AFSP Out of the Darkness Overnight Walk is June 26-27, 2010 in Boston, MA

The 2010 the Out of the Darkness Overnight will take place on June 26-27 in Boston, Massachusetts.

The goal of this journey, which will begin at dusk and finish at dawn, is to raise funds for suicide prevention. I would like to help end the silence and erase the stigma surrounding suicide and its causes, encourage those suffering from mental illness to seek treatment, and show support for the families and friends of the 30,000 Americans who die by suicide each year. Suicide is the third leading cause of death among teens and young adults and the second leading cause of death for college students.

I will post more very soon about what I am doing and how you can join me.

Please consider helping to save lives, reach out to those families who are devastated from losing a loved one to suicide and help create an outlet to help end the silence.

Registration opens in December here.

Some facts about suicide from the World Health Organization (WHO)

•In the year 2000, approximately one million people died from suicide: a "global" mortality rate of 16 per 100,000, or one death every 40 seconds.

•In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide.

•Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020.

•Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries.

•Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex socio-cultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (e.g. loss of a loved one, employment, honor).
- WHO

Unfortunately the list goes on. To learn more you can visit the AFSP website here.

Why 'to settle' can lead to harm

If something seems impossible, is it really? Or is it just hard to imagine?

Ten years ago the Institute of Medicine released To Err Is Human: Building a Safer Health System, the influential report that shared with the world that in the United States each year there are up to 98,000 deaths due to medical error. For example, 7% of patients suffer an error in medication – many of these life-threatening. In addition to causing unacceptable human suffering and loss of life, these errors may result in upwards of $50 billion in total costs. Other important reports followed, including Crossing the Quality Chasm: A New Health System for the 21st Century. The reports seemed to successfully end a period of denial, bringing a variety of stakeholders together. It was an awakening, not only validating those who had been speaking out for so long about quality and patient safety, but also spawning a movement that called upon and motivated improvers from all over the world seeking to change the status quo.

Where do we stand today?

In May of this year, the Agency for Healthcare Research and Quality (AHRQ) published the National Healthcare Quality Report (National Healthcare Quality Report 2008">NHQR) and the National Healthcare Disparities Report (National Healthcare Disparities Report 2008 ">NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. The reports present, in chart form, the latest available findings on quality of and access to health care.

In short:

• Healthcare is suboptimal and continues to improve at a slow pace.
• Reporting of hospital quality is leading to improvement, but safety is lagging.
• Health care quality measurement is evolving, but much work remains.
• Disparities persist in health care quality and access.
• Magnitude and patterns are different within sub populations.
• Some disparities exist across multiple priority populations.

Although we are seeing some gains in improvement, we are challenged to sustain our gains and accelerate our efforts. The reports draw on lessons learned from other sectors about improvement.

Some common themes presented in the reports:

•Constancy of purpose is essential
There is no quick fix, we must remain disciplined in our approach with continued vigilance
• We must form Partnerships
Simultaneous efforts are required by multiple stakeholders
• Measurement is vital to improvement
Focus on quality, focus on results

Change begins with each of us

Earlier this year I noted that I sometimes feel like a radical or perhaps even outlandish in my thinking at times. It was only a few years ago, there were no red lines on the wall behind the beds – how could anyone providing patient care ever guess at what 30 degrees looked like? What was a Bundle? There were no months without a Ventilator Associated Pneumonia (VAP). When I reflect on it now, it feels like in some cases, we almost seemed to plan care knowing that assisted breathing was inevitably, or at least understandably, going to be accompanied by pneumonia. It was hardly imaginable that we could go months without a VAP. Now VAPs are a rare occurrence. When I was initially trained as a nurse- not my formal school-based training, but the ward/unit training which was something different altogether -I was taught that our 'rapid response' was commonly known as a Code Blue, a team of highly skilled clinicians that rushed to a patient in need of respiratory or cardiac rescue/resuscitation. Now we have rapid response teams (Medical Emergency Teams, RRTs, etc..) that rapidly bring extra needed assessment and care to patients when they first exhibit signs that may precede a dangerous decline in health.

Thankfully, things are changing here and everywhere. I find strength in the stories from the bedside of others who are committed to improving health care. I'm not sure I would have ever identified myself as a skeptic, but I can say without reservation, that when it comes to improving health care through the use of improvement science, I do believe.

Refusing to settle

So having disclosed my bias toward improvement science as the way forward, why is it that improvement continues to feel as though it is regarded as a "soft" or support activity? It continues to be an after thought as if it's not the real work of saving lives. I refuse to accept that notion. To improve is to save lives. I am proud to be labeled naïve, outlandish, emotional, passionate, an extremist, or a purist when it comes to driving defects and non-value added activity out of what we do. Standing with you all of you, who are dedicated to serving our community, I will continue to focus on and realize our mission to care for and improve the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems.

B=ƒ(P,E), is not actually a mathematical equation representing quantifiable relationships but rather a heuristic designed by psychologist Kurt Lewin. It attempts to illustrate that behavior is a function of the person and his or her environment. George Halvorson in his book Health Care Will Not Reform Itself, states "the alternative to courage and focused action is a continuation and probably a worsening of the status quo."

Many will agree that it takes acceptance, willingness, courage, caring and honesty to engage in a change effort. I believe that it also takes constancy of purpose and discipline. There are many distractions along the way and the force of the status quo and pervasive nature of the health care industry's hierarchical culture can seem impossibly strong. Many have mastered the current state and their power or position and self-image may be derived from that mastery. I believe that to seek a new order, to resist the urge to 'settle' and to stand up and lead a transformation effort, is indeed the work of the courageous. However, the first step is to change ourselves, which may be the most frightening of all. Many will retreat to the status quo. Many will settle.

I will not.

What will you do?

Public Hospitals and Health Systems: More on Contra Costa Health Services

In an attempt to share information with others about our publicly owned and operated health system- Contra Costa Health Services-, I thought I would pass along a message I received over the weekend. The following a message to our board and to all is a response from Dr. Walker about the article by Drew Voros about ours and other public systems in California. More facts about California's Public Hospitals can be found at CAPH.org.

His response is as follows:

Dear Mr. Voros,

I want to thank you for your timely column today on the role of county hospitals in health reform. I am a practicing Family Physician for Contra Costa County Health Services since 1974, County Health Officer since 1983 and Health Director as well since 1995. I have also served as the Chair of the California Association of Public Hospitals, representing the 19 county hospitals in 15 of California's largest counties where 81% of Californians reside.

Although these hospitals comprise only 6% of California's hospitals, they provide half of all hospital care for the State's 6.6 million uninsured, 30% of inpatient care for patients insured by MediCal, and over 10 million outpatient visits.

Contra Costa Regional Medical Center and its 8 Health Centers throughout the county (reaching from Richmond to Brentwood) provide over 22% of the prenatal care and births in our county and over 430,000 outpatient visits. As you acknowledge in your column, we are daily seeing more and more patients who have lost their jobs, their health insurance and, often, their houses. Many have never been to a public hospital or clinic before and are grateful to find a source of health care in these turbulent times. The county owned Contra Costa Health Plan provides care to over 70,000 members, including those who voluntarily enroll covered by MediCal, MediCare, Contra Costa County Employee Insurance, private individuals and others. We are proud that over 9000 county employees and their dependents (like me and my family) trust their health care to our highly qualified physicians, nurses and other staff
The Health Plan also manages the care of nearly 10,000 low income uninsured individuals who receive care in our system through our Basic Health Care plan. An
important asset for the entire County is our UC Davis-affiliated Family Practice
Residency program, now training 39 Family Practice Residents from the nation's best
medical schools. Many stay on to practice in our community after finishing their training.

I agree a good place to start in considering ways to provide care to the many uninsured in our country is to bolster the Public Hospital and Community Clinic resources throughout the nation. The National Association of Public Hospitals and Health Systems (I am on the Executive Committee)is working with Congress and the Administration on just such a proposal. We are especially seeking support to be able to continue to provide care to more uninsured during the next 3years prior to any implementation of Health Reform in 2013. We anticipate increased demand for our services as more people lose their jobs and health insurance. It make a lot of sense for our country to build on its existing public assets to create expanded organized systems of
health care for the many who need it.

William B. Walker, M.D.,
Director and Health Officer, Contra Costa Health Services

Public Hospitals and the Public Option

Does Contra Costa Health Services represent a "microcosm of a national single-payer health system?"

The following article was posted by the Oakland Tribune and ran in the San Jose Mercury News this week. With the permission of Drew Voros, I am posting the article it in it's entirety.

█ Voros: County hospitals already offer public option
Drew Voros, Oakland Tribune Business Editor
Posted: 11/10/2009 02:53:06 PM PST
Updated: 11/12/2009 09:00:30 AM PST

MARTINEZ — At the county hospital Thursday, they're having a talk titled, "Is it Rest in Peace for a Single Payer National Health Program?''

Considering the Contra Costa Regional Medical Center's growing popularity as a health-care option for residents, reports of the single-payer system's death on the local level are certainly premature. Taxpayer-funded medical services offered here represent a microcosm of a national single-payer system, including its being underfunded and set up to fail.

However, by making county hospitals the centerpiece of universal coverage in this country, we would prevent the need to reinvent the wheel. These facilities have become the de facto public option, so why not treat and fund them as such?

Like at county hospitals throughout the country, Contra Costa Regional Medical Center in Martinez is changing from the place of last resort for health care to the primary choice of many. Demand for its services is outstripping resources as unemployment and underemployment rise.

But even the fully employed come through the doors of county hospitals. Of the some 50 million uninsured in this country, as many as one-third of those choose to go the county-hospital route rather than pay hundreds of dollars a month in employer-subsidized health insurance such as Kaiser.

The "benefit'' of health insurance through employment really means you will get a subsidy, paid by the employer, that more and more workers shun because of the rising costs. We need to make premiums and/or co-pays cheaper for the populace if we want a successful health care system.

While Congress debates creating a public option for the health care industry to compete alongside the Kaisers and Blue Shields of the world, our elected leaders would be well served to examine how county hospitals could expand their role in achieving that goal. Clearly the facilities and personnel are in place. Missing is a system that provides adequate funding, and that's where congressional reform comes in.

Last week a majority in the House of Representatives approved a nearly $1 trillion health-care reform package. Before we waste billions of dollars establishing something new, we should utilize what we have.

Making county hospitals the headquarters for the public option in health care will not make it more or less attractive than private insurance, which of course will always be offered. What it will do is keep the most knowledgeable public health officials in charge of the public health dollars.

Standing outside the Martinez medical facility and ignoring the posted no-smoking rule, one Concord man said he didn't understand what was going on with health care in this country. While he did not disclose the reason he was there, "Bryan'' summed up the problem we face with health care in this country.

"It doesn't matter what they (Congress) do. This is where I will come for my health care because I can't afford insurance,'' he told me.

Sometimes you have to take the water to the horse.

Drew Voros is the business editor. His column runs on Wednesdays. He can be reached at avoros@bayareanewsgroup.com.
Follow him at www.twitter.com/bizeditor. █

In a previous post, I explored how systems like ours -Contra Costa Health Services (CCHS)- may already form part of the foundation of America's "Public Option."

You can find the original post here.

The new climate of change offers us the opportunity to rethink what our (government owned and operated health systems) "value" is in the nation. Are we a place where primary care plays a prominent role? Are we a perfect place to grow the primary care workforce? Are we an example of a publicly owned and operated health system that operates and co-exists in an environment with the private sector? Do we have something to offer when we move beyond the debate of "what" the national health policy will look like, to "how" we will actually reform our health systems at the local level? Questions to think about as we move into the era of reform.

More very soon
~Anna

Here is the video that I included in my original post offering a friendly hello from some of us at Contra Costa Regional Medical Center.

National Survivors of Suicide Day is Saturday, Nov. 21, 2009

Saturday November 21 2009 is the 11th annual National Survivors of Suicide Day.

A day of healing for those who have lost someone to suicide.

It was created by U.S. Senate resolution in 1999 through the efforts of Sen. Harry Reid of Nevada, who lost his father to suicide. Every year, American Foundation for Suicide Prevention (AFSP) sponsors an event to provide an opportunity for the survivor community to come together for support, healing, information and empowerment.

On National Survivors of Suicide Day, simultaneous conferences for survivors of suicide loss will take place in the cities around the world. Please visit the AFSP website to find an event near you. There are several sites in the bay area listed. Here is a link to the conference that is being held at University of California San Francisco (UCSF), Parnassus Campus.

I will bring this event up to the Healthcare Partnership and let you know of any local activities planned on our campus.

For those who don't live near a conference site or who find it difficult to attend in person, the 90-minute broadcast will also be available from your own computer on the AFSP website from 1-2:30 p.m. EST, with a live online chat immediately following the program.

So many lost, so many left behind and all preventable.

~Anna

Some facts about suicide from the World Health Organization (WHO)

•In the year 2000, approximately one million people died from suicide: a "global" mortality rate of 16 per 100,000, or one death every 40 seconds.

•In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide.

•Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020.

•Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries.

•Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex socio-cultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (e.g. loss of a loved one, employment, honor).
- WHO

Unfortunately the list goes on. To learn more you can visit the AFSP website here.

On Possibility: Why 'to settle' can lead to harm

Ten years ago the Institute of Medicine released To Err Is Human: Building a Safer Health System the seminal report that shared with the world that in the United States each year there are up to 98,000 deaths due to medical error, 7% of patients suffer a medication error and in addition to unacceptable human suffering and loss of life these errors may be up $50 billion in total costs.

The report was supported by several leaders such as Don Berwick and Lucian Leape had been talking about the defect prone system of production we call US Health Care.

Several reports followed including CROSSING THE QUALITY CHASM: A New Health System for the 21st Century.

So where are we today? Have we improved?

Earlier this year I noted...
I often feel like a radical and even outlandish at times. I look back just a few years ago. I remember when there were no red lines on the wall behind the beds. How did we know what 30 degrees looked like? What was a bundle? I remember when we didn't believe it possible to go months (even years in some cases) without a Ventilator-Associated Pneumonia. I remember when I believed the only rapid response was known as a "code blue." Why would I think otherwise? It's how I was trained.

Thankfully, things are changing here and everywhere. I find strength in the stories from the bedside of others who are committed to improving health care one test at a time.

I'm not sure I would have ever identified myself as a skeptic, but I can say without reservation that when it comes to improving health care through the use of the science of improvement and reliable design, I do believe.

So having disclosed my bias toward improvement as science and as the way forward, why is it that improvement still feels like it's regarded as a "soft" or support activity? Why does it still feel as if it's perhaps not the real work of saving lives? Why is it I still wonder if I am naive, outlandish, emotional, passionate, an extremist, or a purist when it comes to driving defects and non-value added activity out of what we do and focusing on our mission which is "To care for and improve the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems."

B=ƒ(P,E), is not actually a mathematical equation representing quantifiable relationships but rather a heuristic designed by psychologist Kurt Lewin. It states that Behavior is a function of the Person and his or her Environment .[1]

George Halvorson describes in his book Health Care Will Not Reform Itself, The alternative to courage and focused action is a continuation and probably a worsening of the status quo.
It takes acceptance, willingness, courage, caring and honesty to engage in a change effort [2]. I would add it also takes constancy of purpose and discipline. There are many distractions along the way and the force of the status quo is strong. Many have mastered the current state and their power or position is derived from that mastery. To seek a new order, to resist the urge to settle, to lead a transformation effort, is indeed the work of the courageous and the first step is to change ourselves which may be the most frightening of all. Many will retreat to the status quo. Many will settle.