Public Policy is social agreement written down as a universal guide for social action. We at The Policy ThinkShop share information so others can think and act in the best possible understanding of "The Public Interest."

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How the Great Recession Has Changed Life in America | Pew Research Center’s Social & Demographic Trends Project

As the various candidates for the office of President of the United States define themselves and throw their hat in the ring, we should probably take a good look at their position on the American workforce and the American workplace. Especially important will be how economic policy affects these two important areas of life–both the quality of life for most working families in the country and the quality of life at the community level as it relates to access to quality education and training for working families.

More via How the Great Recession Has Changed Life in America | Pew Research Center’s Social & Demographic Trends Project.

Filed under: access to education, Blogosphere, Data Trends - American Demographics and Public Opinion, Economic Recession, Economic Recovery, Family Policy, Job Sector, Mortgages, News, Policy ThinkShop Comments on other media platforms, Political Economy, Polls and pollsters, Presidential Election, Public Policy, Unemployment, Vote, WeSeeReason

Five million families and children will now sleep a little easier. How will the new Latino/Hispanic immigrant status impact healthcare policy?

Being “in the shadows” has long been a healthcare access issue.  The broken healthcare system has been aggravated by a broken immigration system. Immigration and healthcare are tied together in many ways, especially for the economically disadvantaged.

According to the New York Times:

What Is President Obama’s Immigration Plan?

President Obama announced on Thursday evening a series of executive actions to grant up to five million unauthorized immigrants protection from deportation. The president is also planning actions to direct law enforcement priorities toward criminals, allow high-skilled workers to move or change jobs more easily, and streamline visa and court procedures, among others. NOV. 20, 2014 RELATED ARTICLE

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Who could be affected?

The president’s plan is expected to affect up to five million of the nation’s unauthorized immigrant population, currently 11.4 million according to the Migration Policy Institute. It would create a new program of deferrals for approximately 3.7 undocumented parents of American citizens or legal permanent residents who have been in the country for at least five years. Deferrals would include authorization to work and would be granted for three years at a time.

It would also expand a program created by the administration in 2012 called Deferred Action for Childhood Arrivals, or DACA, which allows young people who were brought into the country as children to apply for deportation deferrals and work permits. The plan would extend eligibility to people who entered the United States as children before January 2010 (the cutoff is currently June 15, 2007). It would also increase the deferral period to three years from two years and eliminate the requirement that applicants be under 31 years old. About 1.2 million young immigrants are currently eligible, and the new plan would expand eligibility to approximately 300,000 more.

It would not provide a path to full legal status or benefits under the Affordable Care Act. Officials have said that the president’s plan will not provide specific protection for farm workers or parents of DACA-eligible immigrants.

Filed under: ACA and Medicaid, Blogosphere, Data Trends - American Demographics and Public Opinion, Family Policy, Feminization of Poverty, Health Literacy, Health Policy, Healthcare Reform, Immigration, Latinos, Maternal and Child Health, Medicaid, News, Public Health, Public Policy,

Moving resources is most often easier than moving minds: Minding our mindfulness in health behavior change.

Healthcare funders, and often healthcare leaders themselves, fail to measure and value the role of emotions in the social interactive processes they must manage to be successful in their work.   Both as responsible stewards of the public trust and as managers of people helping people, healthcare executives, philanthropists and frontline managers must master and value the role that emotions play in all forms of people helping.

Human behavior is central to every human activity.  Nowhere is this more important than in the interpersonal processes required in providing healthcare services.  Successful or efficacious human behavior (whatever one defines or measures success to be) is often dependent on mood, emotions, and psychological process that often go unnoticed.  Although emotions are hard to define, measure and see, our social interactions are often undermined by the miscommunications and misunderstandings that abound when we fail to master them.  Our lack of attention to emotional currents often capsizes our projects and goals.  Enter emotional intelligence, and our need as a society to mind our mindfulness.

Behavioral health is compromised by diseases that are addressed by our mental health and addiction services organizations.  The competencies required for administering behavioral health systems may be quite different from those required to provide and receive effective services.  Recruiting, developing and retaining behavioral health services talent is rarely central to a behavioral health plan, or even provider organizations.   Instead, like most health organizations, behavioral health organizations are most often bureaucracies that manage mortar and brick resources that sustain funding relationships, payment/reimbursement systems, and advocate for a handful of vocal community stakeholders.  The development of practice, both theory, modalities, and efficacies (workforce development) is often relegated to a subunit whose funding and leadership resources may be once removed from the daily operational priorities of the organization.  keeping the doors open may, first and foremost, require material, financial and political resources well outside of workforce considerations.  Perhaps this is the case because measuring practice efficacy and workforce competencies, though vital for direct service quality and outcomes, is not so easily measured or assessed.  Instead, funding and helping organizations (philanthropic investors, government funders, and private do gooders) rely on reports.  Outcomes (real community or service recipient impact/change, progress) and practice efficacy are rarely measured; and when they are, it is episodic, one time, or relegated to academic collaborations that are rarely formal and ongoing, much less sustainable and included in operational plans, accreditation activities, or funding considerations.  It’s no wonder, then, why most health and human service efforts fail in terms of how and who provides the services and people’s ability to take advantage of those services.

Because behavioral health challenges are principally personal and depend on the functioning of the mind, they require insightful and mindful approaches on both the part of the service recipient and the service provider.

We all at one time or another let our emotions carry us to places we thought we could never reach; and to some places and situations we never intended to be in. Emotions are an important part of our successes and failures; and that includes the emotions that drive the actions of others who impact our journey. It is hard to imagine that learning to manage our emotions and to better understand the emotions of others is not always seen as an extremely desirable thing that we can pursue in a straightforward manner. But for many it is not. The concepts that cover this important topic, “emotional literacy” and “emotional competence,” can be summarized in the operational definition of emotional intelligence as follows:

Definition of Emotional Intelligence (EQ): “… the subset of social intelligence that involves the ability to monitor one’s own and other’s feelings and emotions, to discriminate among them and to use this information to guide one’s thinking and actions. We posit that life tasks such as those described by Cantor and her colleagues and constructive thinking defined by Epstein are laden with affective information, that this affective information must be processed (perhaps differently than the cognitive information), and that individuals may differ in the skill with which they do so. Emotional intelligence is also a part of Gardner’s view of social intelligence, which he refers to as the personal intelligences. Like social intelligence, the personal intelligences (divided into inter- and intra­ personal intelligence) include knowledge about the self and about others. One aspect of the personal intelligence relates to feelings and is quite close to what we call “emotional intelligence.” John Mayer and Peter Salovey, 1990

We certainly need creativity on our side when addressing the need for innovative ideas in the area of resource investment in improving and sustaining the health of communities. Emotional Intelligence may be a more useful conception of those aspect of human intelligence needed when understanding, promoting, and/or addressing many of today’s most vexing social interaction problems. For example, finding ways for organizations to embrace, recruit, and implement human diversity; this is especially true in organizations that, of necessity, must deal with diverse communities. Philanthropic entities, government agencies, and healthcare businesses, that address social investing, healthcare planning, program development and implementation, are a good starting point.

Emotional Intelligence (also known as EQ) can be an important construct for defining, understanding, measuring, quantifying, and operationalizing the  professional competencies needed to build and implement more effective healthcare organizations.  Behavioral health is also a logical and much needed starting place.

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Taking Care of Our Healthcare System: The Physician-Patient Encounter

Health Wordle 2014 LinkedIn

Medicine is an art and it is a consequential relationship

Healthcare is largely communication, behavior and understanding.  Physicians do most of their learning working with patients and learn to share that learning to help future patients.  Healthcare learning and help happens within the patient – physician helping relationship.  People helping people is always a wonderful thing to see, but it is also difficult and fraught with some of life’s most vexing and ironic contradictions. Human life and dignity are some of life’s most precious things; yet their value, in monetary terms, is often questioned. The value of a person’s health is often underrated–even by the person themselves. For this reason, it is often difficult to understand and manage healthcare policy priorities for society in general, in terms of public spending and health policy, and for healthcare leaders, in terms of prioritizing and evaluating the components that go into building and managing the primary care process.

The relationship between healthcare services available, healthcare needs, and healthcare outcomes is not always obvious. Nowhere is this more evident than in the conversation between a physician and the person who comes to them for help. To be sure, the physician – patient encounter must remain the locus of control to ensure healthcare quality in a way that balances patient interests, outcomes and healthcare system sustainability and affordability goals. Measuring healthcare quality and patient satisfaction continues to elude most healthcare leaders and systems. Society, however, demands it. Medicine is an art and its goals, preserving and promoting a healthy life, can usually be seen as humane and priceless. Sustaining that art in the professional and public spheres is another proposition. The many variables that have to come together to make the art of medicine function in an optimal way must always be measured by the experience of the provider and the service recipient. At least in the actual healthcare encounter moment, there is a unique opportunity to define and support the quality of the craft and its product.

Creating an environment that can sustain the art of medicine is one of the few universal needs of people in any society. Of course, this easily seen and agreed to truth is always mediated by business concerns and economic considerations. How can we preserve the art of medicine and at the same time design and sustain systems that can take care of all comers as well as balancing the budget of institutions (including governments and corporations) responsible for minding the business of caring?

Medicine is about people and physicians are people too

Most people don’t want to be sick, and to be truthful, they also don’t want to pay for being sick at the expense of what they see as competing personal and family budget essentials. Much of the literature on healthcare problems and on ways of “fixing the healthcare mess” revolves around paying the healthcare bill as the initial catalyst for caring about health. It is the main reason we come to the table as individuals concerned about our family, as leaders addressing budgets or as providers concerned about our role in practicing the healthcare caring profession with real people in real places. If we are going to look at changing how people feel and think about healthcare, we better look at supporting the role of physicians as professionals meeting the expectations of patients within the institutions where they practice; and we better look at the role of publics who pay the bills to sustain those institutions.

Community healthcare outcomes are the consequence of thousands of healthcare decisions at many levels. Chronic health conditions are the largest portion of illness and disease, as the drivers of costs and as ideal mediation points for behavioral health interventions. Chronic health conditions are most often a consequence of specific lifestyle related health activities or the lack there certain activities. In the first and final instance these health problems, and their resulting costs, are caused by health behaviors and can best be moderated by changes in those behaviors. The nexus for that hopeful work is the physician – patient therapeutic and educational encounter.

Most of the serious chronic illness challenges that physicians confront on a daily basis begin and are worsened in private homes behind closed doors. The quality of the practice and the professional potential, of the individuals who embark on the education and then the profession of medicine, are both constantly mediated by the type of patients that health practitioners will see, and the environment in which they will perform the “art” of their practice. Patient mix and environmental demands can present a significant burden to physician motivation, decision making, and professional efficacy and growth. Changing the demands and burdens on physicians that are caused by both patients and payers, administrators and educators, would go a long way towards getting us back to an enjoyable and dignified relationship between persons in need and physicians that can help.

The physician – patient encounter continues to be the central nexus in our healthcare system and it is that encounter that may prove to be most fruitful when we are considering to build a more client centered system that will yield more healthy and sustainable healthy lifestyles. If we intend to keep our treatment systems humane, then we better find ways to support physician decision making and advocacy on behalf of their professional autonomy, their commitment to their professional integrity and to their own well being, and, of course, to the well being of their patients.

The physician – patient encounter can be an important nexus for improving the healthcare learning and treatment experience of healthcare consumers. But it isn’t easy and physicians will not be able to go it alone. Healthcare behavior is perhaps both the most important driver of healthcare costs and of desired healthcare outcomes. It is at once a potential liability and a moderator for escalating costs. And healthcare behavior involves all of us doing our share–both the behavior “actor” as well as all of us who seek to improve and promote healthy lifestyles, health literacy, and just all around good neighborly advice and community quality of life. The RWJ Foundation’s current push for changing local healthcare by promoting and helping to build healthier environments that sustain healthier lifestyles is a start. Physicians need to play a central role in both the continuing evolution and needed conceptualization of such an effort, and the implementation in all the settings where the physician – patient encounter will provide opportunities to teach and support patients in their pursuit of a healthier life.

There are hundreds of physician “types” and roles today, each are shaped by their specialization, their personal motivators for being in the healing and helping business in the first place, and the organizational and business systems in which they practice their craft. As these “supporting” systems change, so do physicians as they are real people with people needs. Our ability to change as sick people needing help is also important. It’s all about change, if the healthcare system changes so can you.

Understanding healthcare system change and knowing how to change to take advantage of the benefits the changing healthcare system offers

The healthcare system is changing and so is the role of the individual who touches and communicates with the person needing healthcare services. The physician – patient encounter is both preceded and surrounded by often conflicting narratives, streams of information, and variables that cause inordinate distraction and preoccupation with things outside of “What is your health problem today and what can I do about it?” Social media and the internet can both help of hinder this important learning and therapeutic relationship. The fulfilled salutary potential in this patient efficacy and health literacy regard remains to be defined and addressed. Physicians can not be all things to all people. We must be creative in evolving the practice environment to bring in roles and technologies that can help both physicians and patients in their predominantly communicative encounter.

In my three decades as a educated health professional and health consumer, and five years in health program implementation, ten years as a health and human services policy advisor, five years as a community health system administrator, I have had the pleasure of looking at the healthcare process from the perspective of just about every imaginable stakeholder. This is even more true in my past ten years, in the public relations and administration areas of behavioral health, in a large policy oversight service payer organization. I have also worked with physicians from every conceivable angle imaginable.

We have seen the role of the physician evolve through and beyond two major national efforts at healthcare reform (during the early 90s with Clinton’s HSA failure, and now with ACA). One could argue that the idyllic role of the “Norman Rockwell” physician continues to be the frame of reference for today’s modern healthcare practitioner and our demands on him/her. Given the evolution of healthcare as a commodity, today’s physician is too often an employee. S/He is certainly an individual equally preoccupied with the challenges of providing effective interventions, as S/He is faced with the plethora of obstacles and challenges surrounding the costly and increasingly evaluated physician – patient encounter today.

Some of these challenges include:

  • The uncertainty and negativity that pervades healthcare today, including preoccupation with costs, competition between the various payers and the patient “recruiting networks,” and the tension between deciding what is needed and what is affordable.
  • The management of pharmaceutical products and information, including how to use those products in the treatment process; and the role of a never ending product cycle that promises to address ever changing patient needs and symptoms.
  • The increasing pace of change in the payer and reimbursement system and the simultaneous challenge of a changing healthcare environment with evolving variables that constantly change the provider’s calculus regarding professional, personal and business risks.
  • The increasing dissemination of health information from multiple sources and the so called “empowerment” of the consumer which can erode (deservedly or not, necessary or not) physician – patient trust and control.

For these and other reasons, practicing medicine today is increasingly less of a one on one, personal experience once driven by laudable helping objectives and noble goals of doing good. Patients enter the physician – patient encounter today with personal and public media marketed fears, agendas, and competing messages in their head.

Physicians, of necessity because of today’s complex primary care process, too often enter that encounter with distractions and pressures from pharmaceutical business, the vicissitudes of insurance reimbursement, and daily business or professional pressures as physicians are also employees, partners or business owners. Today, when you are walking into the physician – patient encounter you could be dealing with a business man, an employee, or a business partner. Each of these roles can significantly mediate the behavior of both attending physician and consuming patient.

We are all in this together. At the end of the day, physicians are real people who also get sick and who ultimately will benefit from you being well. Whether that means less patients in the waiting room and patients that actually followup on the their various recommendations for better health, the important thing is that we go to our doctor’s office with an open mind and a belief that we can help our doctors help us–because we will behave in accordance with their professional advice. This brings up some general ideas regarding the patient’s responsibilities in the physician – patient encounter:

Healthcare change is happening to all of us. Improving our healthcare experience and outcomes will require all of our collective responsibilities in keeping up with the information that will allow us to address how healthcare change affects our specific healthcare needs and how we can improve our communication with our healthcare provider and how we use that communication to live healthier lives.
Just as we expect for physicians to be our advocates we must also be respectful and understanding of their needs as caring professionals performing difficult work that benefits us.
When we make purchasing or political decisions that will impact healthcare policy (whether macro social policy or institutions policies that impact our healthcare), we must always consider that our vote or our healthcare purchase includes the commitment to understanding our responsibility to be informed consumers that can help vet information regarding our needs and to hold both providers and policy makers accountable to protecting our interests and needs.
In the end, we must think of healthcare as a personal behavior issue that begins with how we live our lives and how we take care of ourselves and our loved ones.

Healthcare will always be personal but it will also weigh heavily on our politics and out budgets

After the failure of the early 90s healthcare reform (HSA) and the difficulties with today’s ACA (so called “Obamacare”), what remains is a never ending tension between “Who will pay for this?” and “How can we help people stay healthy so that they don’t incur healthcare costs beyond their economic capacity?” The current RWJ Foundation efforts to invest in transforming the healthcare experience at the community level is a good attempt at favoring the balance towards addressing the second question. Ideally, if we find appropriate answers at the local healthy living level, it will be easier to answer the first question because “Who will pay?” will be addressing a much more manageable bill.

Ask not who will help me pay for my health bill in the first instance, but always ask how will my current lifestyle affect my overall health?

Filed under: News

Gap in Diet Quality Between Wealthiest and Poorest Americans Doubles, Study Finds

Healthy food is not easy to prepare, does not have a very long shelf life, and is more expensive than cheaper canned and mass produced “food” that contains fillers and other ingredients that return adequate profits, facilitate transportation, refrigeration, and distribution.

America’s food consumption and health connection problem goes well beyond socioeconomic issues of lack of cash and proximity and access to healthy food.  Our society’s economy produces commodities and commodities are distributed based on market forces of supply and demand.  Supply and demand pressures have thus far overpowered the traditional forces on the side of promoting community health.  The loosing forces are:

  • Social do-gooders
  • Philanthropy
  • Public health officials
  • Conscientious parents
  • Suburban focused and lead prevention efforts

In short, economic forces have thus far trumped social ideas and groups aiming to undo what are basically the macro and micro consequences of food production and distribution.

Any successful efforts in this area will have to have for-profit corporations at the table with philanthropy and government officials providing public policy leadership and incentives that appeal to corporate America’s economic interests and social responsibility (good corporate citizen) commitments.

More via Gap in Diet Quality Between Wealthiest and Poorest Americans Doubles, Study Finds.

Filed under: ACA and Medicaid, Behavioral Health Outcomes, Blogosphere, Health Literacy, Health Policy, Healthcare Reform, News, Parenting, Philanthropy, Policy ThinkShop Comments on other media platforms, Public Health, Public Policy

RWJF Initiative on the Future of Nursing | The information from the experts has been published. What are you and other community stakeholders doing about it?

Are you familiar with the RWJ report titled “The Future of Nursing: Leading Change, Advancing Health” by the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Penn Medicine (University of Pennsylvania Health System)?

As we know, initiatives like the one that produced this report, as recent as 2011, come and go.  What remains is the report and what committed professional like yourself and our colleagues do with the information.

We at The Policy ThinkShop were inspired by a nurse colleague not only to pullout this report but to post a comment on our blog for your benefit.

The link to the report follows:

According to the report:

“In 2008, The Robert Wood Johnson Foundation (RWJF) approached the Institute of Medicine (IOM) to propose a partnership to assess and respond to the need to transform the nursing profession. Recognizing that the nursing profession faces several challenges in fulfilling the promise of a reformed health care system and meeting the nation’s health needs, RWJF and the IOM established a 2-year Initiative on the Future of Nursing. The cornerstone of the initiative is this committee, which was tasked with producing a report containing recommendations for an action-oriented blueprint for the future of nursing, including changes in public and institutional policies at the national, state, and local levels (Box S-1). Following the report’s release, the IOM and RWJF will host a national conference on November 30 and December 1, 2010, to begin a dialogue on how the report’s recommendations can be translated into action. The report will also serve as the basis for an extensive implementation phase to be facilitated by RWJF.”

The report explains the committee of experts charge in producing the study and report as follows:

The committee may examine and produce recommendations related to the following issues, with the goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system:

  • Reconceptualizing the role of nurses within the context of the entire workforce, the shortage, societal issues, and current and future technology;
  • Expanding nursing faculty, increasing the capacity of nursing schools, and redesigning nursing education to assure that it can produce an adequate number of well prepared nurses able to meet current and future health care demands;
  • Examining innovative solutions related to care delivery and health professional education by focusing on nursing and the delivery of nursing services; and
  • Attracting and retaining well prepared nurses in multiple care settings, including acute, ambulatory, primary care, long term care, community and public health.

“In 2008, the Robert Wood Johnson Foundation approached the Institute of Medicine (IOM) to propose a partnership between the two organizations. The resulting collaboration became the two-year Robert Wood Johnson Foundation Initiative on the Future of Nursing at the IOM. The committee was chaired by former U.S. Secretary of Health and Human Services Donna Shalala, and the goal was to look at the possibility of transforming the nursing profession to meet the challenges of a changing health care landscape. The report produced by the committee, The Future of Nursing: Leading Change, Advancing Health, makes specific and directed recommendations in the areas of nurse training, education, professional …”

More on the initiative via About | RWJF Initiative on the Future of Nursing.

Filed under: ACA and Medicaid, Blogosphere, Health Literacy, Health Policy, Healthcare Reform, Leadership, Maternal and Child Health, News, Philanthropy, Policy ThinkShop Comments on other media platforms, Public Health, Public Policy,

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