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trustsmallAuthor Stephen Covey wrote that “trust is the glue of life.  It’s the most essential ingredient in effective communication.  It’s the foundational principle that holds all relationships.”  Such an observation goes a long way toward explaining the massive disconnection and disaffection between citizens and their elected representatives.

In the latest findings from its annual poll, the Gallup organization showed only 8 percent of Americans rated the honesty and ethical standards of Congress as “high” or “very high.” State officeholders did somewhat better at 14 percent.  In between the two groups are car salespeople at 9 percent. Meanwhile, a Wall Street Journal/NBC poll released earlier this year showed President Obama’s job-approval rating at an all-time low, while only 34 percent of those polled said their member of Congress deserved another term.

At the other end spectrum are those who provide health care.  Nurses once again topped the Gallup poll, with 82 percent rating them high/very high for honesty and ethics. Nurses were followed by pharmacists, who tied with grade school teachers at 70 percent, and medical doctors, who tied military officers at 69 percent.

Hospitals no doubt benefit from these positive perceptions; a 2013 Harris Interactive poll measuring Americans’ trust in various industries showed hospitals second (supermarkets were first).  Still, only 28 percent of Americans agreed that hospitals are “generally honest and trustworthy,” though that easily bested banks (18 percent), carmakers (11 percent) and health insurance companies (7 percent).

In terms of public trust, business has historically fared better than government. The 2014 Edelman Trust Barometer shows the largest ever gap between the two since the study began in 2001, indicating that government is losing trust while business is gaining.  In analyzing these results, CEO Richard Edelman wrote that government now lacks the agility to effectively partner with business to bring about innovation as well as the credibility to lead innovation.

“Now it is business’ turn to ascend the ‘bully pulpit,’ Edelman wrote. “Business has recovered trust from the crisis period because it is seen as having made demonstrable strides in transparency, supply chain and product quality.”

Edelman’s first recommendation: CEOs must become “Chief Engagement Officers” who publicly “make the macro case for forward progress, not just the micro case for a given product…There should be the usual strong economic rationale, but there must be thoughtful consideration given to arguments that address emotion and risk, as well as societal benefit.”

From there, Edelman urges business leaders to empower employees and seek input from a broad range of stakeholders with a clearly articulated business strategy, beginning foremost with how a proposed change will improve lives.  As change moves forward, it should evolve based on collective inputs.  Leaders should report frequently on progress against specific quantitative and qualitative targets and be prepared to acknowledge and deal with shortfalls.

In health care, there are clear connections between Edelman’s findings and advice regarding trust and the issues and strategies hospitals are dealing with.  Coordinated care, patient-centeredness, value-based purchasing, transparency, community benefit, use of social media – these all hold the promise of building public trust in health care providers by strengthening individual relationships with both external and internal audiences.

The primary take-away is that patients, particularly in younger generations, don’t want to be “sold” care; they want to partner with providers to manage and improve health.  They want a relationship. As Covey points out, without trust, relationships dissolve.  As Edelman shows, people expect to be engaged – to have a relationship – with the businesses they choose to trust.


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iowa poisonA poison control center is one of those things in life that most people on most days will never use, yet it fills such an obvious need that people instinctively support it, even if they take it for granted.  This might be why the Iowa Poison Control Center (IPCC) is once again fighting for its future.

Located in Sioux City, IPCC is a cost-effective public health program that saves lives and millions of Iowa taxpayer dollars every year.  The center represents a unique public-private partnership that provides Iowa with an efficient, cost-effective and life-saving public health resource with a breath-taking 16:1 return on investment.

The center has an annual budget of about $1.6 million, including about $600,000 from the state.  Iowa hospitals, which routinely seek the center’s advice on poisoning cases, provide about $400,000 per year.  That leaves IPCC short about $500,000 this year, primarily because of federal funding cuts.  The center is asking state legislators to make up the difference.

IPCC provides an invaluable, 24/7 service to Iowans and their health care providers by taking more than 50,000 calls a year (that’s more than 135 per day).  About 75 percent of the calls come from the public, while the rest come from health care providers.  About half of the calls involve children younger than six years old.

The calls are routed to physicians and nurses who are experts in toxicology and who not only help parents and providers but also teach health care professionals about poisons, including students from Iowa’s two colleges of pharmacy.  Moreover, poison centers are in a unique position to first detect emerging public health threats, such as the dangers posed by synthetic drugs.  And once a threat is detected, these centers are a vital partner in local, state and federal response efforts.

IPCC saves millions of dollars in unnecessary health care spending.  Ninety percent of calls from the general public are treated at home, meaning more than $12 million in medical costs for trips to the hospital or doctor are avoided each year.  In other words, every dollar invested in IPCC saves at least $16 in health care costs.

Patients managed with poison center expertise on average experience shorter hospitalizations, helping health care providers serve more patients, improving health outcomes and decreasing health care costs.  IPCC provides its services to citizens efficiently and effectively; the cost per poisoning call to IPCC is far below the national average.

It’s also worth noting, as the center seeks additional support from the state, that 46 percent of callers are covered by Iowa Medicaid, which saves that program $5.7 million annually.

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psafetyThe 127 hospitals participating in the Iowa-based Hospital Engagement Network (HEN) prevented potential harm to more than 4,300 patients in 2013 and reduced health care costs by more than $51 million, according to data released today by the Iowa Healthcare Collaborative (IHC), which administers the network.

Among other improvements, participating hospitals reduced early elective baby deliveries (which can increase complications) by 90 percent; catheter associated urinary tract infections by 44 percent; adverse drug events by 28 percent; central line-associated blood stream infections in intensive care by 24 percent; surgical site infections by 24 percent; patient falls by 23 percent; and avoidable re-admissions by 11 percent.

This work has taken place as part of the federal Partnership for Patients initiative, with the goals of reducing harm by 40 percent and hospital readmissions by 20 percent.  The program has helped the hospitals develop the infrastructure, expertise and organizational culture that will support further improvements for years to come.  The Iowa HEN, which includes12 hospitals in Illinois and Nebraska, has accelerated improvement across the state and patients are benefiting every day from the spread and implementation of best practices.

In addition to reducing costs, the Iowa HEN reduced the time that patients spent in the participating hospitals by 17,758 days.  It’s estimated that at least 32 lives were saved because of the HEN.

“Through the HEN program, Iowa hospitals and their 71,000 employees are ensuring that patients are safer when they are in the hospital and less likely to return to the hospital, all of which reduces the cost of care,” explained Tom Evans, M.D., IHC CEO.  “In many ways, Iowa was already a leader in these measurements, but our hospitals have taken up the challenge to do even better – and they are succeeding.”

“Iowa physicians and hospitals are committed to raising the quality and safety bar in all parts of the state,” said IHC Board Chair Jeff Maire, D.O., of Mercy Surgical Affiliates in Des Moines.  “Through that commitment we are increasing value and bending the cost curve for all health care consumers.”

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legislatureThe story goes that Andrew Jackson, as the nation’s seventh president, once set out a huge block of cheese to encourage ordinary Americans to visit and interact with the White House.  As folklore, the story is mostly homage to Jackson’s down-home, populist image:  raised in the Carolina backwoods; self-taught country lawyer; first elected representative of Tennessee to the U.S. House; national hero who defeated the British at New Orleans during the War of 1812.

There is some truth to the cheese story.  In 1835, a wheel of cheese four feet in diameter and two feet thick was created by a New York dairy farmer, part of a collection displayed at a local patriotic gathering, which culminated with the largest wheels being shipped to leaders in Washington, D.C.  The biggest, weighing some 1,400 pounds, found its way to the White House.

President Jackson supposedly distributed some of the cheese to friends and colleagues, but by 1837 the wheel was largely intact and still in the White House.  Two years of aging and the accompanying odor pushed Jackson and his staff toward a solution, which led to a public reception where, reportedly, 10,000 visitors devoured the cheese in two hours.

The big block of cheese story, then, is more about symbolism than actual history.  In addition to bringing even more color to Jackson’s already flamboyant personal story, the idea of inviting and feeding thousands of citizens inside the walls of the world’s most powerful residence reinforces how we, as Americans, view our relationship with those who govern – “of the people, by the people, for the people.”

For IHA, that relationship is put into action daily through continual advocacy efforts and comes to a head each year at our Legislative Day.  For more than 20 years, IHA has invited hospital leaders and advocates to come to Des Moines, learn about the issues affecting their hospitals and share their concerns with legislators at the seat of state government, the Iowa Capitol.

Far from being merely symbolic, these personal interactions are truly affective in advancing the Iowa community hospital agenda.  One-on-one conversations with legislators by hospital representatives who have come from all corners of the state make a real impression – and they make a real difference.

Time and again during last year’s Medicaid expansion debate, legislators from both sides were heard to say, “This is what my hospital is telling me.”  Obviously, much of what legislators were hearing was communicated via e-mails, letters and phone messages, so imagine the impact of a face-to-face conversation, particularly if it takes place on their legislative turf.

Make no mistake, however, perception does matter.  The fact that IHA, year after year, is able to bring hundreds of voters representing every state Senate and House district to Legislative Day does not go unnoticed.  The sight of busloads of hospital advocates pulling up to the Capitol serves as urgent notice to rookie legislators and a stark reminder to veterans:  there are real people behind those e-mails, they care about their hospitals and they are a force to be reckoned with.

That force must be re-energized and reorganized each year.  For that to happen, hospital leadership is needed.  IHA is known and respected “on the hill” because behind our expert lobbyists are thousands of hospital leaders, employees, trustees and volunteers ready to spring into action.

On Wednesday, IHA will be asking hospital advocates to bring their passion to Des Moines.  Be heard.  Make a difference.  And who knows, there may even be cheese…

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econ-tableIowa’s community hospitals generate nearly 120,000 jobs that add more than $6 billion to the state’s economy, according to the Iowa Hospital Association’s latest Iowa hospital economic impact report.  In addition, Iowa hospital employees by themselves spend more than $1.6 billion on retail sales and contribute nearly $99 million in state sales tax revenue.

“People are often unaware of the contributions that hospitals make to their local economies, including the number of people they employ, the significance of hospital purchases with local businesses and the impact of their employees’ spending and tax support for an entire region,” said Kirk Norris, IHA president/CEO.  “Just as no one provides the services and community benefits found at community hospitals, there is also no substitute for the jobs and business hospitals provide and create.”

The IHA study examined the jobs, income, retail sales and sales tax produced by hospitals and the rest of the state’s health care sector.  The study was compiled from hospital-submitted data on the American Hospital Association’s Annual Survey of Hospitals and with software that other industries have used to determine their economic impact.

The study found that Iowa hospitals directly employ 71,437 people and create another 48,553 jobs outside the hospital sector.  As an income source, hospitals provide $4.2 billion in salaries and benefits and generate another $1.8 billion through other jobs that depend on hospitals.

In all, Iowa’s health care sector, which includes employed clinicians, long-term care services and assisted living centers, pharmacies and other medical and health services, directly and indirectly provides 307,402 Iowa jobs, or about one-fifth of the state’s total non-farm employment.

Complete information from the study, including economic impact data for each of Iowa’s hospitals, is available on the IHA website at

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