30] ,below, brings us the news that, "University of Iowa patient donor plan delayed,"Gazette Online, November 3, 2009:
The University of Iowa Foundation is delaying a plan to ask patients at UI clinics for donations.
“We want to take additional time . . . to listen to suggestions for how we might improve the program . . .," Jean Robillard, UI Vice President for medical affairs, said today in a statement.
No timeline has been set for refining or resuming the process. . . .
Under the program, patients would receive a letter at registration from Robillard and a form that authorizes the UI Foundation to contact them about donating money to the hospital. Patients who do not want to receive the information in the future would have to sign a form to opt out. . . .
A national watchdog organization, Patient Privacy Rights, had voiced concern about the program.
Founder Deborah Peel said the idea sounded coercive because patients are in a vulnerable position and may feel like they can’t say no.
Several hospitals contacted by The Gazette, including the Mayo Clinic and other universities, said they did not have similar programs.
I was especially impressed with the student editorial, "UIHC Donation Plan Would Inappropriately Pressure Patients,"The Daily Iowan, November 5, 2009, p. A4 ("[it's] like a surgeon placing a tip jar in the operating room"). As I commented on the DI's Web page for the editorial, "Like the boy in The Emperor's New Clothes, our students can spot nakedness of which their adult administrators are either too blind or too frightened to speak. Good editorial."
The concern with which I am left is: If an idea like this could even flit through the mind of a hospital administrator, if having done so it was not immediately rejected, if it was reviewed, approved, and prepared for by numerous persons, and when the ethical dilemmas it poses are pointed out the response is to defend the project, if the UIHC's "moral compass is spinning" -- what other projects that the media and public have not yet heard of is the UIHC capable of creating?
Here's a rumor of one; the first choice of fund raising for the UI Foundation, for which the publicized plan was a reluctant fall-back for UIHC's administrators: doctors were to notify the Foundation of the names of their patients whom the doctors believed might be able to make substantial contributions. I can't know if it's true; but if so we can all hope that this one really has been killed rather than merely delayed.
_______________
A Check-In and a Check (brought to you by FromDC2Iowa.blogspot.com*)
As if there weren't enough pressures from hospitals and sickness insurance companies during this time of a national health care debate, as if we weren't paying enough in the ever-escalating premiums, deductibles and co-pays (for those of us lucky enough to even have insurance), none other than the University of Iowa Hospitals and Clinics (UIHC) has decided that repeatedly pressuring patients at check-in for additional money -- a "voluntary" contribution to the UI Foundation on UIHC's behalf -- is a really nifty idea.
The Gazette has once again brought us this scoop that appears nowhere else in this morning's [Oct. 31] Des Moines Register or Iowa City Press-Citizen or other papers (so far as I know).
[In fairness, this afternoon [Oct. 31] at 2:00 p.m., during the last quarter of the Iowa-Indiana game, I discover that four hours after I posted this blog entry the Press-Citizen had an online story: B.A. Morelli, "Some question soliciting UIHC patients,"Iowa City Press-Citizen, October 31, 2009, 11:13 a.m. Presumably the paper will have even more on Sunday, in its first hard copy edition to be published after this morning's Gazette. [Nov. 1, 3:00 p.m.: Here is this morning's story, B.A. Morelli, "Some question soliciting UIHC patients,"Iowa City Press-Citizen, November 1, 2009.] At this time [Oct. 31 7:00 a.m.] the Register still had no story; nor could I find anything on the Daily Iowan's online site, though this five-day-a-week-hardcopy-paper did manage to have a report of the Iowa-Indiana game at halftime. This morning [Nov. 2] the DI published, Sam Lane, "UIHC Solicitation Raises Eyebrows; UIHC to Begin Indirectly Soliciting Through the 'Philanthropy Contact Consent' Program,"The Daily Iowan, November 2, 2009, p. A4 (including some new quotes from the defenders of the project; e.g., "[UIHC] rely increasingly on private gifts . . . This program will enable patients . . . to self-identify.").]
[Morelli's [Nov. 1] story contributes some pitiful quotes from UI spokespeople. As I noted in a comment appended to his story, "I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed to the light of day UI spokespeople would actually try to defend it, whether on their own or because ordered to do so." Here are some excerpts from Morelli's Nov. 1 story:
"'It is very low key, low pressure, ethical approach,' Moore said. 'The patient will receive world class care whether they fill out the form or not.'
Susan Shullaw, a senior vice president at the foundation, said the aim of the program is to benefit medical care and research. She said it was surprising people would question the program the same week UI announced a $26 million donation from the Pappajohn family to a new facility aimed at finding medical cures.
'I find it surprising that the same week (the donation was announced) the university is also being questioned about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,' Shullaw said. 'And, that is what this is about.'"]
[Why not just admit the mistake and move on? Mistakes can happen in the health care industry, whether an amputation of the wrong leg, or . . . The Des Moines Register awards "roses & thistles" occasionally, and Sunday morning, November 1, awarded a "half thistle to Wellmark Blue Cross and Blue Shield for an incorrect phone number in a recent mailing. Seniors who called the number listed expected to hear about Medicare drug plans. Instead they got a recording that offered chats with 'nasty girls who will do anything you want for $3.99 a minute.' The insurer apologized and sent new mailings with the corrected number - but not before raising the blood pressure of the over-65 crowd." "Roses & Thistles,"Des Moines Register, November 1, 2009. There, UIHC, do you see how it's done? If Wellmark can apologize for its mistake surely you can apologize for yours. After all, you're not even asking patients to contribute $3.99 a minute.]
There are many ways to revive the declining newspaper industry. The Gazette -- one of the few remaining locally-owned newspapers in America, competing with the likes of Gannett (USA Today, 83 daily newspapers, 850 other publications) -- is succeeding, in part, by bringing back the equivalent of the newsboy on the corner shouting, "Extra! Extra! Read all about it."
After all, it was only four days ago that The Gazette was the only paper to report that (a) a grand jury was looking into the 2004 Spence labs break-in, and (b) to bring us news from inside that grand jury's legally confidential proceedings (an almost unprecedented revelation). Nicholas Johnson, "UI Spence Break-In: Gazette Scoop Illustrates Issues," October 27, 2009.
A significant amount of newspaper content is "repeating not reporting." It's from an AP wire story, a release from a corporation's public relations firm, a White House news conference, or a U.S. Senator's text message.
The Gazette is reporting. (My response to the concept of "investigative reporting" has always been, "What other kind of reporting might there be -- non-investigative reporting?")
Although UI spokesperson Tom Moore is mentioned in the Gazette's story, the sense I get is that the exchange between the reporter and Moore, on this occasion, was initiated by the reporter, not Moore.
Anonymous, uninformed sources inside the UIHC were saying there were sketchy rumors of this patient shakedown plan, but I simply dismissed them. For starters, the idea was so outrageous I couldn't believe it would even quickly flit through the imagination of any respectable hospital administrator anywhere, let alone any of those at our beloved UIHC -- or that, if thought of, it wouldn't have been immediately rejected out of hand. Moreover, I had neither a credible source to confirm or deny the rumor, nor enough details (if true) to report.
"The donor program, known as philanthropic contact consent . . . could [start at over 200 outpatient clinics] this winter, spokesman Tom Moore said. . . .
[A] medical privacy advocate [Dr. Deborah Peel, founder of Patient Privacy Rights, a national watchdog group] said the practice is coercive to patients. 'They’re in a vulnerable position, and they may feel like they can’t say no. . . . One party is sick and scared . . . and they don’t want to say "no" to the system they’re dependent on for living.' Under the program, patients will receive a letter at registration from Jean Robillard, UI vice president for medical affairs, and a form that authorizes the UI Foundation to contact them about donating money to the hospital. . . .
Peel said the better approach is a community-wide appeal, and 'the people who are grateful will want to give freely.' . . .
Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place. . . ."
The Gazette does not provide any documentation in the form of internal memos, forms or instructions for those who will be carrying out this program. But based on the rumors (which, I must say, now have a little more credibility than when they first came to my attention) I will add a couple of details.
(1) Although I don't know the form it takes, there are apparently some instructions, or training programs, for the check-in clerks -- or whatever you'd call those charged with putting the arm on the suffering patients.
And the rumor was that there was at least some awareness on the part of whoever came up with this scheme that some patients might have anxiety about whether the existence, and amount, of their potential "voluntary contribution" might affect how much longer they'd have to wait to be seen, whether they'd be seen by a doctor or a medical student, and the quality of care they'd receive. (Presumably the clerks would be instructed how to respond to such concerns; although what reassurance could possibly be effective once those concerns entered a patient's mind is hard to imagine.)
Thus, the issue is not so much whether "donations" will affect the availability or quality of UIHC's service in fact ("of course not," we're assured); it's whether patients might perceive that to be the case.
On the other hand, such patient anxieties might be warranted. There was a CBS "60 Minutes" piece last night [Nov. 1] regarding a Yakuza (Japanese Mafia) godfather moved to the head of the liver transplant list at UCLA's Medical Center because of . . . well, a very generous "voluntary contribution." Here's the text from an excerpt:
Two families, Eisenberg's clients, both lost loved ones waiting for livers at another transplant center in the same area: Salvador Ceja was number two on the waiting list; John Rader was number five.
"Do you think, for one second, that this was legitimate? That they stood in line and waited just like your husband did?" Logan asked Rader's widow Cheryl.
"Absolutely not," she replied. "No. Because nobody gets a liver that quickly."
"I think they were playing God," Yolanda Carballo, Ceja's stepdaughter, added. "Now, I think they were picking and choosing who they wanted to give a liver to."
"So, in your minds, what was this about?" Logan asked.
"Money," Rader said. "Spoke loud and clear. And they listened."
"That's what it was all about. Money," Carballo agreed. Three of Goto's Yakuza cronies also got liver transplants at UCLA. For them, money was no object. UCLA says each of their transplants cost about $400,000 dollars; the Yakuza all paid cash.
The hospital also acknowledged Goto and another Yakuza each made $100,000 donations to the transplant center.
Adelstein says Goto paid even more. "According to police documents and sources, a million dollars for Goto. A million dollars," he told Logan.
"A million dollars for one liver?" she asked.
"A million dollars for one liver," Adelstein said. . . .
Of course, I can't know if this story is true. But if not, CBS is looking at a rather formidable defamation suit.
Could cash affect UIHC care like it apparently did on this occasion at UCLA? Of course not. We're Iowans after all, not Southern Californians.
But we're talking about appearances here. And they're not good.
I don't know which is sadder: that anyone would try this unethical UIHC scheme in the first place, or that once it was exposed to daylight UI spokespeople would try to defend it, whether voluntarily or because ordered to do so. (It's one of those "which would be worse, in a way?" choices.)
(2) Hadish's story states that, "Patients who do not want to receive the information in the future have to sign a form to opt out." Obviously, her sources are much more authoritative than any rumors I've heard.
But my impression was that any patient who refused to sign the form -- granting permission for the Foundation to contact the patient repeatedly for contributions, presumably throughout the patient's lifetime (in other words, "to opt in") -- would continue to be asked at every visit whether they wished to do so.
There was to be no "form" to sign by which a patient could "opt out." The only "form" for opt-ing was the form to "opt in."
But it was not quite as bad as the lyrics of Michael Jackson's song in "The Wiz": a game in which "you can't win, you can't break even, and you can't get out of the game."
It would be possible to get out of the UIHC game, but only if the patient was willing to compose a letter, find a typewriter or computer with printer, prepare the hard copy, find an envelope and stamp, know the person and address to whom to send it, and carry it (or be pushed in their wheelchair with it) to the Post Office for mailing. (Apparently, the UIHC's new $60 million computer is incapable of receiving email.)
[The paragraph immediately above was written on Oct. 31, 7:00 a.m. At least some of those putting comments online following the Press-Citizen's story who have some pretty direct knowledge of all this seem to share my intuitive guess as to what's required. "JoeSchmoe5106" wrote on Oct. 31 at 6:13 p.m., "If the answer is 'no' they have to write a letter to the Privacy Officer. They can't just check a box and say 'no.'" And again at 7:10 p.m., "I have seen the form. Check the very bottom of the form where it says, 'If you do not want the UIHC or the UI Foundation to contact you for fundraising efforts, you must notify our Privacy Officer in writing,...' which is followed by the address."]
Fund raising is difficult -- in part because of the challenge of keeping imaginative and energetic folks within the bounds of moral and ethical decency in doing so. Heavy handed efforts usually backfire.
o The notion of locking potential donors in a room, embarrassing them, and keeping them there until a fixed amount has been pledged always seemed to me a little heavy handed.
o Iowa Public Radio and National Public Radio have started using an even more offensive approach. Listeners are urged to "turn in" friends and family members, Stasi-like, so that Ira Glass can call them on the phone, shame them, record the conversation, and then broadcast it to the nation -- a kind of entrapment into self-defamation. (And no, neither I nor anyone I know personally was subjected to this treatment.)
o Similarly, I don't think a hospital should ask individual patients, as patients, for financial contributions at any time under any circumstances. Putting aside the financial burden on patients of the charges already exacted for insurance and medical services (much of which, admittedly, is through no fault of doctors and nurses), asking them for contributions is always going to create at least some sense in a patient's mind that there may be a connection between the size of their contribution and the quality of the service they'll get. [See the reference to the Nov. 1 CBS 60 Minutes piece, above, regarding such a case at UCLA.]
On the other hand, I see no problem with accepting gifts from grateful patients who volunteer to do so without any contact from health care providers; as Dr. Deborah Peel puts it (quoted above), "the people who are grateful will want to give freely." Nor do I see a problem with including information about the UI Foundation in a literature rack along with pamphlets about diseases and healthy life choices -- so long as patients are not directed to it by employees. I see no problem with including literature sent to all UI alumni, or past UI Foundation donors (not just those who happen to be patients; even though a significant percentage of them will have been UIHC patients at one time or another), about UIHC programs and needs.
I do see a problem with fund raising appeals going to patients, as patients.
This is not the equivalent of the pay-to-play bribery exacted from citizens in Afghanistan, Iraq, and third world countries for goods and services that should be free from the state, or provided at posted prices, and I'm not asserting that it is. (In Washington, D.C., it's legal; the payments are called "campaign contributions.") But it does have a bit of that aura -- or might reasonably create it in the patient's mind.
And what is truly unconscionable, in my judgment, is to do this fund raising at a patient's time of greatest anxiety, stress -- and often pain: when they are checking in to a clinic.
Equally baffling is how and why such a proposal did not lead to the immediate firing of the person proposing it -- or at a minimum an immediate and unequivocal rejection of it by top administrators.
Presumably, what Paul Harvey used to call "the rest of the story" will gradually emerge as the other local media get on it and track down how it came to pass that one of America's greatest academic research hospitals is now as down on its luck as the unemployed Americans of the 1930s:
Bing Crosby sings the 1931 song, "Brother Can You Spare a Dime?" lyrics by Yip Harburg, music by Jay Gorney.
[Press-Citizen readers' comments below:] _______________ * Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
Note: These readers' comments are reproduced here as merely a sample of the range and consistency of at least these readers' disapproval of the UIHC's patients "voluntary" contributions program. I neither represent, nor reproduce them here (1) because they are factually "true" (because I cannot know), although they seem intuitive when factual, (2) because I share all the opinions, for I may not, or (3) because they are a scientific sampling of public opinion (obviously they are not). They do, however, represent, merely by their number (compare the number of news stories in local papers that get no online comments), and content, that what the UIHC has done in this instance has struck a nerve with at least these readers.
There is a shared, almost instinctive, reaction that what the UIHC is doing is wrong, and that it ought to have been equally obvious to those who are doing it that it is wrong. Although I have no one's approval to reproduce these comments here, because I could not find out, and do not know, who any of them are, I feel the authors have knowingly made them public, albeit anonymously. (If anyone wishes me to remove theirs from this blog entry, just let me know and I'll delete it.) -- N.J.
User Image Dave, The Elder wrote: If the group or department in charge of this planning is surprised at the response, that should say much about their knowledge of people and appearances. They are, it is perceived, taking advantage of of sick folks. They should go back to the drawing board and come up with a different plan. This one is sick.
Dave, The Elder 11/1/2009 5:03:28 AM
User Image NickIowa wrote: I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed to the light of day UI spokespeople would actually try to defend it, whether on their own or because ordered to do so.
For an analytical look at what's going on, what's wrong with it, some ethical judgments, and alternative approaches that could save this ethical and public relations disaster, see
"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.
http://fromdc2iowa.blogspot.com/2009/10/uihc-sick-brother-can-you-spare-dime.html 11/1/2009 7:06:37 AM
User Image sparkymalone wrote: Shullaw, go home. Dave and Nick are exactly right.
Why is it that every week UI gives me something new to be ashamed of? Just yesterday I was reading about the plagiaristic exploits of a tenured English prof, Kevin Kopelson, laid out last year by himself in psychologically ill memoir fashion in the London Review of Books. He's still on faculty here, still being funded to wander off to conferences and talk, presumably, about how ludicrous is academe, which shakes a stern finger at undergrads about plagiarism and then continues to employ a lifelong plagiarist like him. I suppose this is transgressive and clever, you see. No doubt Lacan has something to say about it. Makes up for filthy theft. I actually have the issue of LRB and never read the piece, mustn't have looked interesting.
Anyway, that, & employing undergrads as TAs for no money, & pushing the kids to go dig themselves deeper debt holes, and now this. I expect greed in a U, but all this is just in poor taste. 11/1/2009 9:19:45 AM
User Image sparkymalone wrote: Oh, and very nice. This from the Gazette (what's going on, P-C? Brian and the rest, are you muzzled, or just asleep?):
"Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place."
Yeah. Trust us, reporters. And patients, trust us, no one will know whether you've opened your wallet to the hospital or not. I think any such form should carry information about Shullaw's salary ($143,325) and Moore's ($70,644) along with the Gazette stories, and ask patients whether they'd like to contribute to Shullaw and Moore's future employment. 11/1/2009 9:46:13 AM
User Image tvolm wrote: The plan lacks conpassion, understanding and empathy for the sick and ill.
All I can say is it is amazing how callous people can be to the plight of others.
The University Hospital is acting like a private business, operating like a large corporation, perhaps the State should privatize the hospital? 11/1/2009 11:00:22 AM
User Image IowaCityGirl wrote: "The consent form allows the hospital to pass information to the UI Foundation, a philanthropic arm of UI, so the foundation can contact the patient with medical programs and research to which the patient might want to contribute, Moore said. The program would not disclose any diagnostic or medical information about the patient"
They may not disclose specific diagnostic or medical information, but in order to decide which programs a patient might want to cotribute to even discolsing which clinic they were in is too much information and reveals what that patient was seen for. Without some pertinent information how are they to decide where that patient might contribute? It is disgusting that they would even consider approaching a patient in any way, shape or form. If a patient has extra money and chooses to give it to the hospital they already know where it is located.
11/1/2009 11:31:27 AM
User Image IH8IC wrote: This completely negates internal training called "Service Leadership." In fact, it's plain disgusting. This from two "frontline" UIHC employees. The program is designed as an "opt-out" and the Gazette reported that patients must sign a form to refuse the information being revealed to the UI Foundation. It should be an "opt-in" at best, and perhaps would be better received if the request came along with a "patient satisfaction survey" after the healthcare was provided.
The UI Foundation has had some disgusting methods of raising money, including selling off all of the student information in credit card campaigns. This just goes to show how the UI Foundation conducts itself. It has no shame and will do whatever possible to keep its internal salaries funded.
Absolutely disgusting. If I was a patient, I would take my business elsewhere. The UIHC can't be trusted to provide the best of care when these disgusting things happen. 11/1/2009 12:11:25 PM
User Image iowahawkeye wrote: The only acceptable method would be a mailing. Shouldn't be forced to say no to someone at the hospital. By the way, UIHC has been sending "begging" letters to employees for at least the past year. Next thing UIHC will probably try is to have the atm programmed for a 5% withdrawl fee/donation. 11/1/2009 12:58:30 PM
User Image guyinic1 wrote: The next thing with their begging, UIHC will be trying to tell us they are one of the original mendicant orders of friars and nuns. IMHO, there is no place where begging should come into the UIHC patient care equation. Isn't the local, state and federal support they receive enough? Evidently not! This is another example of the University and UIHC's bureaurocratic administrations gone bizerk! If UIHC was privatized like some have suggested, they would fall flat on their face inside a week. They can only compete with the private sector because of their tax subsidies and the special treatment they receive by Medicare and other third party payors. Now they are going after individual patients trying to solicit "donations"! Geesh! 11/1/2009 1:37:02 PM
User Image rd2serfdom wrote: No wonder UI just announced a change to the employee health plan: co-pays for UIHC office visits are going down from $10 to $5, while co-pays for Mercy or another hospital (with better patient service) will go up from $15 to $20. There are other financial "penalties" for out-of-UIHC care, to "encourage patients to utilize UIHC's services". Maybe unethical practices like these are a good reason they need to incorporate these penalties to force their own employees to use UIHC? 11/1/2009 2:19:23 PM
User Image JoeSchmoe5106 wrote:
Replying to rd2serfdom:
No wonder UI just announced a change to the employee health plan: co-pays for UIHC office visits are going down from $10 to $5, while co-pays for Mercy or another hospital (with better patient service) will go up from $15 to $20. There are other financial "penalties" for out-of-UIHC care, to "encourage patients to utilize UIHC's services". Maybe unethical practices like these are a good reason they need to incorporate these penalties to force their own employees to use UIHC?
Having a lower co-pay to incentivize employees use UIHC as their preferred provider is NOT unethical. THIS plan is unethical. 11/1/2009 2:41:46 PM
User Image guyinic1 wrote: Soliciting "donations" and "gratuities" from patients and their family's is not the same as twisting the arms of University employees to use UIHC facilities. I think denying UI employees total freedom of choice in selecting their health care providers is wrong and another of the University's cheap tricks. I think that approaching any patient for money for any reason other than what is due for their care is unethical. How would any of you feel if you went to your private physician anyplace other than UIHC and your doctor or their office staff ask you for a "tip"? You'd be appalled at their audacity and I think the Board of Medical Examiners would hear about it---and act on it! What's the difference here? 11/1/2009 4:22:27 PM
User Image iowamars wrote: Kopelson hardly admits to being a life-long plagiarist. It is a handful of examples - across his entire academic career. None are pertinent to his career. Inexcusable - maybe. But hardly unusual - and have little to no bearing on his current success. As far as the plan to reduce co-pays at UIHC and increase them elsewhere - P/S and faculty are self-insured. The FRIC committee is made up of staff and faculty appointed by both governing bodies. The governing bodies are in turn elected by those they represent. The committee has to address the hyper-inflation in health care costs with limited funds. I would expect no less of them - then cutting the best deal possible to keep health care costs to employees down. Co-pays go to the provider - and offset the cost of insurance to the individual. All Mercy Hospital has to do is accept the same reimbursement rate as UIHC with a $5 co-pay -it is Mercy's decision not to do that, not the FRIC committee or UIHC.
11/1/2009 6:04:33 PM
User Image fnmct wrote:
Replying to guyinic1:
The next thing with their begging, UIHC will be trying to tell us they are one of the original mendicant orders of friars and nuns. IMHO, there is no place where begging should come into the UIHC patient care equation. Isn't the local, state and federal support they receive enough? Evidently not! This is another example of the University and UIHC's bureaurocratic administrations gone bizerk! If UIHC was privatized like some have suggested, they would fall flat on their face inside a week. They can only compete with the private sector because of their tax subsidies and the special treatment they receive by Medicare and other third party payors. Now they are going after individual patients trying to solicit "donations"! Geesh!
The only tax subsidies UIHC receives is Medicare, Medicade, and IowaCare. And they lose money on those.
11/1/2009 6:42:08 PM
User Image NickIowa wrote: Would "volunter contributions" ever affect the quality of medical service -- or, indeed, the availability of medical service at all? Of course not, we are assured.
But I'm sitting here at the moment watching a CBS "60 Minutes" piece about a Yakuza (Japanese Mafia) godfather who was moved to the head of the list for a liver transplant at the UCLA Medical Center (another leading academic medical school/hospital like UIHC) because of . . . well, a very generous "volunteer contribution."
Is the story true? How would I know? But CBS is looking at a significant defamation suit if not.
Could money help improve your medical treatment at Iowa? Of course not. We're Iowans, not southern Californians, after all.
Still, even Iowans would be well advised to avoid the risk of the appearance of that possibility. 11/1/2009 6:52:34 PM
User Image tvolm wrote: A sick solution to a sick business in a sick state in a sick nation.
All good christian greed, god bless, mr bush. 11/2/2009 8:48:52 PM
Here are some more highly edited comments from Morelli's October 31 version of the story (to which readers were continuing to attach comments on November 1):
monashaw wrote: Sounds fairly ghoulish to me. Not to mention out of touch with reality. Most patients are already too stressed about money . . .. 10/31/2009 12:25:30 PM
guyinic1 wrote: I think it is totally inappropriate for UIHC and/or the University's foundation to solicit "donations" from patients. The next thing they will be doing is putting up signs that say "Gratuities gladly accepted!" Even suggesting such a move to me indicates their desparate, juvenile way of thinking. I'll bet anyone the idea came from bureaurocratic administrators and not from the health care providers. More and more I get the idea that most if not all University administrators need to be housed together in a facility adjacent to Psych Hospital. They are bizarre to say the least! 10/31/2009 1:42:01 PM
NickIowa wrote: I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed UI spokespeople would (whether voluntarily, or in response to orders) try to defend it.
For an analytical look at what's going on, what's wrong with it, along with some value judgments, written early this morning in response to the Gazette's scoop, see
"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.
mak52245 wrote: They might as well install a toll booth at each entrance. Then they could get money from visitors and staff as well. 10/31/2009 3:12:35 PM
JoeSchmoe5106 wrote: "Susan Shullaw, a senior vice president at the foundation, said the aim of the program is to benefit medical care and research. She said it was surprising people would question the program the same week UI announced a $26 million donation from the Pappajohn family to a new facility aimed at finding medical cures...I find it surprising that the same week (the donation was announced) the university is also being questions about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,” Shullaw said. “And, that is what this is about.”
This quote proves that these people are so out of touch! How many patients are of the status of the Pappajohns? The Pappajohns are not indigent patients, unemployed Iowans, patients on their Nth round of chemotherapy owing UIHC thousands already.
Shullaw is unbelieveable. 10/31/2009 3:43:15 PM
pharma wrote: UIHC should take a look at their extraneous expenses and make appropriate cuts, instead of counting on patients to pick up the mismanagement slack at UIHC. . . .. 10/31/2009 3:58:19 PM
thetruthman wrote: Here's my donation; Get serious. Thanks for making the hospital look second rate. 10/31/2009 4:15:35 PM
Curls wrote: What lack of class.
As patients of UIHC myself and my family already receive letters requesting donations to the "patient care fund." These letters are also tacky. . . . 10/31/2009 4:27:52 PM
TWinter wrote: It would be fine if they wanted to put donation brochures in the waiting rooms or even include them in mailings, but asking medical personell to get involved is extremely tacky. I hope most doctors and nurses at the hospital would simply refuse to do this because it would be so unprofessional. 10/31/2009 5:02:13 PM
IowaCityGirl wrote: “I find it surprising that the same week (the donation was announced) the university is also being questions about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,” Shullaw said. “And, that is what this is about.” Ummmm, I am pretty sure that any grateful patient can locate the Hospital once they are fully recovered to make a donation, if they choose. They should NOT ask for them. Comparing the everyday patient to the PapaJohn family is ridiculous! 10/31/2009 5:04:26 PM
JoeSchmoe5106 wrote:
Replying to hawkigirl05: "I wish people would realize . . . If they say no, they sign a paper and they will not be contacted. . . ."
If the answer is no they have to write a letter to the Privacy Officer. They can't just check a box and say no. The simple fact is, it shouldn't be done. It's inappropriate and sick and/or confused patients shouldn't be bothered with this at the time of a clinic visit. Period. 10/31/2009 6:13:37 PM
JoeSchmoe5106 wrote:
. . . I have seen the form. Check the very bottom of the form where it says, "If you do not want the UIHC or the UI Foundation to contact you for fundraising efforts, you must notify our Privacy Officer in writing,..." which is followed by the address. It's the fine print . . .. 10/31/2009 7:10:36 PM
sparkymalone wrote: Oh, for shame. Shame on Shullaw and Moore both. This is unconscionable. To take sick people by the arm, in the hospital, and say "Come on out and say out loud you don't want to be bothered, and see what kind of care you get next"? Because that'll be how it's perceived.
Oh, I love the excuse-making, too. "Well, my mendacious friends over there do it, so it must be OK, Mom." My God. I hope they're both paid well for the ordure they have to make come out of their mouths.
Shame, shame, shame. Next we'll see one of them giving a course in medical ethics! 10/31/2009 9:50:20 PM
Lina58 wrote: Patients are in the hospital to heal and anticipate when they are well enough to go home where they feel they belong. The very LAST thing they ever need is to be asked for a monetary donation to the UIHC when they haven't even gotten a bill for the current visit there. Perhaps in the back of their mind they are wondering where they are going to get the money to pay for this visit. TOTALLY out of line and insensitive. Keep asking 'The Papajohn's" of the world for money. NOT SICK PEOPLE!!!! 11/1/2009 8:41:50 AM
IowaCityGirl wrote: They should NOT be bothered with this at all. As I previously stated...Should a gratefull patient be fortunate enough to have expendable/extra money that they wish to donate they know where the hospital is. This should not be happening. 11/1/2009 11:13:26 AM
wardedinburgh wrote: Foundation fundraising is a necessity, and has to be handled very sensitively. Soliciting donations from current patients is NOT a sensitive way to go about it.
I'm currently an Oncology Patient, with a semi-orphan form of ovarian cancer. If I had the income, and if Title 19 would cover it, I'd be going to Mayo. Each time I hit the UIHC for a visit, I feel as if I'm being trampled by a herd of clowns who are unable to navigate in their floppy shoes. The quality of care is relatively good, but the various departments seem unable to communicate with each other, or with me. Some of the problems are probably due to lack of funding for enough staff members--perhaps the executives should take paycuts so that the "grunts" who really have patient contact, and who most closely affect proper communications, can be rehired or have their numbers increased to an acceptible level. This institution doesn't have a hope of becoming a MAGNET MEDICAL CENTER until there are more support staff. 11/1/2009 3:16:37 PM
ahhah wrote: As often is the case, it is the method not the objective in dispute. It used to be you made an appt, checked in, sat down, waited for your name to be called, were seen, and if lucky went home. You felt anonymous and you felt your care was objective not subjective. It has become such an offputting process from beginning to end for both patients and employees. They should have made it a letter plus envelope handed to the patient and checked off on the computer by the receptionist with the date of delivery. Once a year after expiration date, you hand them another one. You also have them available in the racks and on the tables for those who like to read while waiting. 11/1/2009 4:01:48 PM
IowaCityGirl wrote:
Replying to ahhah: Nope...it is the objective I disagree with as well. NO health care facility should ask patients for donations, EVER. If someone has the money to donate they know where the hospital is. 11/1/2009 6:36:15 PM
User Image NickIowa wrote: Could "donations" affect the availability or quality of UIHC's service? Of course not, we're assured.
But there's a CBS "60 Minutes" piece tonight about a Yakuza (Japanese Mafia) godfather moved to the head of the liver transplant list at UCLA's Medical Center because of . . . well, a very generous "voluntary contribution."
I don't know which is sadder: that anyone would try this UIHC scheme in the first place, or that once it was exposed to daylight UI spokespeople would try to defend it, whether voluntarily or because ordered to do so.
For an analytical look at what's going on, what's wrong, value judgments, and some readers' comments from this and the Nov. 1 versions of the story, see
"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.
and bright -- does not mean that when they come together and act as a board that the results will resemble anything done by people who are caring, informed and bright. You may have seen this poster about "Meetings," with the caption: "None of us is as dumb as all of us." [Credit: Despair, Inc.] One of our nation's major gurus of governance, John Carver, puts it this way in defining boards: "boards are incompetent groups of competent individuals." Or you may have heard the definition of a camel, as "a horse built by a committee."
