"Decrease the power distance to empower everyone." That was very well said. I work in an ER and it is terrifying to speak up because of this.

I think this is a great discussion. However once again, I hear a physician saying physicians should be making leadership decisions and making plans for care. Nurses need to be in this picture. We see patients 24 hours per day whilst the physician may spend 5-10" with that patient per day. Nurses and physicians need to be working together along with the inevitable bean counters in administration to improve care, improve satisfaction and determine how we can improve costs while NOT sacrificing care. Then we nurses need to have a nationwide discussion on what it means to be a nurse leader.

I work in LTC. The state of Texas says one nurse to 40 pts in LTC. I currently have 62 pt at a time. This includes 6 g-tubes, 5 wound vacs, 6 peritoneal dialysis, many, many, many wounds, 5 trachs (a lot of these are the same pts) not to mention their medications and total care (turn over is unbelievable and staff typically doesn't even show up.) I COMPLETELY support some sort of regulated and ENFORCED ratios.

Great Show. Dr. Strumwasser finally a message that speaks the truth. I wish more CNO's could hear your message. So many of them have forgotten what it's like on the front line. There would be less adversary between staff nurses and leadership if they spoke more about the reality and were able to use their leadership ability to offer up sustainable solutions instead of cumbersome processes that nurses stop doing or find work arounds. It's important as a leader to utilize all your knowledge not just what you learned at business schools or didn't learn because you advanced based on popularity and years of service. The best tools a leader has is to observe and listen before making blanket decisions .

what’s the point in having more clinicians as administrators if they won’t protect their own people with mandated staffing ratios?

Without staffing ratios nurses are consistent and regularly and systematically denied the right as a worker to have breaks for meals, bathroom, rest. Pt’s needs are often urgent and place so much pressure on nurses that create impossible demands to satisfy patients and administrators. Like being in 2 places at one time. Like taking a patient off the bedpan (later complains)when Pt in another room in a bleeding crisis or seizure. Who could even recall what was going on that day as a nurse? Where is the supervisor supporting the floor and supporting appropriate clinical priorities. Using a CNA for CNA capable tasks for example. Work one 12 hour shift with one floor nurse at your hospital of choice and come back and give your opinion again. Do not assume your experience is isolated. There is widespread abuse of nurses where no laws exist. 39 years of nursing speaking in many areas of practice. Practice by the golden rule. Via Nashville Tennessee. North Carolina PA. VA.

I am 39 yrs veteran of nursing who enjoyed the relationship to learn and teach docs. Lately new nurses aren't aggressive in learning and advocating and docs are treating them derisively and it was hard for me as the vocal, educated persistent nurse

Now that was a great conversation!

Yea to make healthcare the best it can be we have to get outside ourselves and make everything we do about the patient. I don’t care what position anyone has in the hospital, your job is to save lives. Be the best, at what you do with every encounter

ZDogg you need to speak to my hospital healthcare administration on this issue. They literally decided on a protocol they're implementing "one way or another" without ED physician input on admission issues while having us UR nurses enforce their policy. No questions asked. It's absolutely terrifying right now. I've never feared for my license as an RN or the healthcare system I do now.

I'm a non-practicing pharmacist and am listening to this program right now. Interesting comment about Berkeley, CA banning ECT; I had never heard of that but I did look it up, and that was rescinded in 1983. This reminds me of some areas that have tried to require transvaginal ultrasounds before an abortion; there are situations where not doing one would be malpractice, but mandating it is practicing medicine without a license.

I love that he talked about how grey and depressing Seattle is. It's true. Please don't move here, you'll hate it.

Love this guy

Hospital administrators should be accountable to and work for physicians, not the other way around. Physicians as professionals are the experts and leaders in healthcare. They should be empowered and provided with the resources necessary to improve patient care, not told what to do and what is 'best' for patients.

I would have liked to ask Dr Strumwasser why it is that us patients don't get to meet the Anesthesiologist until a few minutes before the procedure when he/she just breezes in and does a perfunctory check-up and asks you to open your mouth to see if you will have problems when they put the tube down your throat. Also, they sometimes switch with another doctor before the procedure without informing the patient or next-of-kin. When my husband had a prostate biopsy in Feb 2019, the original Anesthesiologist was a female and when we got the EOB from the insurance company, I noticed that the doctor that filed the claim was a male doctor. We were never informed there had been a change.

Important to remember that you are the exception. Most admin are not clinicians. They are fully business mindset and if they are unwilling to listen to their clinicians you get ratios that are unsafe. In that scenario we will never have a new generation of experienced nurses who know the nuances of their nursing practice and how to work to the top of their license. Legislate ratios or legislate that all CEOs have clinical background. Which is easier to accomplish?

recently worked for a clinician owned Urgent Care group. They were all MDs with one NP, they worked alongside all the hired providers, most of which were PAs and NPs. This lasted about 2 years but as they grew, it was too much to do both. They created a company, hired a CEO, CFO...ext. Got rid of all their previous HR and admin people. Pt care dropped to anything that took more than 10min-15min was too involved and was to go to the ER. When I hired on I was told they would never hire new graduates, due to the high acuity we saw. When I left after 3 years out of 16 providers, 3 had experience beyond a year and all the rest were brand new graduates.

Your channel is epic and innovative. I’m a professional patient (ileostomy, spinal stenosis, PSC) and you’re more “woke” than any physician I’ve encountered. #Respect

Very cool!

My ileostomy was DaVinci! Dr Lena O’Brien did it and I have had 7 laparoscopic surgeries. Heal time was vastly improved with DaVinci.

Z doc this is the best interview

Doctors need CRM Crew Resource Management.

I tried to address the doctor trying to “bite my head off” multiple times but it seems like very little can be done. It’s hierarchy issue!

Ok, I was good until the discussion turned to legislating patient ratios. I am willing to give him some slack because he is in California. Legislation is crucial to protecting patients and front line staff, it has to be done in a flexible appropriate way. I believe Illinois legislated pt. Ratios responsibly. They require each health system to have a board that consists of 50% floor staff for each clinical area to meet bi annually and set the staffing ratio for that area for the next 6 months. It is flexible, it is organized by the specific health system, they can adjust for changing demographics over time and the staff doing the work have a say in how their work will be done. It fosters empowerment and reduces distance to power.

Btw the CEOs of both the hospitals I have worked at were physicians! And everyone loved them!

When you get more than 4-5 sick patients it is difficult to make sure everyone gets appropriate care. Staffing ratios are sometimes as high at 8:1 for nurses. You are funny because I live in Wa and have a 7:1 ratio and NOT according to acuity! No one uses acuity anymore!

In his Heath 3.0 Video he says trash this guy, he is talking to for his WellHell Health Corp.

Lol they gave me a huge push back on sepsis protocol

hey guys? what if I too want to help and be a good enough health administrator for my masters? Good god in my country I saw people handle disposed glass vials with mere plastic gloves that definitely aren't good enough to protect people, registration systems are broken, and I just want to do something about it. Where to start?

You stated that nurses are being paid well. No way, no how. These men and women require terrific education but are on the front line and are the most vulnerable to poor staffing, nasty docs, and physical and emotional attacks by patients, patient families and physicians. Look outside of unionized nursing locations. Unions have not helped. Being without one is no better. I started as an AS, immediately earned a BS, no pay raise. Immediately earned an MS, no pay raise, immediately achieved ABD doctorate, once again no plus in income but a huge increase in responsibility. And I worked for a well respected medical firm.

Once Medical Personal go to management, they put a hat on of the corporation, making money becomes their priority.

I found this a bit disappointing and borderline obsequious. You were a little too soft here with some of the responses you received from Dr. Strumwasser. I have previously heard you take a much harder line in the past on many of the topics discussed during this episode. I know you don't want to aggressively debate or alienate your guests, but you can still raise some objections when you hear something that contradicts with your principles as a physician and healthcare provider advocate.

Doctors hate admins period

Ohhh I want to hear more about your experience with Sutter. I work for their call center 2 states away, and I always want to know what it’s like for people actually working over there.

Economies of scale has failed health care. Too large happens. Healthcare belongs in the hands of docs and nurses. Together we can achieve better outcomes at a lower cost. Just think about the costs all the business men and regulations bring. Not only are they often misguided but the vast number needed to enforce things unnecessary to the care of patients are quite expensive. I’ve been in meetings where MBA types are leading medical discussions and are way off base. Honestly, they appear to believe that because they are in healthcare they went to medical/nursing school. These men and women do not respect the health care providers as they expect the providers to respect them. A situation where they don’t know what they don’t know. Think back to when docs and nurses went house to care for patients because that was our mission. Anyone believe these business types would have even thought about doing this much less do it? Get with the patient and learn? Heck no.

Lost me at no mandated ratios. Boo.

Great video!! Sorry to be reactionary, but as someone who has witnessed ECT treatment, I am all for passing legislation that prevents it. Yes, the government has a role in regulating healthcare on such a level. Let's not forget that anthropologically speaking in the millennia of humanity's presence on the planet depression has not been as resistant that humans required it. Reprograming someone's brain chemistry can come about in less invasive and traumatic ways.

19:07-How about a programmed computer that can pull up the life saving protocol in the pt. room, like a mirror like large screen pull up the best and proven protocol to save the pt. given that the pt. came in with multiple critical issues in order to help support all the docs in their ethical work keeping them all on the same page to carrying out procedures. plus it would be much simpler to update for improvement each time. sounds like technology, something Elon Musk could invest in!! cut cost, less errors, less stress, much better out come! with that in place nurses and those below can make their voices heard to those in higher power more easily accessible!

Clinicians make the worst administrators in general. Very few actually go back to business school. I was an administrator who went to nursing school at 35. Although I went back into management and still am here. I spend tons of my time teaching clinical only people all the stuff they would have learned in business school... if they had went. You can’t even get clinicians to consistently wash their hands. It’s the clinicians who push back you only need to tell a person who works in the admitting office one time to wash their hands. Also our 2 hospitalist PA’s can run circles around all but one of our internists. Those docs hate them. It’s ego not sovereignty... when you work in a hospital it’s not private practice.

One way doctors can help reduce costs is to stop restricting the supply of doctors. Open the borders to foreign doctors, get rid of de jure licensure and residency requirements, allow the lines between PAs and MDs to be blurred as the market decides, stop requiring prescriptions for drugs, etc.

A Veterans' Hospital dangerous intersection! Please sign this free safety petition at www.gopetition.com/petitions/remove-the-danger-highway-intersection-at-usf-and-tampa-veterans-hospital-campuses.html. ​

Why the fuck are healthcare workers obliged to seek "business" education in order to assume leadership in the healthcare system? Healthcare workers should run the show ourselves.

My question is what are those who are not clinicians doing that make these goal non obtainable. Yes clinicians may know what to do but they are not always taking the steps to do that. Why can't non clinicians accomplish these goals from gaining insight from the clinicians in a give and take relationship.

You can't click box critical thinking! That's the first mistake that needs to change for the new nurses. We need to go back to truly teaching the nursing profession not just teaching to the test. Learn the foundation built on solid ground and use experience and teaching opportunities from those with more experience, they don't know what they don't know

Leadership in healthcare needs more practitioners on the boards, in administration, and in policy. We have to speak our story with each other and identify “turf wars”. Practitioners from ALL levels must be in leadership to represent each profession. AND, NP’s receive a general certification in a Master’s program without the requirements of residency or specialty certification. Doctors have an expansive academic curriculum, pressure induced residency, and certification requirements for each specialty interest. The Mid-level label identifies NP’s autonomous practice as one that meets criteria below the requirements of a physician. With that said, an NP is trained and certified in a mid-level medical model PLUS an expanded NURSING foundation. NP’s are uniquely qualified a medical model that does not equal the physician’s focused training or the PA’s medical training with physician approval. The conversation sounds like “stick and stones”. I know my place in healthcare and to change the foundational thought of diagnose and cure, we have to collaborate and improve certification and payments. As independent practitioner we can work on chronic care within an interdisciplinary model. Focus on the transparency of the disease process. Teach the patients how they got to that point, make joint patient goals. Patients take accountability right then, we document patient response, and base payments on patient engagement, and quality practitioner care. Patient engagement can be rewarded with lower medical cost and unmet goals, reinforced through telehealth or educational attendance. Just some thoughts. Interdisciplinary teams do not need turf wars; we learn from each other and provide insight that is original from each profession and practitioner’s experience.

This is bogus. This administrator behaves as if his hospital doesn’t push and advertise robots, devices and other BS. He behaves as if administrators don’t encourage physicians to maximize billing. This is disinformation. Blame the nearly powerless medical staff and not the MBAs that have taken over medication

😎

Docs are paranoid