On June 13, Michael O. Leavitt, Secretary, U.S. Department of Health and Human Services, convened a leadership forum on pandemic preparedness, which brought together highly influential leaders from the business, faith, civic and health care sectors to discuss how best to help Americans become more prepared for a possible influenza pandemic. The Department is hosting this five-week blog to expand the conversation as part of an ongoing effort by the Department to help Americans become more prepared. HHS does not edit blog postings and cannot ensure that all included links are functioning. We apologize for any inconvenience.
The next evolution in quality reporting is here as outcomes data goes public.
As the number of public Web sites on hospital performance have flourished during the past couple of years, mortality data has been noticeably absent. That’s all changing. The question is: Are hospitals ready?
This month, the federal government’s Hospital Compare Web site, which posts data on how well hospitals meet performance measures, will for the first time publish 30-day mortality rates for heart attack and heart failure. Pneumonia will be added soon. Using Medicare claims data, the site will show whether a hospital’s death rate is better or worse than what is expected for a hospital’s patient population.
A recent study predicts that the nursing shortage in the United States will grow to 340,000 by 2020. And, as a story on page 60 of this issue shows, it’s not just baby boomer nurses who are leaving the workforce; first-year nursing school graduates quit at an exceptionally high rate. One way to ease the exodus is to improve work conditions. If nurse statisfaction data from Press Ganey and others is an indicator, there’s plenty of room for improvement. In a survey of more than 33,000 registered nurses in 2005, Press Ganey found that nurses’ satisfaction with work conditions and senior leadership was lower than their satisfaction with co-workers and job security. Not surprisingly, increased staffing level was cited as the top area in need of attention.
The National Labor Relations Act of 1935 (NLRA) gives private sector workers the right to join or form a labor union and to bargain collectively over wages, hours, and other working conditions. An issue before Congress is whether to change the procedures under which workers choose to join, or not to join, a union.
Under current law, the National Labor Relations Board (NLRB) conducts a secret ballot election when a petition is filed requesting one. A petition can be filed by any union, worker, or employer. Workers or a union may request an election if at least 30% of workers have signed a petition or authorization cards (i.e., cards authorizing a union to represent them). The NLRA does not require secret ballot elections. An employer may voluntarily recognize a union if a majority of workers have signed authorization cards.
Legislation introduced in the 110th Congress would, if enacted, change current union recognition procedures.
As immigrant workers nationwide battle for basic respect, a leading domestic workers’ organization released a full, unprecedented report detailing exploitative conditions and demographics of the nation’s most hidden low-wage industry. The report combines statistical analysis of data from over 500 mostly immigrant workers with personal stories of workers and employers, in a joint effort between DataCenter and Domestic Workers United. Dr. Robin D. G. Kelley’s introduction explains how the nation’s troubled history of race, gender and class inequality come shamefully together in its domestic work industry. New York University’s Immigrant Rights Clinic delivers a historical look at why the law continues to ignore household labor, perpetuating ancient views that domestic labor is not “real” work.
In 2002, Mujeres Unidas y Activas and the San Francisco Day Labor Program Women’s Collective of La Raza Centro Legal came together to analyze and to strategize to improve the household work industry. Because there is no official data available about the number of household workers or information about their work conditions in California, these membership-based and membership-led organizations of low-income immigrant Latina women, many of whom are household workers, joined with the DataCenter and the San Francisco Department of Public Health to create a participatory research project to assess the industry. Over thirty immigrant women were trained to administer the survey and together they collected two hundred and forty surveys from their peers in the San Francisco Bay Area. The hour-long surveys were conducted on buses, in parks, at Laundromats and in the homes of household workers. As the Household Worker Rights Coalition Survey (HWRC Survey) results make clear, this is a very vulnerable industry. Rampant abuses of household workers must be addressed.
As our nation becomes more diverse, so do the patient populations served by our nation’s hospitals. Few studies have explored the provision of culturally and linguistically appropriate health care in a systematic fashion across a large number of hospitals. With funding from The California Endowment, the Hospitals, Language, and Culture: A Snapshot of the Nation project is working to strengthen this understanding. Hospitals, Language, and Culture is a qualitative cross-sectional study designed to provide a snapshot of how sixty hospitals across the country are providing health care to culturally and linguistically diverse patient populations. This project sought to answer the following questions:
• What challenges do hospitals face when providing care and services to culturally and linguistically diverse populations?
• How are hospitals addressing these challenges?
• Are there promising practices that may be helpful to and can be replicated in other hospitals?
The project findings will be presented in multiple reports. This report highlights findings regarding the first two research questions.
One out of every six full-time U.S. workers earns less than 125 percent of the poverty line—under $18,865 a year for a family of three. And the share of low-wage workers is considerably higher in many of the sectors with the most job growth: retailing, hotel and food services, health care, and human services. Full-time workers in the bottom tenth of the wage distribution saw their weekly earnings decline by about 1 percent over the past six years, reversing the trend of rising wages that occurred from 1995 to 2000. For low-skilled youths, finding even a bad job has become more difficult. The problem is especially acute for young black men, with only 33 percent of black high school dropouts able to secure any type of job, and only 25 percent working full time in 2005.
Workforce development can be a promising strategy, but by itself it cannot compensate for inadequate schools, the serial disadvantages of poverty in early childhood, and a labor market that often leads only to more low-wage jobs. Workers would have a far better chance of improving their earnings if they were better educated before they entered the workforce, and if education and training were complemented by other labor market interventions such as higher minimum wages, stronger unions, and a national strategy of creating good jobs.
Medicine may be hard, but health insurance is simple. The rest of the world’s industrialized nations have already figured it out, and done so without leaving 45 million of their countrymen uninsured and 16 million or so underinsured, and without letting costs spiral into the stratosphere and severely threaten their national economies. Even better, these successes are not secret, and the mechanisms not unknown. Ask health researchers what should be done, and they will sigh and suggest something akin to what France or Germany does. Ask them what they think can be done, and their desperation to evade the opposition of the insurance industry and the pharmaceutical industry and conservatives and manufacturers and all the rest will leave them stammering out buzzwords and workarounds, regional purchasing alliances and health savings accounts. The subject’s famed complexity is a function of the forces protecting the status quo, not the issue itself.
Source: Sean Slone, State News, Vol. 50 no. 4, April 2007
Health care is the most important challenge facing state governments today, according to a recent state trends survey of state leaders by The Council of State Governments. States, spurred by the urgency of rising health care costs, aren’t waiting for Washington to take action. Many states are serving as policy laboratories for innovative plans to reduce the number of uninsured. States are also developing initiatives to encourage healthier living by addressing poor diet and tobacco use, two factors that continue to threaten overall improvements in the nation’s health over the last two decades.