You’re old road is rapidly agin’
Please get out of the new one
If you can’t lend your hand
For the times they are a’changin’.
— Bob Dylan, February 1964
I’m getting confused. So much change. How do I cope?
Not that I’m unused to dealing with change. I’ve done it all my life. We almost all have.
But now we have new tools. One of the top-ranked sources Google offers when I enter “how to deal with change” is Web MD, written by its editorial contributors and “medically reviewed by Dan Brennan, M.D. on October 25, 2021.”
Hmm. My late mother’s birthday. On that day, had she lived, she would have been 107 years old. Good portent or bad?
“We all experience change,” medically reviewed Web MD begins its explanation. “Change is fluid and can be negative or positive. When things change in your life, it can impact your mental health and well-being.”
Not quite as classy as Heraclitus telling us moiré than 2000 years ago that we couldn’t step into the same stream twice, but we get the idea. Though the Greek philosophers frequently attributed their opponents’ philosophical reasonings to madness, they rarely suggested explorations of treatment for their fellow seekers’ mental health.
Times have changed. The times they are a’changin’. And they always will.
Improved performance
Dr. Michael Doyle is executive director and chief medical officer of HealthAlliance Hospital in Kingston, which five months ago opened a new two-story 79,000-square-foot addition adjacent to its current Mary’s Avenue facility.
Back on April 12, an amended press release from the hospital provided data on the new hospital wing’s first 100 days. It had hosted 7800 emergency department visits, attended to 147 critical-care patients, performed 830 surgeries, conducted more than 100 cardiac catherizations, and helped deliver more than 55 babies.
That’s all very well, Dr. Doyle, but a number of community members had been complaining about hospital wait time before they received care. How did the wait time at the new facility compare with what it had been before?
Obviously, he answered, emergency care is available immediately 24/7 as needed.
He said that the median wait time at the new facility has been 17 minutes as compared to the previous 23 minutes. And now 80 percent of the patients are being attended to within a half-hour as compared to 60 percent previously.
Has the medical staff stayed in place during the transition? All the staff doctors have remained, Doyle replied. In fact, there’s now an additional doctor.
On March 13, the New York State Nurses Association and HealthAlliance’s parent company, WMCHealth, reached agreement on a three-year contract covering more than 200 nurses at HealthAlliance Hospital. The pact, retroactive to January 1, delivers annual wage increases for all nurses and increased experience differentials for longer-tenured ones. The union president called the agreement “a fair new contract that raises the bar for nurses in the Hudson Valley.”
Healthcare delivery change
The maxim “Change is a double-edged sword” expresses a vivid truth. The sword of change cuts both ways. Much of the change at HealthAlliance has had unavoidable negative as well as positive consequences. Human nature encompasses both people who welcome change and people fiercely resistant to it. Both kinds are in plentiful evidence in Ulster County.
HealthAlliance has built a spanking new 79,000-square-foot two-story wing adjoining the current hospital. It has also refreshed 48,000 square feet of the old hospital.
The new $113-million wing is more than a large lobby, plentiful corridors and glass-walled conference rooms. At its core are a ground-floor 25,000-square-foot emergency care facility and an intensive care unit for the hospital’s sickest patients.
The eternal tussle between centralized and decentralized healthcare has been playing out in Kingston. Parent company WMCHealth has been handing more Kingston patients requiring specialized care over to its facilities in Poughkeepsie and mother ship in Valhalla in Westchester County — even while announcing new specialized services in Kingston. Generally speaking, intensive acute care is more effectively handled at system-wide centralized locations while less costly primary care is more convenient – as well as far less costly – delivered decentralized.
A clean, modern look
Brick and mortar rarely impress healthcare consumers. Bricks and mortar – or in this case glass and corridors — do not alone a hospital make. What counts most to the general public is timely access to high-quality care.
HealthAlliance knows that. It knows that well-configured space, new modes of treatment and expensive up-to-date technology provide needed tools. All that is a precondition to what can happen outside as well as inside the facility walls.
In a sense the physical setup is the cart before the horse. To most consumers, the quality of the skilled workforce, their sense of teamwork, their opportunities for training, and their degree of job satisfaction are what count. These are the more important determinants of how well the hospital does its job.
Though essential, the well-designed box providing healthcare for all is just a first step, a precondition to the goal of more successful outcomes .
For the new wing, HealthAlliance Hospital contracted with the Philadelphia-headquartered Francis Cauffman Architects (CFA), which has extensive experience with healthcare design. The firm favors a clean, modern, no-nonsense look with no vernacular touches. The HealthAlliance main entrance bears more than a casual resemblance to the one CFA designed for the Geisinger Health System’s cancer care center in Wilkes-Barre, Pennsylvania.
As a strategy, box-first carries with it a certain risk. Your customers will need to be persuaded how the new stuff you’ve put into your fancy new box will enhance the quality of their healthcare. Will the new facility be a change for the better?
High costs, mediocre outcomes
Compared with the systems of other advanced countries, United States healthcare is notoriously disjointed, fractured and wasteful. It’s easily the most expensive in the world, and its care often leads to mediocre patient outcomes.
“Yes, medical treatment has made astonishing advances over the years with an innovative thinking process,” said one articulate California physician, M. Zakirul Karim, about U.S. healthcare. “But the packaging and delivery of that treatment are often inefficient, ineffective, and consumer-unfriendly.”
The National institutes of Health has summed up four major weaknesses of the United States healthcare system in unflinching terms: No central governing agency and little integration and coordination. Technology-driven delivery system focusing on acute care. High in cost, unequal in access, and average in outcome. Delivery of healthcare under imperfect market conditions.
In 2021, the Commonwealth Fund published a now-famous study of 14 nations called “Mirror, Mirror 2021: Reflecting Poorly.” It found that “the United States trails far behind other high-income countries on measures of healthcare affordability, administrative efficiency, equity, and outcomes.” Norway was first, the United States last.
Various sources use similar numbers tracking per-capita healthcare expenditures. The 2021 figures, the most recent numbers cited by Statista, show United States spending at $12,218 per capita. The next highest-spending nation, Germany, spent $7383 per capita for better outcomes than the U.S. reported.
In all the other major nations, healthcare is regarded as a human right, like education. In the United States, healthcare is delivered “under imperfect market conditions.”
In 2021, 18.4 percent of the gross domestic product (GDP) of the United States was spent on healthcare, as compared to 12.6 percent in Germany. And less than 12.6 percent in every other nation.
It was not always thus. In 1980 the United States was the highest per-capita spender by a narrow margin. Since then, the spending of other nations on healthcare has increased markedly, partly because of their adoption of innovative U.S. technology. But their growth in spending on healthcare has nonetheless been dwarfed by that recorded in the United States
The Kingston two-step
Statistics like these disturb the folks in Washington. D.C. The federal government has become willing to provide financial incentives to the states to experiment with reforms. From 2015 to 2020, New York State received $6.42 billion – we’re talking about big money here – to restructure its ailing healthcare delivery system so that Medicaid costs could be substantially reduced. The ambitious program was called DSRIP (Delivery System Reform Incentive Payment). Its primary goal was to reduce avoidable hospital use by 25 percent over five years.
Whoa, there. WMCHealth is a 1700-bed regional healthcare provider with nine hospitals and a workforce of 13,000. What was been being asked of it during DSRIP was to decrease bed use, to continue to invest in acute-care services, and to anchor an integrated community healthcare system. No small task,.
With DSRIP contributing the bulk of the funding ($88 million) in Kingston, HealthAlliance is spending $134.9 million in a two-step reorganization, the first part being the $113-million expansion of the Mary’s Avenue facility and its renovations, and the second $22-million portion being the health village at the former Kingston Hospital on Broadway. With the larger capital investment made, the second step will now be taking center stage.
Though successful in making improvements, the first step was only the beginning of the efforts to bring down the cost of New York healthcare. Serious attention is being paid in Albany these days to negotiating a new $13.5-billion DSRIP-type program with the federal government which would begin where its predecessor left off.
The adoption of value-based payments (systematic interventions to drive down cost or reward quality) in U.S. healthcare will be part of the new round of reform. New York has suggested a $325-million item for the more active coordination of collaboration among the healthcare players through nine regional “health equity organizations.” Emphasis may include major investment in such varied areas as drug treatment, long-term care and housing.
Healthcare, it seems, is no longer the standalone community silo it once seemed to be. It’s connected to all the other community institutions that shape behavior
What could the role in this new universe will the HealthAlliance health village in the health neighborhood play?
Doctor Doyle said it was likely the physical changes required for the health village on Broadway would be completed this year. WMCHealth projects the walkable health village will open for care in 2025.
Village and neighborhood
What is a health village? A variety of definitions have been offered in different settings. Here’s one:
A health village is a mixed-use setting where a healthcare anchor integrates community healthcare providers with various other services. At the Kingston site, WMCHealth has said, that “HealthAlliance Hospital workforce members will collaborate with community partners to deliver preventive and primary healthcare services as well as lifestyle counseling.”
Conceptually, a health neighborhood extends health partnerships beyond medical and social supports and the coordination of healthcare delivery. A flow of information is encouraged not only among providers of primary care, specialists, hospitals, home health, long-term care, and other clinical providers but also among non-clinical partners like community centers, faith-based organizations, schools, employers, public-health agencies and other community partners. The health neighborhood promotes care coordination, fitness, healthy behaviors, proper nutrition, and healthy environments and workplaces.
HealthAlliance is yet to prove that that it is an effective change agent of decentralization. The jury’s still out on that one.
A successful health neighborhood, its proponents say, will focus both on meeting the needs of the individual patient and on incorporating aspects of population health and overall community health needs. That mission sounds like the local version of the state goal of more active coordination among the healthcare players,
Is the health neighborhood becoming more than a concept still in formation?
Coming to terms with change
The times they are a’changin’. What sort of change agent would function best in this dynamic heathcare environment characterized by a high level if public recalcitrance? An outside professional with good listening skills would make a better catalyst for change than an inside communicator.
The members of the public and representatives of local organizations need to be able to express their concerns and voice their opinions as freely as possible. Their feedback and concerns must be prioritized. Change comes much more easily when people feel listened to. Management gets a fair hearing. Feelings of audience anxiety and powerlessness diminish.
WMCHealth declares that it is transforming healthcare in the Hudson Valley by creating an environment that puts people first. Its aim, known as the WMCHealth Culture of Care, “is to build trust and promote well-being for every person, every time, always.”
Such bold declarations are certainly worthy of being put to the test.
Since our story began with advice for dealing with change began with no less an authority than Web MD, it’s only fitting that it end with a few homespun tips from that same source,
Heraclitus, be forewarned. Here they are:
Find something familiar. Even if it’s small, search for something stable that you can focus on. This grounding point will help guide you in unfamiliar moments and feelings. Performing daily habits, rewatching a television series you love, or even eating your favorite comfort food can ease the stress you have during a transition. These are great ways to make yourself feel happy and improve your overall mood.
Understand your perspective in the world. When you look outside your situation, you’ll be able to see how everything is in movement. There will be changes that may or may not impact your life. Seeing the world in a global sense can put your situation into perspective. This may make things seem smaller or more manageable.
Be flexible. Learning to accept the unpredictability of the world will help you deal with unexpected events in your life. Letting go of expectations and restrictions in your life may make a new routine seem less scary. Try to keep an open mind with new experiences to understand them more fully. Perhaps some will even become enjoyable.
Find people who understand. When you’re dealing with a new transition, it’s good to talk to a trusted person in your life. Having others to lean on is better than trying to manage alone. Being supported by people you care about will help to make new experiences easier to handle.
Join the family! 
