At first, the Werners settled in Mazar i Sharif, Afghanistan’s fourth largest city, where Rob worked in tuberculosis control.  In that capacity he worked with community-based programs applying government initiatives to cure patients.  After 1 ½ years, Rob was offered a job as advisor to the manager of a women’s hospital in Kabul to oversee a grant that funded the creation of vital new programs.

Afghanistan has one of the world’s highest child and mother mortality rates, underscoring a need for improved maternal care.  At that dime one in six women would die due to complications of childbirth.  Only 13 percent of babies were delivered in hospitals or with any sort or trained medical personnel, such as midwives.  During her time in Afghanistan Lisa didn’t meet one woman who had not lost a child in her family.  One in four children would die before the age of five.  The medical priorities seem very basic to Americans familiar with modern healthcare delivery.  According to Rob, “Before we set up an oncology center, we said, we should do something about all the kids dying of diarrhea.”

Medical education is not entirely absent from Afghanistan.  For example, there is the Kabul Medical University and a few smaller schools elsewhere in the country.  The level of education they provide varies widely.  Many aspiring physicians study in Pakistan because the facilities there are better, and there are more medical resources.  Afghani nurses tend to function as patient attendants and have minimal exposure to such disciplines as pharmacology.

Although Afghanistan has been at war for decades – with the Russians in the 1980s, various warlords in the 1990s and the Taliban through 2001 – the Werners may one day return.  Their three young children are in favor of it.  In Kabul, the Werners lived in an Afghan neighborhood where most people were going about their business and daily lives.  According to Rob, “Once we got over there and got to know people we found that they are just like us – they want to raise their kids, send them to school, see them get a good education and job, marry and have kids of their own.  The majority just want to live a peaceful life.”

To listen to the full podcast, click here.

Cutler, who has spent more than 30 years in the healthcare insurance industry, recalled the ongoing national debate that began nearly 20 years over HillaryCare with the objective of how to provide universal coverage for the more than 50 million uninsured Americans.  Cutler believes that the Obama administration has chosen to focus on access and doesn’t sufficiently address affordability issues.  Healthcare industry groups recognized that the day would come when reform would be a top-line issue and that we would not be well served by just saying “no”.  Cutler says “We’ve worked hard on positioning the industry to accommodate reforms and tried to be very accommodating because getting more people covered is a laudable objective.”

As the healthcare reform bill was drafted, it soon became clear that the insurance industry would have a problem with some of the issues.  Unfortunately, according to Cutler, the politicians decided they needed an enemy and “that turned out to be us.  We continue to be vilified as an industry”, a situation that could – and should — have been avoided.  The Patient Protection and Affordable Care Act will have some unintended consequences in terms of how the legislation will affect the behavior of various stakeholders who comprise the healthcare economy – consumers, providers, insurers, regulators, etc.  It is inevitable that the insurance industry will have to raise rates if they are to comply with the healthcare law, which essentially constitutes a new tax on the American people.

Cutler cites the example of the $5 billion set aside to subsidize people in high-risk pools.  The government estimated that by this time, upwards of 500,000 individuals would be enrolled in these pools.  So far, just 8,000 people have signed up, an example of where government expectations were totally unrealistic.  Additionally, there is the issue of pre-existing conditions, which the government has characterized as an industry-abusive position, and one which relates to affordability of coverage.  According to Cutler, if people buy homeowners’ insurance only after their house catches fire, the premium obviously would be higher.

In a recent interview for the Alter+Care Inspire Podcasts, Stallard and Pankau cited a Gallup Poll that ranked 132 countries in terms of happiness.  The United States ranked 12^th, which was lower than the Scandinavian nations of Denmark and Finland and even Costa Rica.  According to Stallard and Pankau, “If you look at what’s happening, people are working longer and harder days.  We spend the bulk of our waking lives in certain kinds of relational environments – this has an enormous impact on our happiness and ability to connect with others.”

Using a number of systems, including humanist psychologist Abraham Maslow’s hierarchy of needs, Stallard and Pankau have created a list of six universal human needs that people want to experience in the workplace.  They include:

• Respect – When we are with people who are condescending, patronizing, passive-aggressive or who look down on us in some relational way, there is a negative emotional impact.  No one can thrive in that kind of environment, because humans need a basic level of respect in the workplace.

• Recognition – We rely on the interactions of people around us to recharge our internal batteries.  Authentic, positive affirmation – not false – is the most effective.  Otherwise, employees are drained of energy.

• Sense of belonging – Everyone needs people who have our backs and who are trustworthy.  These people help us live up to the values that we aspire to, support us and are with us through the ups and downs of life.

• Autonomy – This gives us the freedom and flexibility to do our work free of bureaucratic red tape and without the presence of over-controlling personalities.  Autonomy allows us to master our tasks and assists with personal growth.

• A challenging environment – When people are over challenged, they are stressed; conversely, people are bored when they are not challenged.  When work provides the right degree of challenge, people are so immersed in the task at hand that time flies and it is energizing.

• Need for meaning – People typically derive meaning from work that is consistent with a mission that is important to them.  Additionally, they find meaning in the relational connections they have in the workplace; this provides a connection with their personal life.

Leading hospitals across the country recognize the need to create connections between management, physicians, nurses, staff, patients and – importantly – their families, because it positively impacts the quality of care and medical outcomes.  A primary proponent of fostering connections in healthcare environments is Herb Pardes, M.D., a psychiatrist who is president and CEO of New York-Presbyterian Hospital and New York-Presbyterian Healthcare System.  Other hospitals that are proactively creating workplace connections are the Yale New Haven Health System and the Cleveland Clinic.  To sign up for Michael Lee Stallard’s and Jason Pankau’s newsletter and receive a free digital download of their book, click here.

To listen to Michael Lee Stallard’s and Jason Pankau’s full interview on happiness in the workplace, click here.

In concierge practices, patients pay a flat annual fee and receive an expanded suite of services that includes the ability to call the physician on his cell phone at any time, obtain same-day appointments and – most importantly – receive personal care from the primary-care doctor when hospitalized.  Dr. Donnersberger notes that the current reimbursement system pays more to the radiologist and the radiology department for a chest X-ray than for an hour-long conversation and annual physical exam of the patient in the doctor’s office.  He believes that more information can be gleaned from that extensive conversation and physical exam, and serves as the starting point for years of personalized healthcare.

Practitioners of concierge medicine tend to have smaller practices than other physicians.  While a typical primary-care physician may have 2,000 to 2,500 patients, Dr. Donnersberger and his three partners have a smaller load of between 1,200 and 1,500 individuals.  Dr. Donnersberger’s practice is a hybrid – one which accepts patients who pay the upfront flat fee as well as others who rely on their healthcare insurance for reimbursement.  Concierge medicine’s most powerful tool is its ability to control costs.  Knowledge of a patient’s medical history can save money because the physician is keenly aware of pre-existing conditions that become crucial whenever that individual is hospitalized. This in-depth knowledge also saves the healthcare system thousands of dollars of workups that otherwise would have to be performed.

The financial reform legislation currently undergoing reconciliation by a Senate-House conference committee is not a reinstatement of the 1933 Glass-Steagall Act – which separated investment and commercial banking — because banks will still be allowed to deal with securities.  Under the new law, banks will have to register derivatives with some type of formal exchange and maintain records on who is borrowing money and under what terms.  This marks a significant change from before the Great Recession, when derivatives were traded with virtually no oversight.

Downs believes that former Federal Reserve Chairman Alan Greenspan contributed to the financial crisis in two ways.  In 2001, when Greenspan was informed that there was fraud in the subprime housing market and that he should do something about it, he refused to take action because he didn’t believe in regulation.  According to Downs, “that was a terrible mistake and meant that all the horrible loans made in the subprime market could continue unchecked.”  Greenspan’s second error was to maintain low interest rates for as long as he did at a time when an enormous amount of capital was coming into the United States economy from overseas.  Because investors were avoiding the stock market, they put their money into real estate.  That drove the price of properties sky high and destroyed the concept of intelligent underwriting and evaluating the risk before approving the loan.

In a recent interview for the Alter Inspire Podcasts, Mattoon warned that most people probably don’t feel like the nation is coming out of a recession because there are few signs of job creation or easier access to credit.  One of the major concerns economists have is that this will be a double-dip “W-shaped” recession because once the bump from the $787 billion stimulus ends, there will be scant pent-up consumer demand for products and services to take the place of government spending.

One positive sign is an uptick in hiring by temporary employment agencies, which usually is considered to be a good harbinger of what future demand will be.  Another interesting theory about this particular recession in terms of jobs is the idea that companies adjusted their employee levels much more aggressively at the beginning of this cycle.  As a result, they are operating at extremely lean levels and so may hire earlier rather than later.

One problem is that there is a skills mismatch in the economy.  Many people who have lost their jobs don’t possess the right skills to find employment in growth industries such as clean energy or healthcare.  The challenge is training these individuals to bring their skills up to par.

In a recent interview for the Alter+Care Podcasts on Healthcare, Jeff Newkirk, Alter+Care Vice President, says that while wellness centers have certain similarities to health clubs, the primary difference is that all programming is medically based.  What’s more, wellness centers are an enormous driver for a hospital’s revenue.

In a typical wellness center, between 15 and 25 percent of the members have had previous exposure to the affiliated hospital – that’s a relatively low number.  Considering that the wellness center may attract 1,000 daily visitors, members become better acquainted and more comfortable with the healthcare system.  The chances are excellent that these wellness center members will then visit the hospital they have come to know when they need medical attention.

The wellness experience assures an uninterrupted continuum of care after a patient has undergone surgery, suffered an injury or been hospitalized for a medical condition to assure full recovery.

Eckenhoff is founder and president of the National Rehabilitation Hospital (NRH) in Washington, D.C.  A paraplegic since a 1963 auto accident, Eckenhoff is at the forefront of efforts to enhance the quality of care provided to patients undergoing rehabilitation.  He led the creation of the New Value Process, a loyalty program that draws inspiration from Disney’s model customer relations efforts.  By creating a culture of excellence at the NRH, Eckenhoff and his team members are cutting the average length of stay, making the rehabilitation process seamless for patients and their families and delivering optimal outcomes at discharge.

Consider this:  The average length of stay in a rehabilitation hospital has changed from as long as four months to an average of 30 days.  A lot of activity is now packed into that short time period, including three to 4 ½ hours of intensive therapy every day.  Within 24 hours of arrival, the patient’s team – including the physician, rehab nurse, physical therapist, occupational therapist, speech/language pathologist when needed, rehabilitation engineer and neuropsychologist – is in place and a discharge date established.  That is the culture of patient care he has created.

In a recent interview for the Alter+Care Podcasts on Healthcare, Edward Eckenhoff says that a patient arriving at the NRH likely will have been assured by the staff of the acute-care hospital that “everything will be fine”.  The rehabilitation hospital staff’s job is to break the reality to the patient from day one by assuring the patient that they will teach him to live with reasonable independence and functionality – especially when a spinal injury is involved.

Since opening in 1986, the NRH has grown into the NRH Medical Rehabilitation Network, which operates in 34 locations, and serves thousands of patients with disabilities ranging from spinal cord injuries to traumatic brain injury, stroke, arthritis, amputation and other neurological and orthopedic conditions.  Recognized as one of “America’s Best Hospitals” by U.S. News & World Report, the NRH has more than 1,500 staff members, including over 200 physicians.

In a recent interview for the Alter+Care Podcasts on Healthcare, Wanda Jones discusses the paradigm shift in terms of new technologies that will make obsolete the knowledge base on which healthcare systems, hospitals and physicians have made money up until now.  Every surgical specialty will use robotics, and cures for cancer will be based on technology that has arisen out of the human genome project.  The New Century Healthcare Institute is a research-and-development and educational foundation devoted to population-based planning and adaptation of the healthcare system to future conditions.

In a recent interview for the Alter+Care Podcasts on Healthcare, Dr. Sweeney noted that “A few powerful payers control a good share of our reimbursement market.”  Reimbursement issues also are luring younger physicians to work in large hospital-owned practices — where the financial risk is limited — and in lower-pressure specialties with less legal exposure and shorter work hours.  That’s bad news because it means that fewer new physicians are choosing to specialize in essential fields like general surgery, OB/GYN, ENT and neurosurgery, areas where critical shortages already exist.

To listen to Dr. Sweeney’s full interview on the challenges facing today’s and tomorrow’s physicians, please click here.