Category Archives: Health care system
In the more than two years since the launch of the Future of Nursing: Campaign for Action, state-based coalitions around the country have been working to strengthen the nursing profession to improve health and health care. These Action Coalitions have identified priorities and strategies specific to their states, and forged diverse partnerships to help reach their goals.
A new series of videos on RWJF.org features leaders from some of those Action Coalitions discussing their work and successes, and some of the unique challenges and opportunities they’ve faced.
This blog post offers perspectives from seven Robert Wood Johnson Foundation Nurse Faculty Scholars who attended TEDMED 2013 last week.
Seeing things in new and different ways will advance nursing practice, research, and education. We need to think of creative strategies to raze perceived boundaries. One way for nurses to enter new frontiers is to engage in interprofessional dialogue with consumers, health care providers, researchers, entrepreneurs, technology experts, designers, and artists. We experienced this interchange at TEDMED 2013—an interprofessional conference for sharing and exploring solutions to health care’s most pressing challenges.
Collaboration is Key
Adejoke Ayoola: The opportunities to explore new advances in technology and interact with innovators remind me of an African Proverb, “If you want to go fast, go alone; if you want to go far, go together.” The outcome is more fulfilling with collaboration. By collaborating with stakeholders (e.g., community residents, community health workers, local agencies), research not only becomes more effective, it becomes more relevant to societal needs. Collaboration with my nursing colleagues promotes scholarly growth and may involve writing manuscripts or conducting smaller studies associated with a bigger study.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
What policies optimize nurses' role in solving the shortage of primary care practitioners? What approaches will promote and incentivize interprofessional education and practice in health care so as to improve the quality and safety of care? What promising state and federal initiatives are likely to achieve the Institute of Medicine's recommendation to increase the proportion of nurses who hold a baccalaureate or higher degree to 80 percent by the year 2020?
These and other crucial issues confronting nursing and the health care system are the focus of the Robert Wood Johnson Foundation (RWJF) Charting Nursing’s Future policy briefs. Launched in 2005, the series now includes 20 briefs covering a range of topics, including:
- Unlocking the potential of school nursing;
- Expanding the nation’s capacity to educate nurses through state-level partnerships;
- Improving the recruitment and retention of older and experienced nurses as a way to stem the looming nursing shortage;
- Understanding the relationships among such issues as access, cost, payment systems, and quality of care;
- Optimizing nurses’ role in closing the health care quality and safety “gap”;
- Addressing the nurse faculty shortage through public and private partnerships;
- Strengthening public health nursing;
- Driving policy change with data collected and analyzed by state nursing workforce centers;
- Easing the nursing shortage through government, school and employer collaborations; and more.
The award-winning documentary, Escape Fire: The Fight to Rescue American Healthcare, will premiere on CNN this evening at 8 p.m. EST, and again at 11 p.m. EST.
Through the real-life experiences of physicians and patients, the film “reveals flaws in the notion that the healthcare delivered via America’s patchwork of facilities, practitioners, and insurers offers good value for its outcomes,” according to a CNN news release. It shows the pressures providers face, and the frustrations of patients that are often exacerbated by insufficient care.
The film also offers features innovative solutions from noted leaders in the public and private sectors.
Following the broadcast, CNN chief medical correspondent Sanjay Gupta, MD will moderate a 30-minute discussion exploring how Americans can increase their access to health care and save money.
Carole Pratt, DDS, is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program, where she worked in the office of Senator John D. Rockefeller (D-WV). Pratt was a practicing dentist in rural southwest Virginia for 32 years. This post is part of the "Health Care in 2013" series.
The Times Square ball has dropped, crisp new calendars have been affixed to office walls, and clean new agenda pages gape at us from computer screens, signaling prudent resolution makers that it is time to get serious about 2013. February 10 will mark another New Year, the beginning of the Chinese New Year festival ushering in the Year of the Snake. Parades will be held, people around the world will celebrate, and for a time at least, inherent fear of reptiles will be set aside.
In a century-long history that is somewhat convoluted, the American medical profession has come to be represented by the winged staff and serpent symbol, the Caduceus. So during 2013, the Year of the Snake, it may be no coincidence that things are looking up for the health care profession and the health of the nation in general. In its 2013 annual ranking, U.S. News & World Report announced the top ten most attractive jobs based on factors such as opportunity for employment, salary, work-life balance, and job security. Six of the top ten spots were claimed by jobs in health care.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published more than 350 posts in 2012. On Friday, we shared five of the ten most-read posts published on this blog in 2012. Today, as we prepare to usher in a new year, we report on the top five.
Isolation in America: Does Living Alone Mean Being Alone? In this provocative piece, Eric Klinenberg, PhD, recipient of an RWJF Investigator Award in Health Policy Research, discussed his well-reviewed book, “Going Solo: The Extraordinary Rise and Surprising Appeal of Living Alone.” It looks at the health problems associated with social isolation. Klinenberg calls the increase in people living alone the country’s “biggest demographic change since the baby boom.” His post attracted the biggest audience on this blog in 2012.
Supreme Court Ruling Offers a Sense of Hope. This very personal piece by Thomas Tsang, MD, FACP, an alumnus of the RWJF Health Policy Fellows program, was the second most-read post on this blog in all of 2012. Tsang reacted to the U.S. Supreme Court ruling upholding key elements of the Affordable Care Act from the perspective of immigrant families like his own. Tsang said he hoped the ruling would allow “the country [to] start healing together and work on finding better solutions for future generations who believe that life is indeed better here in America—as my parents and I still do.”
Legal Experts Were Completely Stunned by John Roberts’ Health Care Opinion. This post by RWJF Investigator Mark Hall, JD, also addressed the U.S. Supreme Court’s health reform ruling. “We all knew it would be close, but we never saw this coming,” he blogged about the Chief Justice’s vote to uphold the highly controversial individual mandate. It was the third most-read post on the RWJF Human Capital Blog in 2012.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published more than 350 posts in 2012. Which ones were your favorites? Today and on Monday, with the year coming to an end, we’re taking a second look at the posts on this blog that attracted the most traffic this year.
A Dream Comes True: A Single Mom with Five Kids Becomes a Nurse. Christy O’Keefe, RN, made the leap from hospital administrative staff to emergency room nurse with help from the RWJF Jobs to Careers program. In the sixth most-read post published on this blog in 2012, she shares the experience, talking about overcoming doubt and what her career means to her and her family.
New Careers in Nursing: A Whole New Direction. Karen Jennings, MS, RN, PMHNP-BC, was well on her way to earning a PhD in clinical psychology. But while working at McLean Hospital, she noticed the impact nurses had on patients, providing medical knowledge and advanced clinical skills as well as comfort and security. It was then that Jennings changed course, becoming a nurse with support from New Careers in Nursing, a program of RWJF and the American Association of Colleges of Nursing. Her account was the seventh most-read post published on the RWJF Human Capital Blog in 2012.
Nursing Needs All Hands on Deck, Including the Quiet Leadership of Introverts. When Jennifer Doering, PhD, RN, joined the RWJF Nurse Faculty Scholars program, she wondered and worried about whether an introvert could be the kind of effective nurse leader that patients, the health care system and the country need. After reading and pondering, she concluded that “introverted leadership” is not a contradiction in terms. Read more in the eighth most-read post on this blog in 2012.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Sara Rosenbaum, JD, is the Harold and Jane Hirsh Professor at George Washington University, School of Public Health and Health Services, Department of Health Policy. Rosenbaum received an RWJF Investigator Award in Health Policy Research in 2000, and is on the board of the RWJF Health Policy Fellows program.
In affirming the constitutionality of the Affordable Care Act, the United States Supreme Court assured the legal survival, not just of thousands of discrete legislative provisions, but also the big ideas embedded in the Act. One of the biggest is its emphasis on strengthening the juncture between health care and health, an opportunity whose potential is only beginning to be explored. The most publicly visible aspect of this emphasis is the Act’s expansion of coverage for clinical preventive services without cost-sharing across the principal health insurance markets recognized under the Act: Medicare; employer-sponsored health plans, state regulated individual and small group markets (including the new Exchange market) and the Medicaid “benchmark plan” market that will serve newly eligible beneficiaries. (Ironically, the Act leaves out of this expanded clinical preventive coverage design the health plan market serving traditional Medicaid beneficiaries; other than a state option to expand coverage at slightly favorable federal financing rates, the law does not require expanded clinical preventive benefits for the very poorest beneficiaries. Although family planning services are a required benefit for all beneficiaries of childbearing age, services such as screening colonoscopies and adult immunizations remain optional for the traditional coverage group).
But the opportunities to bridge the health/health care divide go well beyond the important, threshold question of coverage design. The biggest opportunities are those that are intended to change the way that two of the principal players in the health care system—physicians and hospitals—envision their role in society and position themselves in communities. In the case of physicians, the Act incentivizes formation of accountable care organizations (ACOs), entities that assume responsibility not simply for health care of a defined group of patients (like any practice network) but for the health of the population they serve. ACOs are expected to move beyond improvements in the quality of clinical services they furnish and to reach into their communities through greater involvement in community health improvement activities. Similarly, the Act expands and strengthens the community benefit obligations of the nation’s nonprofit hospitals seeking federal tax-exempt status, upping their responsibilities related to community health improvement planning, and incentivizing investment in community health improvements and community building.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Andru Ziwasimon Zeller, MD, is co-founder of the Casa de Salud family medical office and the Community Coalition for Health Care Access in Albuquerque, and a 2010 RWJF Community Health Leader.
I’m a doctor and supporter of health care for all and happy that we as a nation have achieved almost universal health care. The Affordable Care Act has flaws and areas of disagreement. It was forged from 100 years of argument and compromise, bringing together liberal universal health care with conservative personal responsibility
I don’t love every detail of the law but I love that we as a nation, through the leadership of President Barack Obama, have removed a massive injustice in our society which has contributed significantly to stress, disease, death, medical debt and household bankruptcy. These have been “silent killers" since those affected tend to keep their suffering to themselves. Many of us have born witness to that suffering. I am so glad it is coming to an end.
Yet I feel the fear and anger of those in our nation who oppose this new law and see in it an assault on individual freedom, a government invasion of health care, and a grand plan to destroy what is perceived to be our founding principles.
I resonate emotionally with the first point—no one likes to be told what to do. Seat belts, car insurance, driver’s license to vote, passport to travel, taxes, and now health insurance? Why not let the hospitals eat that cost? Or drop it on the county health fund? Is this a slippery slope to dreaded socialism or an evolution towards health and personal accountability?
Facts are hard to come by. Trust is next to impossible. We are a nation of belief against belief in search of the ultimate political power to create a singular vision of the future—Republican vs. Democrat, and who knows what either of those really mean. This battle, more than anything, is the greatest threat to the vision and political prowess of our founding fathers. Democracy is conversation, compromise and decision-making for solutions that help us take care of each other and improve our place in this world.
This is our democracy in action. I give thanks that we fight the ‘war’ between liberals and conservatives with words and election ballots.
The decline of our schools, health care system, manufacturing, and prestige internationally stems from and contributes to our inability to care for each other. We are squandering our resources, fighting for control instead of forging a better society. This criticism is not about “hating” America. I’m saying that we Americans are wasting the equity that all of our forebears gave us. All of them. Native Americans and all of the immigrants who come to these shores by force, or hope for a better future. This hope and equity are not owned by any one segment of our society, they are our shared birthright as Americans.
It is time we each take a deep breath, do an internal inventory of our emotional tenor, and start to engage in perhaps stressful, but important conversations with people who have ideas that we don’t like. Passion is a beautiful thing when it can be restrained by reason and respect. Let’s embrace this challenge as a nation, hear what we each have to offer, and live better lives together.
Read more about Ziwasimon Zeller’s work, visit the Casa de Salud website, and learn about the Robert Wood Johnson Foundation Community Health Leaders.
Last summer, in anticipation of the Foundation's 40th anniversary and of her tenth year at the helm, Robert Wood Johnson Foundation (RWJF) President and CEO Risa Lavizzo-Mourey, MD, MBA, took on a challenge of a different sort. Together with her adult daughter, she joined a team climbing to the "Roof of Africa," the summit of Mount Kilimanjaro.
In her 2012 President's Message, Lavizzo-Mourey tells the tale of the trek, and recalls the advice her hiking group leader gave her:
• Measure each pace — Step. Pause. Step. Pause.
• Keep progress slow, but steady.
• Always onward. Always upward.
• Maximize progress. Minimize risk.
• Know your limits.
• Know when to stop / rest so you don’t have to stop / halt.
Lavizzo-Mourey writes, "It wasn’t until I was back on the job in Princeton that I realized these are the same basics RWJF has followed over the past four decades. That’s when it hit me: As we push our philanthropy to higher and higher levels, the one mountain that really matters is the mountain RWJF’s been trying to move all along!"
That mountain, of course, is the challenge of improving health and health care for all Americans, and RWJF has invested $9 billion in the effort over the last four decades. Lavizzo-Mourey continues:
In our practice of philanthropy, this is where the “Kilimanjaro Effect” comes into play. Step by step we progress onward. We may have to “discover the new terrain” and new ways to traverse it. It may take us a generation, or two or three, but we have the will and the means to hang in there until momentum occurs, progress is secured, and evidence confirms that the change we seek is producing positive results. If it is not—well, we have learned the hard way to know our limits, when to step, when to pause, when to stop, suspending the climb for a better route on a better day. Ours is a spirit of resilience and resolve our founder and namesake built into our philanthropic DNA from the very start.