Jane M. Von Bergen, Inquirer Staff Writer
In other election news, low-paid workers will get raises due to ballot initiatives in three cities.
In Albuquerque, the minimum wage will rise from $7.50 to $8.50 an hour, starting in January, with automatic cost-of-living increases, a move that may affect 40,000 or one-seventh of the city's workers, said the National Employment Law Project, citing a New Mexican study.
San Jose workers will receive $10 an hour, up from California's $8 an hour minimum wage, again with an automatic cost of living increase built in. NELP cites a University of California study that says that 69,000 workers, or 18 percent of the workforce, will benefit.
Jane M. Von Bergen, Inquirer Staff Writer
"The problem may not be that executives are paid too much, but that employees are paid too little," writes corporate consultant in Donald P. Delves in the most recent issue of Directors and Boards, a trade magazine that focuses on corporate board governance.
In his column, Delves credits a reporter for prompting him to think about why so many people complain about executive compensation, when, in fact, there are increasingly more trends that link pay to performance. That's all well and good, the reporter said to Delves, but what about the regular worker whose pay has not increased in real terms for decades?
Delves said he didn't mean that everyone should get a big raise. But, he said, companies put so much thought into how to compensate the top dozen executives that they haven't turned enough attention to the rest of the group.
Jane M. Von Bergen, Inquirer Staff Writer
A proof of employee engagement, experts say, is that staffers fully understand their organization's mission and can articulate their role in it. If that's the case, the nine people working for La Salle University registrar Dominic Galante are fully engaged.
That's what struck me when I visited Galante at La Salle on the day the university feted him for his 50 years on the job. He left the office on an errand and when he did, I walked around talking to his folks. Their responses to him and their job were remarkable for how closely they mirrored the philosophies that Galante had expressed to me in an interview minutes earlier. You can read my story about him in Friday's Philadelphia Inquirer.
Keep in mind, this is a university, where everyone is equal, except maybe the academic types, like the professors, may be a little more equal. The people in the registrar's office, which keeps academic records for La Salle's alumni and 6,600 current students, plus handles all the class scheduling, are more like the invisible hamsters that keep the place going, rowing the oars (to mix a metaphor) on the great ship of higher learning.
Jane M. Von Bergen, Inquirer Staff Writer
Maybe, if the practice of medicine goes the way Temple University's associate vice dean of health care services Paula L. Stillman thinks it will, community health workers will move from the margins to an integral part of patient care.
And if that happens, what is basically an ad hoc profession will probably require standards and definitions and core competencies and regulation. Stillman wants Temple to be a pace-setter in that conversation.
"Here's the problem," said Stillman, a physician and Temple University Health System's vice president of health care services. "People use the term community health worker without defining what the person's background is, what the level of care is and a lot of the studies that examine the outcomes are soft studies or stories."
Jane M. Von Bergen, Inquirer Staff Writer
So, who gets the savings? Let's assume that community health workers are successful, as Michael "Chris" Gibbons says they were in Baltimore, in reducing the number of babies who end up in the neonatal intensive care unit. All good, right? Maybe.
All good for everyone except doctors who specialize in that kind of care.
"The issue of saving money is a complicated one," said Gibbons, associate director of the John Hopkins Urban Health Institute. "The question becomes savings to whom?"
Jane M. Von Bergen, Inquirer Staff Writer
Michael "Chris" Gibbons doesn't doubt for a moment that the kind of community health workers being trained at Temple University Hospital can make a difference in health outcomes. But paying for them is a whole 'nuther story, as I reported in my story in the Philadelphia Inquirer.
"These programs suffer because of funding," said Gibbons, a surgeon who is the associate director of the John Hopkins Urban Health Institute in Baltimore where community health workers have long been part of the program. Community health workers "can't get paid through the same mechanisms that doctors get paid -- fee for service through Medicaid or Medicare" or other insurance.
Instead, he said, his program has to rely on flavor-of-the-month funding, although he didn't use those words. Ten years ago, his program had eight community health workers, now it has two. "You have to be a revenue-generating personnel to get paid," he said. Otherwise, "you have to find funding either through philanthropy or research."
Jane M. Von Bergen, Inquirer Staff Writer
Imagine what would happen if you were the last health professional who saw an abused woman alive before her boyfriend beat her to death. In the scenario I described yesterday, imagine that you had said nothing. Imagine that you had said something. Imagine that something had gone terribly wrong. Can you picture the guilt, the remorse?
Health care, education, social work. Where are the boundaries? There is so much responsibility, such great need and resources are few -- the resources of the system, our own personal resources, our own personal strength, our own personal capacity.
When I was reporting on the story on community health workers that appeared in the Philadelphia Inquirer, I asked the director, Paula Stillman, vice president of health care services at Temple University Hospital, about the psychological training given to these workers. Frankly, I wasn't satisfied with the answer. Basically, the answer was, when these workers feel uneasy, when they feel beyond their capacity, they should call their supervisors.
Jane M. Von Bergen, Inquirer Staff Writer
Imagine that you are a community health worker visiting a woman who has missed a couple of doctor's appointments. While sitting in her living room, you notice something disturbing. Just above her wrist are a series of bruises, spaced so they look like they were caused by someone roughly grabbing her arm. There's more. She's in pain, limping badly and seems very despondent. She says she has fallen lately. Maybe something is broken.
Now what? It looks a lot like domestic violence. Should the health worker bring it up? What should be the response? That was one of the scenarios experienced by the students in the Temple University Hospital community health worker program I wrote about in the Philadelphia Inquirer recently. The students were tested, one-on-one, with "standardized patients," people trained to act out scenarios or illnesses so doctors and health care providers can practice. The goal in this case was to get the woman to agree to see a doctor.
I watched some of these from the other side of a one-way mirror and I also listened to a debriefing later. Almost all the students picked up on the possibility of domestic violence, but not everyone brought it up in the conversation. I saw a 20-year-old young man attempting to counsel this woman, a prospect that horrified me. Talk about rushing in where angels fear to tread.
Jane M. Von Bergen, Inquirer Staff Writer
About 150 miles away from Philadelphia, Mississippi, the Delta Health Alliance in Washington County, Mississippi uses community health workers to handle some of the same problems found in our Philadelphia. (Read my article in today's Inquirer here.)
"The Mississippi Delta is one of the poorest areas in the country," said Jane Calhoun, an official with the health care organization. "We're a very impoverished area. We have a low literacy level, a lot of uninsured among our population, obesity, diabetes. We’re in the stroke belt. There's a lot of cardiovascular disease and hypertension."
Unlike our Philadelphia, where there's almost a hospital on every corner, health care facilities are a few and far between and there's a chronic shortage of providers. It's so bad, Calhoun said, that until they trained community health workers, there was no one to talk over diabetes care with the diabetics themselves. "They may have been told how to do the insulation injection and then hope that they grasped it." Health education for diabetics consisted of a printed handout, sometimes written in medical legalese by the pharmaceutical companies selling the insulin, not in language that someone with an elementary school education could understand.
Jane M. Von Bergen, Inquirer Staff Writer
I wish the word "management" had fewer letters, because then maybe, it would show up in headlines along with "union" or "labor," nice short words to top a one-column article. What bothers me so much about the news and commentary on unions is that people forget that contracts are involved.
At some point in the employer/employee relationship, managers from the business or enterprise and union leaders representing workers come to an agreement on a contract. While negotiating, each side brings to bear whatever strengths and tactics it has. Is this a surprise? This is how it works in every contract or relationship, from buying a car to being married. However, unlike marriage, once an agreement is reached in workplace negotiations, it is put into writing. At that point, it becomes just as much a management contract as a union contract.
It's a contract, period.
