By Peter Lazes and Marie Rudden

The purpose of this book

As both of us have been occupied in our careers with what makes organizational systems more effective and have observed the central role of frontline staff and caregivers in this effort, we offer methods for restructuring healthcare systems in a way that makes collaboration and active communication among administrators, medical staff, and patients a key value. This book explores exactly what it takes to effectively engage staff and providers in improving the patient care shortcomings within their institutions. We do this by presenting case studies of institutions that have successfully implemented major systemic changes in this manner, by reviewing research findings and outcomes, and by conveying the direct words and experiences of staff who have participated in changing their healthcare organizations.

We have shaped this book around the specific methods that healthcare systems can employ in order to enlist their frontline staff in diagnosing and rectifying difficulties in providing high-quality patient care. This book not only is a manual detailing what can be achieved when frontline staff have a direct voice in controlling their practice environments, but also was written to provide a method for accomplishing transformative changes in how our hospitals and outpatient clinics work.

All Americans deserve and should have access to high-quality, affordable healthcare services delivered by professionals who know them and who have sufficient time and resources to care for them.

In sum, this book will inform you about the historical development of approaches for engaging frontline staff in job redesign and in the creation of more effective organizational systems. The book gets you under the covers, so to speak, exploring what it really takes to effectively initiate, implement, and sustain employee involvement activities. It demonstrates how Labor-Management Partnerships particularly can help organizations to evaluate the effectiveness of their current systems and to design more functional structures. We emphasize too the importance of establishing collaborative leadership processes to engage and sustain employee participation efforts.

Peter Lazes, PhD, a clinical and industrial psychologist, was the founder and former director of Programs for Employment and Workplace Systems and of the Healthcare Transformation Project, both at Cornell University.

Marie Rudden, MD, his wife and co-author, is a psychiatrist and psycho-analyst, an associate editor for the International Journal of Applied Psychoanalytic Studies, a member of the North American Editorial Board of the International Journal of Psychoanalysis, and a clinical assistant professor in psychiatry at Weill Cornell School of Medicine.

https://www.penguinrandomhouse.com…

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Comment:

By Don McCanne, M.D.

In a personal email communication, Peter Lazes writes, “In addition to a national payment system, I would suggest that it is critical to create ways for frontline staff and unions to become active partners in the creation of new structures and systems to improve access and coordination of care. Bills, administrative actions and some form of Medicare for All are important, but it is critical that we find ways to make use of the sufficient knowledge of frontline staff (from housekeeping staff to attending physicians) in order to achieve needed breakthroughs… structures themselves will not be sufficient nor will just “bold” leadership from management. Current healthcare management leadership has achieved only anemic improvements in improving the quality of patient care. And a national payment system by itself will not achieve reducing inequalities nor improve overall health outcomes. Systemic changes along with a national payment system is needed.”

It is absolutely essential that we replace the current dysfunctional health care financing system with one that ensures equitable, affordable health care for all – single payer improved Medicare for All. Although the financial realignment will certainly correct many of the deficiencies in the health care delivery system, it will also greatly benefit from continual oversight, analysis and improvement from those most important to the patient – the frontline staff and their patient-oriented organizations, such as the unions.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

He used medicine to take on poverty, racism and the threat of nuclear destruction. Two groups he helped start won Nobel Peace Prizes.

By Denise Grady
The New York Times, December 28, 2020

Dr. H. Jack Geiger, who ran away to Harlem as a teenager and emerged a lifelong civil rights activist, helping to bring medical care and services to impoverished regions and to start two antiwar doctors groups that shared in Nobel Peace Prizes, died on Monday at his home in Brooklyn. He was 95.

His death was confirmed by David Shadrack Smith, his stepson.

Dr. Geiger was a leading proponent of “social medicine,” the idea that doctors should use their expertise and moral authority not just to treat illness but also to change the conditions that made people sick in the first place: poverty, hunger, discrimination, joblessness and lack of education.

“Jack redefined what it meant to be a physician,” said Dr. Irwin Redlener, the founding director of the National Center for Disaster Preparedness at Columbia University and the co-founder of the Children’s Health Fund. He added, by email, “He felt it was our right and responsibility as doctors to ‘treat’ hunger, poverty and disparities in health care, as directly and openly as we treat pneumonia or appendicitis.”

The social order, not medical services, determines health, Dr. Geiger said in “Out in the Rural,” a short documentary film made in 1970 about the first community health center in Mississippi. “I’ve never seen any use in what I call the Schweitzer bit,” he added, referring to the humanitarian Dr. Albert Schweitzer, “which is the idea that you stand around in whatever circumstances laying hands on people in the traditional medical way, waiting until they’re sick, curing them and then sending them back unchanged into an environment that overwhelmingly determines that they’re going to get sick.”

In the 1960s, Dr. Geiger was a co-founder, with Dr. Count Gibson, of community health centers in South Boston and in Mound Bayou, in the Mississippi Delta. They provided desperately needed health care but also food, sanitation, education, jobs and social services — what Dr. Geiger called “a road out” of poverty. The centers inspired a national network of clinics that now number more than 1,300 and serve about 28 million low-income patients at more than 9,000 sites.

“I don’t know if some of the Mississippi white power structure cares about dead Black babies or not,” Dr. Geiger said in the film, about the first center in Mississippi. “But if they don’t, even they can’t afford to say so publicly. We have been able to enter and to do things under the general umbrella of health that would have been much harder to do if we’d said we were here for economic development or for social change per se.”

Dr. Geiger was a founding member of two advocacy groups, Physicians for Social Responsibility, which shared the 1985 Nobel Peace Prize for its efforts to end the nuclear arms race, and Physicians for Human Rights, which shared the 1997 prize for working to ban land mines.

He rallied doctors in the Cold War era to speak out against what he saw as a myth being promoted by the government, that nuclear war could be survivable. On the contrary, he insisted, hospitals would be quickly overwhelmed, and even victims with treatable injuries would perish.

Drawing physicians out of the clinic and into the political fray “was a really signal event,” said Dr. Robert Gould, a pathologist in San Francisco and president of the Bay Area chapter of Physicians for Social Responsibility.

In an email for this obituary sent in 2012, Dr. Geiger said he was driven in part by an outrage over injustice.

“I’ve been angry,” he wrote, “seeing terribly burned children in Iraq after the first Gulf war, or interviewing torture victims in the West Bank, or listening to Newt Gingrich say ghetto kids should learn to be part-time janitors and clean toilets (in another country, they called that Bantu Education). So anger doesn’t vanish, but is replaced by a determination to do something.”

Home Was a Way Station

Herman J. Geiger was born on Nov. 11, 1925, in Manhattan. (It was unclear what the J. stood for, but he was mostly called Jack throughout his life.) His father, Jacob, born in Vienna, was a physician; his mother, Virginia (Loewenstein) Geiger, who came from a village in central Germany, was a microbiologist. Both parents, who were Jewish, had emigrated to the United States as children. Mr. Geiger grew up on the Upper West Side of Manhattan, and their home was often a way station for relatives fleeing the Nazis.

“The last to appear were some cousins from my mother’s birthplace, Kirtorf,” Dr. Geiger said in the email. “When they got their visas to come to the U.S., they said, the Nazi authorities were furious. On the night before their departure, the authorities ordered all their neighbors to go out at twilight and stone their house. The neighbors all dutifully gathered — and threw loaves of bread instead.”

That story, Dr. Geiger said, taught him not to stereotype.

He skipped so many grades in the city’s public schools that he graduated from Townsend Harris High School (then in Manhattan, now in Queens) at 14. Too young to start college, he learned typing and shorthand and went to work as a copy boy for The New York Times. He also began hanging out at jazz joints, listening to Billie Holiday, Art Tatum and Fats Waller. His parents were often beside themselves, waiting up for him and sometimes even calling the bars to ask if “Jackie” was there.

Jack soon ran away from home and turned up, suitcase in hand, in Harlem’s Sugar Hill section on the doorstep of Canada Lee, a Black actor whom he had seen on Broadway and had gotten to know after talking his way backstage. Mr. Lee, once a teenage runaway himself, let young Jack sleep on the couch — after consulting with his parents — and though Jack sometimes returned home, he spent most of the next year in Harlem.

The year was 1940, and Mr. Lee’s home was a hub for writers, actors and musicians — Langston Hughes, Richard Wright, Orson Welles, Paul Robeson, Billy Strayhorn, William Saroyan. The Black guests told harrowing stories of racism, and Harlem was seething over the mistreatment of Black troops at military bases in the South. Jack Geiger took it all in.

In 1941, with a loan from Mr. Lee, he began studying at the University of Wisconsin. He worked nights at a newspaper, The Madison Capitol Times. Because Madison had a curfew for anyone under 18, he said, “I am probably the only police reporter in history who had to get a special pass to be out at night.”

In 1943, after meeting James Farmer, the founder of the Congress of Racial Equality, Mr. Geiger started a chapter of the group in Madison. It was the height of World War II, and after turning 18 that year he left school to enlist in the merchant marine, which he chose because it was not racially segregated.

Rabble Rouser for Justice

Discharged in 1947, Dr. Geiger enrolled as a pre-med student at the University of Chicago. He discovered racial discrimination there — Black patients being excluded from certain hospitals, qualified Black students being rejected by the medical school. He fought the policies for three years and ultimately helped organize a 1,000-strong faculty and student protest strike — an activity virtually unheard of in that era.

He paid a price for his rabble-rousing. The American Medical Association wrote to medical schools warning of his “extracurricular activities.” No school would take him. He had, in effect, been blackballed.

Dr. Geiger went back to journalism for the next five years, as a science and medicine editor for the International News Service (later part of United Press International). It was, he said, “a gorgeous education” that let him read journals, attend conferences, interview researchers and, significantly, meet deans whom he could lobby to let him into medical school. In 1954, at 29, he was admitted to what is now Case Western Reserve University’s medical school in Cleveland.

During his last year at Case Western, he traveled to South Africa and worked with two physicians who were setting up a health center in an impoverished, disease-ridden region of the country called Pholela, which was then a Zulu reserve. A key to the center’s success was that local people — its own patients — worked there and helped run it.

For five months Dr. Geiger took care of patients, visiting thatch huts and cattle kraals, meeting traditional healers and seeing the huge improvements — pit latrines, vegetable gardens, children’s feeding programs — that the health center had brought to the region.

“I learned a little Zulu, including the three oral clicks in that language, which always made me drool, to the hilarity of my African teachers,” he wrote in a chapter he contributed to the 2013 book “Comrades in Health.”

Dr. Geiger’s time in Africa made him want a career in international health. He trained in internal medicine at Boston City Hospital and in epidemiology at the Harvard School of Public Health.

In the “freedom summer” of 1964, he traveled to Mississippi to help care for the civil rights workers who were pouring into the Deep South to campaign for voting rights. The next year, he organized medical care for the people who marched with the Rev. Dr. Martin Luther King Jr. from Selma to Montgomery, Ala.

“I took a long look around,” Dr. Geiger recalled of his first visit to Mississippi. He saw conditions much like those in South Africa: families living in shacks with no clean drinking water, toilets or sewers; sky-high rates of malnutrition, illness, infant death and illiteracy; few or no opportunities for residents to better themselves and escape. He did not have to travel to Africa to find people in trouble, he realized.

A Clinic in Mound Bayou

Under President Lyndon B. Johnson, the war on poverty had begun, and the Office of Economic Opportunity had been created to pay for projects to help the poor. Sponsored by Tufts University and armed with grants from the opportunity office, Dr. Geiger, Dr. Gibson, Dr. John Hatch and others set up a health center in Mound Bayou, Miss., a poor, Black small town where most people were former cotton sharecroppers whose way of life had been wiped out by mechanization.

The center was a copy of the Pholela project. The clinic, which opened in 1967, treated the sick but also used its grant money to dig wells and privies and set up a library, farm cooperative, office of education, high-school equivalency program and other social services.

The clinic “prescribed” food for families with malnourished children — to be purchased from Black-owned groceries — and the bills were paid out of the center’s pharmacy budget.

The governor complained, and a federal official was sent to Mound Bayou to scold Dr. Geiger for misusing pharmacy funds, which, the official said, were meant to cover drugs to treat disease.

“Yeah,” Dr. Geiger replied, “well, the last time I looked in my medical textbooks, they said the specific therapy for malnutrition was food.”

The official, he said, “shut up and went back to Washington.”

Dr. Geiger helped found Physicians for Social Responsibility in 1961. The group argued that official predictions of the effects of nuclear war minimized the number of casualties and the extent of the destruction it would cause. At the group’s public meetings, Dr. Geiger’s job was “the bombing run” — offering a detailed account of what a one-megaton nuclear bomb would do to the city in which the meeting was being held.

He had a resonant voice and a crisp, forceful delivery. His presentations left audiences stunned, according to a colleague in the group, Dr. Ira Helfand.

Dr. Geiger was a co-author of one of the first articles to look at the medical costs of nuclear war. The article, in The New England Journal of Medicine, predicted the fate of Boston in a nuclear strike — 2 million dead, a half-million injured and fewer than 10,000 hospital beds left in the entire state of Massachusetts. Doctors must “explore a new area of preventive medicine, the prevention of thermonuclear war,” the article said.

It was published in May 1962 — five months before the Cuban missile crisis, which took the United States and the Soviet Union to the brink of nuclear war.

Dr. Geiger’s marriage in 1951 to Mary Battle, an administrator and executive assistant in health care, ended in divorce in 1968. They had no children. (Ms. Battle died in a car accident in 1977.) In 1982, he married Nicole Schupf, a neuroscientist, epidemiologist and professor at Columbia University.

In addition to his wife and his stepson, Mr. Smith, Mr. Geiger is survived by two stepgrandsons. An older sister, Ruth Ann, a schoolteacher, died in 1986.

In 1978, Dr. Geiger became a professor of community medicine at the City University of New York Medical School at City College of New York.

In his final years, which were marked by bladder cancer, lung cancer and blindness from glaucoma, he continued to write book chapters, articles and editorials and to give talks.

To the end he was an impassioned advocate for civil rights. In an essay published in 2016 by Physicians for Human Rights, he called for more action to fight the lead-poisoning of the water supply in Flint, Mich., and to hold accountable the officials responsible for it.

With characteristic bluntness, he ascribed the contamination to “a contemptuous disregard for the health of people of color, especially if they are poor.”

https://www.nytimes.com…

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Comment:

By Don McCanne, M.D.

Jack Geiger was a revered member of PNHP. He was way ahead of the pack in addressing racial and socioeconomic injustices in health care – problems for which there seems to be a new awakening on the horizon.

We can best honor Jack by continuing to emulate his work on behalf of health care justice for all, with special attention to those with the greatest neglected needs.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Though a state board rejected Mercy’s application to close, hospital officials are working to shut down by May 31. Activists want a moratorium on hospital closings and pressure from the city and state to ensure Mercy remains open.

By Maxwell Evans
Block Club Chicago, December 22, 2020

A coalition of activists are demanding elected officials maintain pressure on Mercy’s ownership to keep the hospital open or sell to someone who will.

The activists held a vigil Monday, a week after a state board unanimously rejected Mercy Hospital’s request to close. Board members agreed closing the Near South Side institution would negatively impact South Siders, especially in the middle of the coronavirus pandemic.

Mercy Hospital leadership announced in July the city’s first chartered hospital would shut down, citing monthly operating losses of $4 million and shifting trends in the field of health care away from inpatient services. The news came two months after a billion-dollar plan to consolidate the hospital with three others on the South Side fell apart.

Despite the Illinois Health Facilities and Services Review Board’s rejection of Mercy’s request, the hospital still has options for shutting down — and intends to take advantage of them.

If local leaders don’t take action, organizations within the coalition will mobilize against them in their next elections, Bennett said.

Coalition members include local representatives of the Kenwood-Oakland Community Organization, SEIU Healthcare Illinois, National Nurses United, Physicians for a National Health Program, White Coats for Black Lives, and several other groups.

While keeping Mercy open is the coalition’s focus for now, its battle for health equity reaches further.

Members are also organizing to address the dependence of safety net hospitals on Medicare and Medicaid reimbursements, “a racist system that in its structure is guaranteeing hospitals don’t have what they need,” said Jitu Brown, board president of the Kenwood-Oakland Community Organization.

Hospitals lost 13 cents on every dollar spent caring for Medicare and Medicaid patients in 2017, according to the American Hospital Association. Three out of every four Mercy Hospital patients pay through Medicare or Medicaid, according to a 2019 report.

The battle the keep Mercy open is part of a decades-long struggle to maintain critical health services throughout the South Side.

But health care has continued to shrink, shift or disappear altogether in the South and West sides for years.

https://blockclubchicago.org…

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Comment:

By Don McCanne, M.D.

How could shutting down a safety net hospital in a region struggling to maintain critical health services advance the cause of health equity? It can’t.

So what reason is being given for the efforts to close Chicago’s Mercy Hospital? They are losing money, they say. How can a busy hospital lose money? They say that it is because three-fourths of the patient population is covered by Medicare or Medicaid, and the American Hospital Association claims that hospitals lose 13 cents on every dollar spent on these patients.

Wait a minute. If your home catches on fire, doesn’t the fire department show up to put out the fire? You have fire insurance on your home so that insurance is used to pay the fire department for its services? No. The fire department provides a public service that is funded by the government. We pay taxes to cover that service. We don’t call that a “loss.” We don’t call care and maintenance of our parks a “loss.” We don’t call highway maintenance a “loss.” They are strictly essential services most appropriately provided by the government.

How is health care different? Shouldn’t it also be a public service funded by the government? Well, it partially is through government programs such as Medicare and Medicaid, so we do acknowledge the legitimate role of government in health care financing. But because of the fragmented, dysfunctional method we have of funding health care, we allow tremendous waste in administrative excesses and we have a failure to set prices appropriately, and thus the government appears to underpay for services in comparison to the private commercial insurers (though the concept of cost shift has been refuted by Austin Frakt). When the dependence of safety net hospitals on Medicare and Medicaid can be legitimately labeled a “racist system,” clearly we have an intolerably dysfunctional health care financing system.

The point is that, although we spend more on health care than any other nation, we clearly are not spending it equitably. Though government funds are the major source of Mercy Hospital’s revenues, the amount by which Mercy comes up short in paying its cost of care is not a “loss,” rather it is failure to enact an adequate, comprehensive health care financing system that will meet legitimate costs while, most importantly, providing health care equitably to everyone.

Regular readers know the bottom line here. We need to replace our unjust health care financing system with a well designed, single payer, improved Medicare for All program. Under such a system, with regional planning, Mercy Hospital would be reinforced or replaced to help meet the needs of South Chicago’s residents. In no way would that be a “loss.”

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