With Trump's Health Care plans, due for voting today, these ETFs may see considerable movement.
**E.M. Halliday** (2001): _[Quotes from Understanding Thomas Jefferson]_: >p. 1: In June 1782... Marie-Joseph-Paul-Yves-Roche-Gilbert du Motier, Marquis de la Fayette, was an honored guest at possibly the most lavish full-dress ball... Marie-Antoinette... had ever given at Versailles... Twenty-four, Lafayette... a general in both the American and French armies... lionized in...
Whether rejoicing or mourning, millions of Americans awoke on January 21st feeling suddenly at the threshold of a new and uncertain era. However, in public safety-net emergency departments across the nation - like Harborview Medical Center in Seattle, where we work - the service of healing continued seamlessly, paying no heed to the national drama that has unfolded for the past several months. That day and into the night, there were simple moments that typify and define our work. Picking up an elderly homeless woman's shoes. Using a translator phone to ensure a Somali teenager had the right insulin dose. Jumping into action when medics arrive with a young cyclist struck on his way to work. It was comforting to lose oneself in the tide of humanity, the true cross-section of society that streams through our doors 365 days a year. Though healthcare is undergoing unprecedented evolution, our fundamental mission to serve remains steadfast. At the entrance to Harborview, there is a banner that states, in seven languages, "Harborview welcomes and respects ALL." Regardless of our political identities, physicians choose to rise above politics to carry out the principles of service that underlie our profession every day. However, we now find ourselves at a crossroads in US healthcare and politics that threatens those that rely on us most for their wellbeing. The desire to remain apolitical in our duties must not silence our collective responsibility to protect our patients. Although the new administration has viewpoints on healthcare that substantially differ from those which preceded it, the one thing that most everyone can agree on is that there is plenty of room for improvement. However, we must speak firmly and act swiftly against reactionary changes that reflect political posturing without thoughtful policy to back them up. President Trump's day one mandate to repeal the Affordable Care Act (ACA) without offering a carefully formulated plan for revision or replacement endangers our patients. It also threatens the principles of fair and accessible healthcare for all Americans - regardless of party lines. In Washington State alone, over 500,000 people have obtained insurance through the ACA, and the uninsured rate has dropped by 54% since 2010. Nationwide, there are over 20 million newly insured, mostly working-class citizens and those afflicted by pre-existing conditions over which they have no control. In the ER - often the last resort for those that are uninsured - we experience alongside our patients the tragedies that befall people without access to health care; they are heartbreaking for us to witness, let alone for our patients to live. Physicians, nurses, and other healthcare providers have important, on-the-ground perspectives that must shape these debates. We can accomplish this by advocating for a principle-based approach to improving US healthcare. The core tenants that must guide healthcare reform are simple and bipartisan, outlined in the Triple Aim of the Institute for Healthcare Improvement (IHI): improve access to healthcare, improve the quality of care, and decrease overall costs. Utilizing thoughtful observation, rigorous research and careful data analysis to solve complex problems is the hallmark of modern medicine, and we must take on the enormous task of reforming healthcare policy with this approach at the forefront. Congressional Republicans can still put forth a rational replacement that does not abandon the millions of Americans who currently depend on the ACA for health care access. If our newly elected leaders can communicate concrete ideas for how to improve access, increase quality, and decrease costs, the healthcare community should engage with them in a collective effort to make our system better. Until then, we must constantly remind ourselves that the eyes we look into on a daily basis at our hospital are not merely a backdrop. The easy thing to say is, "This is not my role," and to bury our heads in the daily tasks at hand. Our mission and principles are clear - but there is much work to be done. For us to simply hope for the best and stand by as mute stakeholders is an abrogation of our duties as healthcare workers, healers, and Americans. Anna E. Condino, MD, MPH Andrew G. Lim, MD, MS Paul W. Charlton, MD, MA Sabiha K. Barot, MD, PhD Emergency Medicine Resident Physicians Harborview Medical Center Seattle, WA -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.
The market for exchange-traded funds (ETFs) has grown dramatically over the past decade, as investors have sought greater diversification at a reduced cost. While ETFs offer plenty of upside, they are not immune to risks and costs. Investors who seek to maximize their success in the ETF market while keeping danger at bay must become familiar with these risks to ensure longevity in the market.
Robert Etheridge has been appointed by IHI E&C International Corp. (IHI E&C), a Houston-based wholly-owned subsidiary of IHI Corp., as project director for the Dominion Cove Point LNG export project effective immediately.
No one wants to toil away at a health care improvement effort only to see that progress disappear as systems and processes revert to the old way of doing things. Leading health care organizations recognize that improving care isn’t enough; having a systematic approach to sustaining improvement is equally important. To learn how to build systems that sustain improvement, the Institute for Healthcare Improvement studied health care organizations that were able to achieve standout results and then build on them — organizations such as Intermountain Healthcare in Salt Lake City; Saskatoon Health Region in Saskatchewan, Canada; and Virginia Mason Health System in Seattle. These high-performing health systems offered a key insight: To sustain change, you need a strong strategy for engaging and standardizing the work of frontline managers. From their efforts, we derived four steps on how to get started with introducing new standard work processes for point-of-care staff. 1. Choose a Pilot Unit Within the Organization Most organizations standardize work for managers by testing it on a small scale in one pilot unit. Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, describes the pilot unit as the “model cell,” a place for experimentation, learning, and modeling new methods for the rest of the system. It’s important to select this pilot unit carefully. Here are a few characteristics to look for: Stability. The candidate unit should have low staff churn — the movement of staff in and out of job roles — which makes it easier to train teams. As others have described, a focus on listening to staff and helping them understand how their work is connected to the larger organization and its purpose can increase joy in work and reduce burnout and churn. Alignment around goals. Managers in the unit should understand what’s expected of them, how their work is going to change, and why standardizing work is important to sustaining quality. (Standardizing work processes is a concept from lean management.) Management “hygiene.” Good management practices should already be in place — for example, effective budget practices and a stable staff schedule. It’s also good to look for areas with stable processes. A manager who’s running around in a chaotic environment will have trouble focusing on the changes needed to promote sustainability and implement standard work. Engagement. The unit should have a respected local champion who can build excitement for change, encourage participation, coach the team, and celebrate success. Insight Center Innovating for Value in Health Care Sponsored by Medtronic Exploring cutting edge ways to lower costs and improve quality. In addition, organizations working to sustain their improvements may find that standardized work processes are easier to introduce in service units with more-easily definable and predictable clinical processes. For example, a surgical unit, an endoscopy suite, or a radiology service might be a good initial candidate for the pilot unit, rather than a general medical unit, which sees patients with widely divergent needs. In addition to such clinical units, you might select support services that are critical to effective patient care. Efficiencies gained in human resources and housekeeping can free frontline unit managers and clinical staff to spend more time at the patient’s bedside. Some systems that we studied have focused on these support departments to introduce their pilots and build goodwill among caregivers. 2. Start with the Immediate Supervisor at the Point of Care Many leaders think “frontline manager” and turn to the administrative manager, the patient care director, or unit supervisor. But successful organizations have told us that the true frontline clinical leader is the day-to-day operations manager — often the charge nurse who supervises the nursing care given to patients in the unit. Charge nurses and others in similar roles are the leaders responsible for immediate process management before, during, and after shifts. Charge nurses and nurse managers typically lead team huddles — 10-minute all-staff meetings at the start of each shift to assign roles, identify patients in need of special attention, and anticipate issues during the shift. During the shift, charge nurses coach frontline staffers and ensure they follow standard processes, monitor care, change course when needed, and solve problems. Finally, they escalate to the next layer of management those issues encountered during the shift that are beyond their control to resolve. Organizations that manage and sustain change successfully build the changes into the standard, well-defined work processes of these frontline clinical leaders. Without such clearly defined standardized work for the day-to-day operations manager, two things happen. First, systems revert to previous behaviors and processes. Second, administrative supervisors, noting this regression, feel obligated to get involved in the routine management of the clinical unit. This kind of micromanagement often causes confusion, fear, and resentment of the change, further diminishing the likelihood that it will stick. 3. Use Early Wins to Build Momentum Once the pilot unit is established, think about what goals the unit can accomplish in the short term. For example, leaders of the improvement project — such as a quality manager working together with an administrator or nurse manager — may decide to conduct a daily huddle to monitor processes introduced through improvement initiatives, along with creating visual management boards with simple metrics for easier tracking. These processes are relatively easy to test and implement over a few weeks. Especially in the early stages, be cautious about asking pilot units to achieve complex, hard-to-achieve goals that require significant interdepartmental teamwork — like medication reconciliation or staff onboarding. Doing so may demoralize the team and even set them up for failure. Several successful organizations stressed the importance of early wins to boost staff motivation. For example, Greater Baltimore Medical Center introduces managers to its frontline management system by asking them to select one simple metric to track, which aligns with the organization’s overall strategic framework. 4. Motivate Frontline Clinical Managers by Tackling What Irks Them The key to standardizing work for managers is motivating the managers themselves. No matter how well you define roles and tasks, if managers haven’t bought into the change, the system won’t work. Managers should know that their participation in standardized work is one way to earn good performance reviews and promotions. Beyond extrinsic motivators, managers really do want clinical improvements to stick, especially those that benefit their patients. So what does it take to help them commit to the work of sustaining quality through the introduction of formalized management systems? Health system leaders told IHI that they succeeded by focusing on problems that frontline clinical managers really cared about. Virginia Mason calls these problems “rocks in your shoes” — the daily irritants that frontline managers want eliminated. Implement changes that eliminate these daily hassles, reduce chaos and confusion, and streamline operations and workflows, and you’ll find that the managers will begin to believe in the improvement methods and make them last. From there, you’ll build momentum to tackle other problems. Many health care systems struggle with understanding the initial steps to build standardized work at all levels and reinforce management systems. Small tests of change at the unit level — starting with existing standard work and building basic management practices like daily huddles and clear escalation protocols for problems that arise at the point of care — can help set the stage for broader changes in systems that lead to sustained improvement.
* IHI Corp to develop gasoline-fueled unmanned aerial vehicles; will spend around 400 million yen by 2018 to develop drones at fukushima facility - Nikkei Source text for Eikon: Further company coverage:
With Clinton seemingly winning the first presidential debate, these asset classes and ETFs are likely to be in focus in the coming days.