Cultural Decline and the Publishing Industry

Just how bad are things in our economy right now? We’ve all heard the horror stories about Random House restructuring. We’ve all heard that the once impervious publishing industry has taken a major hit due to the bleak economy and the recession.

Recession. It’s a dirty 10 letter word that “describes the reduction of a country’s gross domestic product” [Wikipedia]. And books, just another product put out by just another big business industry, have been slammed.

All the reports indicate that the recession we’re in isn’t going to end anytime soon.

But is it really the recession that’s to blame for where the publishing industry is right now, or is it our country’s cultural decline [meaning the moral, social, and behavioral condition of our society, e.g. our 'values']? To me, that’s a far bigger issue that recession. Books encourage learning and curiosity and passion and our minds. We need books!

When the average US child watches 4 hours of television a day [which has been proven to put them in a state similar to hypnosis], is it a wonder that obesity [hence type 2 diabetes, before a rarity in children, but now an epidemic] rates continue to be on the rise, that SAT scores continue to decline, that full days can be spent wasted on the internet, that our children’s [and many, many adult's] expectations and perceptions of the female body and of sex have become skewed because of pornography on the internet?

The fallout of our cultural decline means that our youth is getting their world experience from Gossip Girls [the TV show] and the like instead of Tom Sawyer and The Hardy Boys. Is Gossip Girls becoming the real world? Which came first, the chicken, or the egg?

Many parents try to offer their children opportunities to see and know true stories. Opportunities to enlighten their kids and show them humanity and compassion rather than the self-centered value we’ve come to place on self-expression. Hannah Montana and American Idol won’t show us the real world or the true human experience. They won’t expose us to life outside of our safe bubbles or teach us or model tolerance or compassion or love. Sure they save us from boredom, but really, where is the value? Again, don’t get me wrong, I love a good TV show or an engaging movie. My daughter watches Wizards of Waverly Place. My son’s watch, egads, The Family Guy [they're teenagers]. The internet offers us all quick and efficient ways to communicate with friends and family, it gives us research and information, right at our fingertips, but it also strips us of the interaction that used to be necessary to achieve the same things. Gone is the human connection.

Hours in front of a TV or commuter [writing time aside] every day? Uh-uh. There’s not enough time. And there are too many other fascinating things to do, read about, experience. Music to play. Too many issues that to be understood. Too much about the human condition that needs to be explored.

As I observe my children’s school-one of the institutions that used to be free of televisions, and a place that should be passionate about instilling a love of learning and a passion for exploration of ideas, one question comes to mind: Since when is mediocrity something to embrace and celebrate? How is a love for learning being instilled here? Where is the vibrant environment, the passion, the architectural development of the soul? Why is everything test oriented, right down to the Accelerated Reading program which sucks the joy of reading for reading’s sake right out of the process? When did we stop teaching our kids-and ourselves-how to think and feel and act? How is our social and emotional culture being nurtured? When did so many parents and so many schools and such a big part of our society stop striving for excellence?

I was so thrilled when I read that the National Endowment for the Arts recently released a new report saying that “More Americans adults read literature”. And, even better than that, the report goes on to say that “the biggest increases among young adults, ages 18-24″. For two decades, the number of readers has been declining. Now, despite our bleak economy and the recession, despite our cultural decline, that trend is reversing. Maybe there’s hope after all.

I should add here that I’m not pointing fingers; I’m only trying to make a point that we have to stand up. We have to demand excellence. We have to want more for ourselves and our children, and for human kind. We have to have higher expectations. I’m a parent and a teacher and a writer. Do I make mistakes? Yes! Do I have weaknesses? Too many to count. But will I ever give up trying to overcome mediocrity and trying to better the human condition and build up the culture within my own family? Never!

And I’ll never stop loving books and the way they can make me see things in a new light, take me places I couldn’t have gone in any other way, and expose me to ideas that I couldn’t have thought of on my own.

How Did the Tattoo Industry Gain Popularity?

Tattoos have become so popular that they have even entered our culture, tradition and religion. The demand has been increasing constantly such that you can easily come across a professional or even a homemaker in a tattoo parlor as compared to rebels alone, which was the case long ago. The acceptance of tattoos into our culture has led to increasing requirements for tattoo parlors, experienced tattooists, tattoos and supplies. In fact, tattoos have grown into a leading industry that is in its growth stage.

The tattoo business is booming all over the world since tattoos are gaining more esteem and recognition in our culture irrespective of age, sex, status, etc. In order to better show its integration into our culture, it has been estimated that one out of every seven adults wear a tattoo.

Cable TV broadcasts popular shows such as Inked or Miami Ink that takes the viewers deep into the tattoo artistry world. These shows project the lives of various experienced and skilled tattoo artists who were capable of bringing the tattoo industry to such great levels. Their works and arts are highlighted in the shows. In fact, these shows are also one of the reasons for bringing in popularity for tattoos. It also serves as an advertising medium, luring more people into the tattoo world. New phrases like pounding skin and slinging ink (related to tattoo artistry) have entered the nation’s vocabulary.

During the past, tattoo industry did not flourish so well. It was underground and meant only for sailors or bad-boy images. It did not gain popularity all of a sudden. The developments in tattooing procedures like reputable equipments, sterilization techniques, etc, popularity created by celebrities, athletes and a focus on safety and health by the industry has led the industry to the position where it is now.

Its recent focus is on professionalism and development of more artistic talents. All the above-mentioned reasons have led to the generation of a safe, comfortable environment. The tattoo artists search for supplies matching their needs. Quality tattoo starter kits are very helpful especially for cost reasons. It includes all that are needed to start a career in tattooing.

Hospital Leadership, Strategy, And Culture In The Age of Health Care Reform

With just eleven months to go before the Value-Based Purchasing component of the Affordable Care Act is scheduled to go into effect, it is an auspicious time to consider how health care providers, and hospitals specifically, plan to successfully navigate the adaptive change to come. The delivery of health care is unique, complex, and currently fragmented. Over the past thirty years, no other industry has experienced such a massive infusion of technological advances while at the same time functioning within a culture that has slowly and methodically evolved over the past century. The evolutionary pace of health care culture is about to be shocked into a mandated reality. One that will inevitably require health care leadership to adopt a new, innovative perspective into the delivery of their services in order to meet the emerging requirements.

First, a bit on the details of the coming changes. The concept of Value-Based Purchasing is that the buyers of health care services (i.e. Medicare, Medicaid, and inevitably following the government’s lead, private insurers) hold the providers of health care services accountable for both cost and quality of care. While this may sound practical, pragmatic, and sensible, it effectively shifts the entire reimbursement landscape from diagnosis/procedure driven compensation to one that includes quality measures in five key areas of patient care. To support and drive this unprecedented change, the Department of Health and Human Services (HHS), is also incentivizing the voluntary formation of Accountable Care Organizations to reward providers that, through coordination, collaboration, and communication, cost-effectively deliver optimum patient outcomes throughout the continuum of the health care delivery system.

The proposed reimbursement system would hold providers accountable for both cost and quality of care from three days prior to hospital admittance to ninety days post hospital discharge. To get an idea of the complexity of variables, in terms of patient handoffs to the next responsible party in the continuum of care, I process mapped a patient entering a hospital for a surgical procedure. It is not atypical for a patient to be tested, diagnosed, nursed, supported, and cared for by as many as thirty individual, functional units both within and outside of the hospital. Units that function and communicate both internally and externally with teams of professionals focused on optimizing care. With each handoff and with each individual in each team or unit, variables of care and communication are introduced to the system.

Historically, quality systems from other industries (i.e. Six Sigma, Total Quality Management) have focused on wringing out the potential for variability within their value creation process. The fewer variables that can affect consistency, the greater the quality of outcomes. While this approach has proven effective in manufacturing industries, health care presents a collection of challenges that go well beyond such controlled environments. Health care also introduces the single most unpredictable variable of them all; each individual patient.

Another critical factor that cannot be ignored is the highly charged emotional landscape in which health care is delivered. The implications of failure go well beyond missing a quarterly sales quota or a monthly shipping target, and clinicians carry this heavy, emotional burden of responsibility with them, day-in and day-out. Add to this the chronic nursing shortage (which has been exacerbated by layoffs during the recession), the anxiety that comes with the ambiguity of unprecedented change, the layering of one new technology over another (which creates more information and the need for more monitoring), and an industry culture that has deep roots in a bygone era and the challenge before us comes into greater focus.

Which brings us to the question; what approach should leadership adopt in order to successfully migrate the delivery system through the inflection point where quality of care and cost containment intersect? How will this collection of independent contractors and institutions coordinate care and meet the new quality metrics proposed by HHS? The fact of the matter is, health care is the most human of our national industries and reforming it to meet the shifting demographic needs and economic constraints of our society may prompt leadership to revisit how they choose to engage and integrate the human element within the system.

In contemplating this approach, a canvasing of the peer-reviewed research into both quality of care and cost containment issues points to a possible solution; the cultivation of emotional intelligence in health care workers. After reviewing more than three dozen published studies, all of which confirmed the positive impact cultivating emotional intelligence has in clinical settings, I believe contemplating this approach warrants further exploration.

Emotional intelligence is a skill as much as an attribute. It is comprised by a set of competencies in Self-Awareness, Self Management, Social Awareness, and Relationship Management, all leading to Self Mastery. Fortunately, these are skills that can be developed and enhanced over the course of one’s lifetime.

Keeping the number of handoffs and individuals involved in delivering the continuum of care, let’s examine how emotional intelligence factors into the proposed quality measures the Department of Health and Human Services will be using come October, 2012:

1.) Patient/Caregiver Experience of Care – This factor really comes down to a patient’s perception of care. Perceptions of care are heavily shaded by emotions. Patients consistently rate less skilled surgeons that have a greater bedside manner as better than maestro surgeons that lack, or choose not to display, these softer skills. Additional research into why people sue over malpractice also indicates how perceptions of care are formed. People don’t sue over a medical mistake in and of itself. People sue because of how they felt they were treated after the error occurred. From the patient’s perspective (and often their family’s) there’s a difference between being cured and being healed. The difference often can be found in the expression of authentic empathy through healthy, professional boundaries.

This is a key driver in patient decision-making as well. Patients tend to choose a hospital based upon one or two criteria; the recommendation of their primary care physician (with whom they have an established relationship) and/or upon the recommendations from family members or friends that have experienced care in a particular hospital or an individual surgeon. A quick look into the field of Applied Behavioral Economics supports this finding. Economic decision making is 70% emotionally driven with the remaining 30% based in rational thought. In many instances, it would appear that a lot of hospital marketing initiatives don’t seem to reflect an understanding of this phenomena. Waiting room times in Emergency Rooms have little to do with why patients choose a hospital, yet we see billboards everywhere that have the actual E.R. wait times electronically flashing along the roadside.

A patient’s experience (and perception) of care can be highly impacted at the handoff points within the continuum of care. Any new model of care will require exceptional cross-organizational communications to emerge. This requires a high level of engagement and commitment to the new vision at every patient touch-point.

This metric also addresses the caregivers’ experience of care. This speaks largely to the experience of nurses that are delivering that care. The research related to the impact of cultivating emotional intelligence in nurses clearly demonstrates a reduction in stress, improved communication skills, improved leadership and retention, the ability to quickly connect and engage patients, as well as a reduction in nurse burnout (which leads to turnover and additional stress amongst the remaining staff).

2.) Care Co-ordination – Again, this will require optimal engagement and pro-active communication intra-organizationally and cross-organizationally. Each handoff introduces opportunities for variable care to emerge that must be seamlessly co-ordinated. Poor co-ordination also introduces the risk of eroding the quality of the patient’s experience.

3.) Patient Safety – Research shows that the cultivation of emotional intelligence competencies in nursing contributes to positive patient outcomes, lowers the risk of adverse events, lowers costs at discharge, and reduces medication errors, all while lowering nurse stress, burnout, and turnover. Each time a nurse resigns it adds to the nursing shortage on the floor, requires additional hours from other nurses, and costs the hospital approximately $64,000, on average, to backfill the open position. Improving how an institution cares for its nurses improves the level of patient care and safety as well. In many institutions, this will require a shift in leadership’s perspective in order to support a culture that embraces and values the critical role nurses play in maintaining patient safety.

4.) Preventive Health – Elevating Self-Awareness and Social Awareness in clinicians helps them quickly connect and effectively communicate with patients. Subtle, non-verbal cues become more readily apparent, helping clinicians understand the fears and emotions of their patients. Self Management and Relationship Management helps clinicians communicate appropriately and supports the expression of authentic empathy through healthy, professional boundaries. All of these factors come into play when speaking with patients about lifestyle choices, course of treatment, and preventive health care.

From our own personal lives we’ve all learned we cannot “fix” other peoples’ behaviors. We can, however, be in relationship and help support healthy changes they’re ready to embrace. Pro-actively moving to improve preventive health will require deeper, more authentic relationships to emerge between front-line health care providers and patients.

5.) At-Risk Population/Frail Elderly Health – Like preventive health, being measured on the care of the community’s at-risk population and elderly will require an innovative approach to community outreach and pro-active communication. These are not populations that can be easily reached via Facebook or Twitter. Building effective relationships with these demographics will require trustful, human contact and deep engagement with each population, both of which are supported through the development of a mindful approach (i.e. emotionally intelligent) to the challenges at hand.

It will be interesting to see how reform unfolds and how leadership within the health care delivery system chooses to respond to the challenges that lie ahead. Systems and hospitals that choose to take an honest, evidence-based look at how they choose to lead, how they create and execute strategy, and the organizational culture they’re cultivating will be well served in preparing to successfully navigate this unprecedented change.