In the Broadway Musical “The Music Man”, the very charismatic, handsome and articulate Professor Harold Hill (a traveling salesman) lands in River City Indiana for the purpose of selling to the community musical  instruments and uniforms for a Boy’s Band. In order for him to succeed, however, [...]]]> Reflecting upon the Obama Presidency, haven’t we seen this play before?

In the Broadway Musical “The Music Man”, the very charismatic, handsome and articulate Professor Harold Hill (a traveling salesman) lands in River City Indiana for the purpose of selling to the community musical  instruments and uniforms for a Boy’s Band. In order for him to succeed, however, Professor Hill first had to create a need by way of a small crisis for which a boys band would be the perfect solution. Hill focuses on the fear of corruption and debauchery of boys that would certainly result from a pool table being installed at the local town billiard parlor.

“Oh, we’ve got trouble, right here in River City, with a capital T that rhymes with P that stands for Pool”.  Sure enough Professor Hill successfully creates a non-problem which his boys band would cure.  The only challenge was that he wasn’t a “Professor” and couldn’t read a note of music. Instead he taught the “Think Method”, hum the Minuet in G over and over again, and you’ll be able to play it on any instrument, as if by magic; that is he sold hope.

Indeed, Mr. Obama is the perfect Harold Hill,  proclaimed by many to be the smartest we’ve seen, even a  Constitutional scholar, but wait a minute, is it true or is he just another traveling salesman?  My layman’s reading the Supreme Court transcripts on the Affordable Care Act sounds to be the real life analog to “playing the minuet in G by the Think Method”.  Despite very knowledgeable and sophisticated discussion by well meaning individuals over three days, the Affordable Care Act it still sounds like noise; it is confusing, contradictory, incomplete, complicated, wasteful, and un-affordable.  This is Obama’s cure for a problem he does not understand.

So just where do the skills, knowledge an expertise of Barack Obama differ from those of Professor Harold Hill? How is Obama’s strategy of “Hope” different from playing a musical instrument by the Think Method?  On what evidence do we believe future outcomes can possibly be any different than what we’ve seen?

Finally this little gem from The Music Man courtesy of my brother.  Professor Hill as asked by his friend: “Are you still selling steam automobiles?”, to which Hill replies: “No, someone actually invented one”.

Tom

Seeing Informatics Nurse positions requiring specific vendor experience such as Meditech, Cerner or Epic, leads me to believe that hospitals continue to poorly understand the role of information in their business. Vendor specific experience or [...]]]> “The purpose of information is to affect the efficiency of achieving outcomes”
The Character of Information, Curtiss Priest, Ph.D.

Seeing Informatics Nurse positions requiring specific vendor experience such as Meditech, Cerner or Epic, leads me to believe that hospitals continue to poorly understand the role of information in their business. Vendor specific experience or certification requirements help underweight the technology investment while sadly missing the point of the investment in the first place.

Clinical Informatics it is about delivering clinical information to decision makers that is accurate, relevant, timely and trustworthy in a way that can be consumed by a human, a point we often overlook. Technical expertise in one vendors system or another, makes it easier for hospitals to deploy a foreign system into a unique organization, but that’s looking at the problem from the wrong perspective, it should be the other way around.

By my 15 years of experience any vendor will work just fine, it really doesn’t matter to me, still before you require vendor specific tactical skills, perhaps you should be asking why that’s necessary?  Do you suppose Yo Yo Ma, can only play one specific manufacturer of Cello? Have you heard of a pianist who could only play a Steinway, but not a Yamaha? How about a Radiology Technician who can only work with Philips X-Ray equipment?

Perhaps we need to be a bit more demanding of the vendor as well as the Nursing Informatics; to begin with we need the information to do work, and not just create work.  This means an understanding of clinical heuristics, business rules and design that fits digital technology into the analog world of clinical medicine. This also means a deep enough knowledge of technology to know when what you’re hearing is less than truthful.

Tom

Soon the [...]]]> Two college professors are traveling the West Coast on a train; one is a “man of letters” a professor of English literature, the other a scientist, a professor of Physical Chemistry.  After a few hours discussing respective tenure tracks, conversations dwindled as they read and gazed out the window to the passing scenery.

Soon the professor of English Literature looked out to see a herd of sheep grazing in the distance “look” he says to his colleague “those sheep have been shorn”; the professor of physical chemistry looks out the very same window, at the very same herd of sheep and says “well at least half of them anyway”.

What did the English professor see that the Chemistry professor did not?

At a distance images tend to appear two dimensional, it’s difficult to appreciate depth and based upon the available evidence the scientist was not willing to presume that the sheep were shorn circumferentially, whereas the professor of English applied no such constraint.

How refreshing and rare the discipline to objectively report only that which is seen.

Tom

In this article by the Journal of the American Medical Association on Risk Prediction Models for Hospital Readmission the authors looked at a large group of studies and tested for their predictive statistical significance [...]]]> Being exceptionally fond of statistics, and even more so, aware of their limitations, I’m often delighted with when those limitations are discovered.

In this article by the Journal of the American Medical Association on Risk Prediction Models for Hospital Readmission the authors looked at a large group of studies and tested for their predictive statistical significance with interesting results.

This remains yet another indication of our limitations in treating “populations” rather than patients.  Despite how exquisitely educated we may be or think we are, the incredible complexity of human biology and spirit requires that humility be practiced, as well as science.

First, the demand for RN’s will continue to grow at an average 2.2% per year, with supply of RN’s short of demand through 2018.  Given that the mean age of all nurses [...]]]> I’ve come across comments on various nursing websites highlighting difficulties for new grads finding jobs and thought some economic perspective might be helpful.

First, the demand for RN’s will continue to grow at an average 2.2% per year, with supply of RN’s short of demand through 2018.  Given that the mean age of all nurses is in the low 50′s, while baby-boomers are just now hitting the retirement age at the rate of 10,000 people per day, the gap between RN’s willing to work and the demand for their services will continue to diverge, i.e. stay healthy, you may be on your own. For certain, how RN’s are treated today can dictate how profitable institutions will be five years from now.

What you may not know is that nursing is part of what Jacob Mincer, Labor Economist of the 1950′s identified as part of the “secondary labor force”. This labor force, according to Mincer, tends to provide secondary income to the household where there is another income producer providing the largest income.  Nursing, being part of the secondary labor force, tends to run countercyclical to the general economy.  When things are good, the secondary labor force is relatively quiet, nurses work less hours or perhaps not at all, while asserting muted demands for attracting their highest marginal wage. When the economy slows down resulting in lay-off’s of primary income producers, the secondary labor market becomes more robust. People return to the labor force, work longer hours, and begin seeking higher wages.

This latter response to a downturn in the economy can produce an illusion that shortages have gone away, when it certainly has not, that is, it’s a head fake.  A second wave problem happens when employers of nursing services fail to recognize the fragility of their current situation.  This secondary labor force can quickly return to lower participation rates as soon as household income needs are met, and do so much faster than any hospital can possibly hope to manage.  The second wave effect includes students who also misread the market and choosing not to pursue nursing fearing an absence of work when they are finished. Times like these present a tremendous opportunity for hospitals and healthcare organizations, or can set them up for future disasters if they handle these times poorly.

This is a time for healthcare organizations to be as accommodating and supportive as they can be in attracting new and experienced talent. Hospitals can gain a ton of good will, as well as an exceptionally deep and loyal bench of RN talent for the future, if they take advantage of these times and build solid relationships with returning RN’s as well as warmly embracing new grads. Failure to engage nurses now will result in profound shortages and an explosion of expense in the future, and there is absolutely nothing a hospital will be able to do to reverse the damage.

Questions?

Tom

What if you give me money [...]]]> If I steal from you it’s theft, but what if I purchase lots of stuff on your credit card for which I expect you pay, is that any different?  Oh I know, it’s for a good cause, still if I do not have your permission is it still OK?

What if you give me money that you can deduct from your income tax, and later I arrange for you to receive money and it happens to be very much the same amount, does that sound right?

This spending bill stinks.