Sunshine Can Be Best Disinfectant

You’ve seen the beautiful ambulatory centers, many in the wealthy suburbs. Some have lovely landscaping, envious marketing budgets and slick brochures with impressive before and after photos.

Who could blame you for thinking these surgery centers are clean and safe?

Some certainly are safe.

But not all.

Here’s just some of what surveys from the state department of health found at some New Jersey surgery centers:

• Staff members walking through sterile operating rooms in street clothes.
• Physicians and staff not having current licenses and credentials.
• Not cleaning or sanitizing surgical instruments correctly.
• Using single use items more than once, on more than one patient.

These surveys have always been public for those with time and initiative and understanding of the system. They could file Open Public Records Act, or “OPRA” requests. But that didn’t help the average consumer.

Now things have changed. For the first time sunshine is disinfecting the state’s surgery centers. This week the state Department of Health and Senior Services announced, effective immediately, that the department will be putting all inspection reports and plans of correction of licensed ambulatory centers on their website. Also on the site will be Medicare-qualified unlicensed surgery centers surveys and registration information of the unlicensed centers that haven’t been surveyed…yet.

The Quality Institute has long pushed to make these inspection reports easily accessible to consumers and we are thrilled that the state health department has scanned thousands of pages of inspections and placed them of the website. The inspections go as far back as 2008.

It’s hard to overestimate what an important step forward these postings are for patient safety.

The average consumer cannot walk into a center and tell anything is wrong. State inspectors know what to look for, and in 2009-2010 state surveys found something alarming: 49 of 91 facilities did not meet standards to participate in Medicare, and more than 25% of the facilities were cited for “Immediate Jeopardy,” which means the centers could potentially cause patients serious injury, harm or death.

I hope everyone checks out the state website before getting their tummy tucked or their knees improved or their colons scoped. The state has asked us to help them make the site more user-friendly and we are happy to do so. In the meantime, here’s the site with some navigation tips.

Go to the NJ Department of Health website
Select”Expanded and Improved Ambulatory Surgical Center Web Site”, in the “Hot Topics” box.

*Or go directly to that site with this link

Next either put in the county you’d like to search or a specific facilities name
Once you’ve found the surgery center you want to review from the search query, click on the “Survey/Inspection Information” link and view the results.

A step into a surgery center will never be the same again when you become an educated health care consumer.

Joe Vitale–Back Where He Belongs

Joe’s back at the helm.

Most anyone who follows health care in New Jersey has figured out by now that I am talking about Joe Vitale, who will soon return as Chair of the Senate Health, Human Services and Senior Citizens Committee.  No one has been more important to the issues that directly impact the delivery of health care in New Jersey than Joe Vitale. If you look behind most every initiative protecting patient safety, improving access to health care; advancing the nursing profession and advocating transparency in health care, you will find Joe. He is kind of like the “Where’s Waldo” of health care in the Garden State. Not in your face, but always there.

Joe Vitale is committed to many of the initiatives we support at the Quality Institute such as the public release of health care information. He knows sunshine is the best disinfectant. Joe is passionate about health care, and, if necessary, he will take the political hits that come his way. He will leave the room with the best idea, even if that idea came from someone else. He cares less about who gets the credit and more about who will be helped.

I have walked out in the 19th Legislative District with Joe and his connection and compassion for people is deep and abiding.

In a legislature filled with degrees – especially law degrees – Joe lists his education as follows: John F. Kennedy High School. He is, shall we say, a regular Joe. But if he lacks formal education he does not lack for common sense and that thing called “street smarts.” And I’ve always wondered if his own background makes him especially connected to the struggles of every day New Jerseyans.

None of this, or course, should be construed as a slap against Loretta Weinberg, who did a more than admirable job as chair for the past two years.

But we just can’t help but cheer the return of Joe Vitale. We look forward to our continued relationship and to our efforts to work together to make health care in New Jersey safer and more accessible than ever before.

In The End We Need Candor and Honesty

This past spring, the Quality Institute organized a seminar examining end-of-life issues in New Jersey, and our keynote speaker was Pauline Chen, the noted physician and New York Times writer who mesmerized us all with her heartfelt stories from the front lines of medicine.

At the end of the seminar, Don Sico, our public relations expert, videotaped an interview with Dr. Chen (available to members on our website) and asked her a simple question:

If you could reach a nationwide audience and say just one thing about end of life care, what would you say?

Dr. Chen was silent for a rather long and uncomfortable moment. As she thought deeply, Don began to think that he had caught her off guard and should have let her know the question ahead of time to give her time to prepare.

But what she said was something so important and so spontaneous that the awkwardness quickly disappeared. Dr. Chen said, “We owe it to those we love to be clear about our wishes for the end of our lives.” Dr. Chen offered up a simple, free, essential health care initiative to help all of us have the death we envision.

When we think of death, most of us do not envision a death in an ICU, perhaps on a respirator, surrounded by strangers and with a series of doctors coming around to prescribe futile interventions.

But in New Jersey that is exactly how many of us will die.

In New Jersey we will see more specialists, spend more days in the intensive care unit, and get more tests in the last six months of life than patients in any other state, according to the Dartmouth Atlas Study. It is a top ranking for which no other state envies us.

Yes, there is a monetary cost associated with this type of death – but the human cost is considerably higher.

Nobody wants to talk about death, and some doctors, trained to save lives, may see death as a failure of medicine and not as a natural course of life. Medicine and research continually raise our expectations of what our doctors can do to save us. What we need at the end is candor and honesty.

What are the repercussions of putting an elderly person in the last stages of Alzheimer’s Disease on a gastro-intestinal tube? Does putting a dying person on kidney dialysis change the course of an illness?

We need to ask questions and doctors need to give us honest answers..

These are emotional issues fraught with complications. I recall a friend with a life-threatening cancer, a brilliant physician. He said he wanted a bone marrow transplant that was experimental. There was no evidence that it would cure his disease. The intervention caused him great pain and, in the end, failed to save him.

But he had children and a family. He said he felt he had to try. Who wants to be the one to tell him he cannot?

Our seminar did not answer all the questions surrounding our efforts to improve end-of-life care in New Jersey. But we promoted a much-needed dialog. We agreed we need a better language to talk about death. Just what does it mean when the doctors asks, “Do you want us to do everything?” What does “everything” mean?

Hospice professionals are trained to help us through these difficult days. But in New Jersey we use hospice less than almost every other state in the nation. Perhaps we need to re-think hospice. Must hospice require a doctor to certify the patient will likely die in six months? Must we require that patients forego all curative treatments?
Perhaps some flexibility will allow more people to benefit from hospice, save us all money on futile, in-hospital care, and give more people the peaceful deaths they envision.

There are a lot of questions about end of life care … I hope we all begin asking them soon.

Welcome to KnowltonKnotes

We had a running joke in my family when our children were younger. I would return home from work and my sons would inquire about my day.

I would start to talk and my boys would stop me:

“Wait! Don’t tell us, Dad. Something new happened in health care today?”

Well, as a matter of fact something new inevitably did happen – in those days and still today. Is there a more dynamic, exasperating, challenging and exciting world than the world of health care? I live and breathe health care. I forever think about health care. My wife Diane says that the dreams that I forget about are probably about  health care.

I travel the dense forest of impenetrable health policy tomes. I debate elements of health care reform, draw up hospital quality initiatives, and harangue our elected officials to envision their own lives without health insurance.

Several times each month I will write – in this space – about what I see as I trek from Trenton to Washington and back again in pursuit of health care quality for our state and nation.  Sometimes you will get the inside scoop and learn something you did not already know. You will always get “my take.” I intend to release breaking health care news on this site. I think those who care about the world of health care will be interested, informed and, I hope, sometimes amused. If you are, tell me. Provide a comment. If you are not, tell me. Provide a comment. I want to have a dialogue with you. I expect to be just as interested in your thoughts as you are in mine.

For lengthy, carefully crafted White Papers turn to our website – www.njhcqi.org. You won’t get that here. On KnowltonKnotes, you get the first draft. You get my opinion – my cut-to-the-chase views on health care issues. Perhaps you will disagree, or decide to add your own perspective. I encourage the conversation. Social  media gives us all a chance to connect as never before, and I would like to learn about your neck of the woods.

Our organization, impartial and non-partisan, works to improve patient safety and  quality of care. We don’t work for hospitals, or government, or doctors, or nurses, or surgery centers or pharmaceutical companies. We work to make sure the voices of consumers are heard when important decisions are made. Our responsibility is to the patients who lie down on the surgery table, or unfurl their arms for injections, or take their pills – anyone who puts their trust in our medical system.

As we move forward in an ever-changing health care environment the quality institute works to give consumers a seat at the table. Sit down and join us.