JCAHO out of touch
Regarding your editorial, "Deja vu all over again?" (Oct. 14, p. 22): My dissatisfaction with the Joint Commission on Accreditation of Healthcare Organizations comes from personal experience. In 30 years of attempting to spit-shine emergency departments, surveyors have yet to ask me a few key questions, such as: How well do my on-call panels work? What is the process for arranging patient transfers?
Instead, they focus on politically correct issues such as restraint, seclusion policies and the temperature of the refrigerators.
This proclivity for being out of touch starts at the top. As I recall, it was JCAHO President Dennis O'Leary, M.D., who not long ago stated that the problem of emergency department overcrowding was just another passing fad.
Loren Johnson, M.D.
Health Access Associates
Change at JCAHO is good
I read with much interest and excitement your cover story "Changing the rules" (Oct. 7, p. 8). I really believe that the Joint Commission on Accreditation of Healthcare Organizations is on the right track. I am from a small rural facility (44 beds) with a mostly geriatric population and find myself increasingly frustrated after every triannual survey. No two surveyors are the same or interpret the standards the same. I thoroughly agree with the "muffin in the refrigerator" problem. I am excited about the changes and am looking forward to the "outcomes."
Assistant administrator, JCAHO coordinator
Copper Basin Medical Center
Reporting is right on
I follow the hospital industry from a debt-municipal bond perspective and truly appreciate your ongoing reporting on Medicare provider relief (Modern Healthcare's Daily Dose, Oct. 11).
I can't fathom why more news reporters don't follow this story. The amount of money involved is huge and has a real day-to-day impact on hospitals and other healthcare providers in just about every representative's district. Your "nail in the coffin" reporting is sad news but right on.
Director of marketing research
Ziegler Capital Markets Group
Citing the entire team
Our firm wishes to thank Modern Healthcare and the American Institute of Architects' Academy of Architecture for Health for the sponsorship of the 17th annual Design Awards Competition (Oct. 7, p. 28). It is an honor for any firm to receive this premier healthcare architecture award, and Hellmuth, Obata + Kassabaum is privileged to share this award with the entire project team that provided significant contributions to the overall project design.
We believe that effective healthcare design truly comes from collaborative efforts. A partnership among firms was ultimately responsible for creating the Center for Advanced Medicine/Siteman Cancer Center project, a facility that supports patients and staff and assists in fulfilling the client's vision and mission.
HOK collaborated with many firms on the project. While HOK served as executive architect and was responsible for the overall planning and design, Cannon Design was responsible for the programming, clinical planning and interior architecture.
In order to provide all firms with appropriate recognition and deserved credit, we would suggest that the credits on your Web site list the entire project team, as was submitted with the Design Awards entry form.
Thank you to all who coordinated, judged and organized the Design Awards process, especially to Modern Healthcare for its commitment to excellence in healthcare design.
Senior vice president of healthcare
Hellmuth, Obata + Kassabaum
Stop the ding-dongs
Re "Changing the rules" (Oct. 7, p. 8), it's high time the Joint Commission revamped its survey process. Perhaps now we can get on with the provision of safe, quality care without the fear of being "ding-donged" for a faux pas unrelated to patient care.
Senior vice president of patient-care services
Onslow Memorial Hospital
HUD program works
I read your article "HUD reviving loan program" (Sept. 30, p. 14), regarding the Federal Housing Administration's Section 242 mortgage insurance program and its inherent delays, with some consternation. Memorial Hermann Healthcare System was one of the four hospitals referred to in the article as having received FHA loan insurance since January 2001. Our system used the program to insure a $110 million financing for our facilities located in Beaumont and Orange, Texas.
Our experience with the program was absolutely the opposite of that conveyed in the article. Our financing requirements for these two separate facilities were complicated in many respects, not the least of which was the fact that each was a separate legal entity. Prior to submitting our FHA loan insurance application, we submitted a financing plan to FHA to solicit its input regarding the best way to structure our proposal.
FHA officials' response was both immediate and thorough and gave us a clear understanding of how to proceed. Our application was submitted on Feb. 21, 2001. We received our loan insurance commitment on June 29, 2001, and closed on the loan Aug. 15, 2001. FHA's personnel were available to us on an immediate basis throughout the application process and more importantly in structuring the application prior to the submission. The review process was painless and efficient.
The FHA insurance product, providing 90% financing at AAA interest rates, is an incredible financing resource for both hospital systems and single facilities. Contrary to the impression conveyed in the article, our experience is that this resource is available with no more effort than obtaining commercial bond insurance.
Senior vice president, chief financial officer
Memorial Hermann Healthcare System
The nurses' response
An editor's note appearing after a letter to the editor from Scott Chisholm Lamont, a specialty nurse, (Sept. 23, p. 21) generated a huge response from readers. The note explained Modern Healthcare's policy of not using credentials such as "RN" as a journalistic courtesy. However, we do note, when appropriate, that a source is a registered nurse. The lone exception to the credential policy is for physicians. The use of "M.D." echoes the standard style followed by newspapers and magazines both inside and outside of the healthcare industry. As reflected in this selection of letters-all from registered nurses-not everyone agrees with our policy:
I was shocked by your editor's note. While your comment about the widely varying levels of training and education among RNs is certainly true, the title RN is definitely not a courtesy title. RN is the professional designation for registered nurse that is granted only after successful completion of a state licensing examination. Your comments were a disservice to each of the more than 1.3 million RNs working in the U.S. who have achieved this professional status.
Director of professional services
Healthcare Information and Management Systems Society
I encourage you to reconsider your editorial policy and use the title RN. With today's concerns about the shortage of nurses, your magazine can contribute to a positive image of nurses by letting your readership know who is a nurse as you do for physicians. I hope that in future issues your readers, many of whom are nurses, will see a change in your editorial policy.
Associate clinical professor
Duke University School of Nursing
RN is not a "courtesy" bestowed upon an individual without substantial training and education, followed by successful completion of the national RN boards. I acknowledge there are different levels of training and education (I have always been an advocate of changing this practice). However, I fail to understand why any individual would presume to belittle the designation RN as a mere courtesy title. Is "editor" a courtesy title?
Director of nursing
A policy of not using RN credentials strikes me as a policy that trivializes the licensing of nurses and nurses' special expertise in healthcare. I ask that you reconsider your decision, particularly in the context of Charles S. Lauer's Publisher's Letter "Teamwork needs cultivating" (Sept. 23, p. 22). Perhaps the best policy, as Lauer says, for "getting good people to work together" would be to eliminate the use of any professional credentials, as they reinforce the hierarchy Lauer is trying to change.
The whole issue of how a person becomes a registered nurse is an issue that professional nursing needs to deal with within its own ranks. It should not be a reason to omit a title that has been earned. After all, if we are trying to overcome a serious professional nursing shortage and if we are seriously interested in recruiting young people to nursing, wouldn't it be helpful to have those initials "RN" visible to everyone who reads Modern Healthcare? Isn't that a way to overcome some of the negativity about the power that nurses do or do not have? It's sometimes the little things, such as omitting a professional title, that tell the story.
Kay Ann Hamilton
Vice president of nursing-care services
Lewistown (Pa.) Hospital
Paramedics deserve respect
Re your editorial on disgruntled nurses, "The best revenge" (Sept. 23, p. 20): I want to inform you of another side of healthcare and the conditions under which some in that field are being asked to work.
I am a paramedic with a bachelor's degree in emergency medical care and healthcare administration. I have multiple certifications and several years' experience. The industry I work in is being asked to function at $1 billion under operating costs nationwide. Paramedics work a minimum of 48 hours per week, often in extreme conditions. The opportunities for advancement and other arenas to work in are very limited. The average paramedic makes $10 per hour. A typical ambulance is staffed with two people, often one less credentialed, which means one person is fully responsible for patient care. We provide advanced care and must maintain a minimum number of continuing education hours a year and often have to have a whole list of additional certifications.
This is not meant to complain about my chosen profession. I am fully aware that it's a relatively new field and has experienced much growth in three decades. It still has a long way to go. We are often compared to the nursing industry, although our focus, education and training vary greatly. Most paramedics got their certificates through continuing education. Few degree programs are available and are not yet the standard.
With all of that said, one statement in your editorial struck me and prompted me to respond. "(Nurses) ought to be recognized for the increasingly sophisticated care they provide." I feel the same about paramedics. We provide physician-level care. We are physician-extenders. No, we do not prescribe medications or diagnose, but we treat signs and symptoms. However, with the lack of healthcare available to rural settings and our mobility, I can foresee this changing.
I take any opportunity I can to educate and promote my profession. I also would like to bring a little reality to those who constantly complain about their career. I chose emergency medical services. Some choose nursing. Our purpose is the same, to care for people. But I have to work 800 more hours per year than the average nurse and still make $10,000 to $15,000 less per year. Sometimes people need a reality check. I realize it does me no good to complain about it if I do nothing about promoting change. It is my responsibility to make my chosen career better. I do not care to put the blame or responsibility on some other group. I would like to see the nursing profession do the same.
FirstHealth EMS Montgomery