Two physicians from Beijing, China saw health care from a very different point of view while visiting the United States as part of an International Health Fellowship, sponsored by Health Bridge International, a non-profit organization based in the United States.
Yong Jiang, M.D., vice chair of the Department of Surgery, and Sheng Wu, M.D., attending physician of the Emergency Department at Peking University First Hospital, spent a month visiting Mills-Peninsula Medical Center, in Burlingame,Calif., to learn about the U.S. health care system. In December the physicians explored the outpatient setting at Palo Alto Medical Foundation. In January, they spent time at Mills-Peninsula in as many departments as possible and shadowed several physicians.
At the conclusion of their stay, they spoke at a briefing at Mills-Peninsula to share their thoughts about health care in China and what they have learned during their visit to the medical center.
They related that in China, one of the biggest health care challenges is the disparity between health care need and resource allocation.
“Seventy percent of the population in China is rural but they get only 30 percent of the medical resources,” Dr. Jiang said. “The cities have 30 percent of the population but get 70 percent of the medical resources. As a result, rural people flood the city hospitals.”
Another problem is the lack of an appointment system at hospitals in China.
“Patients just show up at the hospitals and take a number,” Dr. Jiang said.
The photo he shared with the audience depicted long, dense lines of people waiting, making the emergency room entrance look as crowded as an international airport closed for severe weather.
Dr. Wu said that doctors never know how many patients they will see in a day and may have only 10 minutes to spend with each person.
He also cited Chinese hospitals’ inefficient processes for transferring of patients between departments.
“We don’t have a quick way to get a heart attack patient from the Emergency Department to the cath lab,” he said. “In China it can take three hours.”
When asked what he has learned about health care in the United States that could be implemented in China, Dr. Wu said, “Everything and nothing. We have learned from your ideas, but we cannot copy them because our systems are just too different.”
One of the goals of the visit was to learn more about the patient-centered approach to care in the United States.
Mills-Peninsula Physician Services Manager Donna Everix, who coordinated all of the scheduling for the month-long visit, described a visit to the Mills-Peninsula cardiac catheterization (cath) lab.
“While visiting the cath labs, Drs. Wu and Jiang were surprised to see that we asked the patients what they wanted to do, rather than ask the family, which is how they do it in China. They are not accustomed to a patient-centric approach so seeing how we make that a priority was eye-opening to them.”
Dr. Yong Jiang described health care inChina as a “ticking time bomb”:
- 350 million people smoke
- There is a huge aging population
- Rural residents lacking health care insurance often have to take out loans or sell their homes to pay for hospital care
- There is very high resistance to antibiotics and penicillin because of over prescribing and self prescribing; antibiotics are sold over the counter with sales and use regulations are not always enforced.
- There are no public health workers or community health programs.
- Philanthropy and volunteerism are very uncommon
Peking University First Hospital is quite large; three campuses house 60 wards, 36 clinical departments and 1,500 beds. Nearly 7,000 patients are treated there every day. More than 45,000 patients are admitted and an estimated 20,000 operations are performed annually. The medical campus integrates health services with teaching, research and preventive medicine. Opened in 1915, the hospital is near the old imperial city in the center of Beijing.
“Many of our physicians and staff took time to meet with Drs. Wu and Jiang and show them all of Mills-Peninsula’s wonderful programs and services,” Everix said. “They are very grateful for the time and knowledge we have shared.”
In the last days before they return home, Mills-Peninsula scheduled the doctors to meet with local representatives of the Red Cross, emergency operations at San Francisco International Airport, and the San Mateo County Department of Public Health.
“This was a great opportunity to learn from each other and we hope to have ongoing programs to share our best practices,” Dr. Jiang said. “Our goal is better health care at a lower cost and we have a long way to go.”
“After more than a year of negotiations, we have reached agreement with the California Nurses Association (CNA) on a contract that helps Mills-Peninsula achieve the goal of being more affordable for our patients,” according to Bob Merwin, Mills-Peninsula CEO.
“The agreement, which Mills-Peninsula registered nurses voted Thursday to ratify, represents compromise on both sides, resulting in a good contract for registered nurses and progress toward greater parity in wages and benefits across our organization,” Merwin said. “We began this work in May 2011 committed to fairness for all Mills-Peninsula employees while also focused on responding to the market-place demand for lower health care costs.”
Mills-Peninsula’s overarching goals stated at the beginning of negotiations were to align wages with the rate of inflation, increase staffing flexibility, and establish more equitable RN contributions to health plan benefit premiums.
The new agreement largely achieves these goals over its remaining two years:
- Two percent wage increase on ratification; two percent in September 2013 (no ratification bonus or retroactive 2011 increase)
- Move from a zero-cost health plan option for the RN-only to $48 per month in 2014.
- Transition from the legacy retiree health plan benefit to a retiree health savings account in 2014 with a maximum of $30,000, at $1,000 for each year of service.
- Retain the extended sickness leave (ESL) benefit, capping it at 700 hours.
“I thank the Mills-Peninsula RNs who voted to ratify the new contract and look forward to building on this collaboration to be more affordable for our community,” Merwin said. “I gratefully acknowledge the dedication and commitment of managers and staff who stayed the course this past year and a half to care for our patients through five strikes. Thanks to all these efforts, we are moving in the right direction with key agreements now that help ensure a strong future for everyone at Mills-Peninsula and excellent health care for the communities we serve.”
State Earthquake Safety Law Prompts Change
To meet earthquake safety standards set by the State of California, the Standby Emergency Department (ER) at Mills Health Center in San Mateo must close on Dec. 1, 2012. The Standby ER will be replaced with an Urgent Care Center in the same space, scheduled to open in fall 2013.
California Senate Bill 1953 requires that as of Jan. 1, 2013, all California acute care facilities either retrofit their buildings to meet stricter standards or discontinue acute care. The law is intended to protect the most acutely ill patients who are confined to bed and couldn’t be easily evacuated in the event of an earthquake.
At Mills-Peninsula, critical emergency care has been provided exclusively at Mills-Peninsula Medical Center in Burlingame since 1997, when all acute inpatient care was consolidated at that location. Emergency surgery and other care services required for treating critical emergencies have not been provided at Mills since the 1997 consolidation.
“We examined the use of the Mills Center Standby ER in recent years and found there is a greater need for urgent care in the area,” Bob Merwin, CEO, said. “Ambulances have bypassed Mills Health Center to take critically ill or injured patients to Mills-Peninsula Medical Center in Burlingame since the Mills ER was downgraded to standby status.”
In 2011, the Mills Standby Emergency Department served about 34 patients a day, compared to about 100 at Mills-Peninsula Medical Center and up to 145 a day at San Mateo County Medical Center. Between midnight and 7 a.m., on a daily average, three to four people come to the Mills Standby ER for care.
“Steep construction costs combined with the proximity of the new hospital and emergency services in Burlingame made the retrofit of the Mills Center economically unfeasible,” Merwin said. Estimated retrofit costs for the Mills Center were as high as $80 million.
The building that houses the Standby Emergency Department is the only building at Mills affected by the law. All the other programs and services provided at Mills meet applicable earthquake safety standards and will continue operations.
“The new medical center that opened in Burlingame last year has a full service emergency department that was designed to serve twice as many people. We are consolidating our emergency services and are ready to care for all of the patients who traditionally have used the standby emergency department,” Emergency Services Medical Director Allan Brody, M.D., said.
Mills-Peninsula Medical Center is only four miles away and easily accessible from California Drive, El Camino Real or Highway 101.
Mills-Peninsula is working closely with state regulatory agencies and local government to ensure the public is well informed about the changes.
The San Mateo Emergency Services Department is holding a public hearing on the closure on Sept. 27, 5-6:30 p.m., in Room 100 of the San Mateo County Health System at 225 37th Ave. in San Mateo.
Mills-Peninsula also is implementing extensive community outreach including personal letters to patients, advertisements and presentations to senior residences and community groups. A detailed “Question & Answer” sheet is being provided in the Standby Emergency Department at Mills.
The Difference between Emergency and Urgent Care
Generally, an emergency is a condition that may threaten a person’s life or cause impairment if treatment is delayed. Urgent care treats medical problems that, while not emergencies, do require prompt care within 24 hours. According to Brian Roach, M.D., president of the Mills-Peninsula Division of the Palo Alto Medical Foundation, who is developing Center, it will offer:
- Diagnostic services including laboratory and radiology
- Treatments such as IV fluids and medications, splinting and casting, wound suturing, urgent minor surgical procedures
- Respiratory therapy treatments
- Extended hours, 365 days a year
- Urgent care for all patients, regardless of insurance type
From six-figure average wages for full-time nurses to an employer-paid pension and other quality benefits, Mills-Peninsula and all Sutter Health hospitals understand that providing high-quality care for patients starts with taking great care of nurses—and all employees.
Full-time RNs at Mills-Peninsula with open labor contracts earn on average:
- More than $140,000 a year (based on 2010 W2 data)
- An employer-paid pension plan worth about $84,000 a year
- Employer-paid retiree health care benefits; most receive a spending account valued up to $35,000 to help cover the cost of premiums, medications, etc.
- Up to 40 paid days off annually to use for vacation, sick time and other personal uses—about eight weeks of each year
Despite this generous compensation package, the California Nurses Association (CNA) leaders have called yet another strike for June 13. This is the fourth strike in less than one year and the second in 45 days. Read More about Nurse Wages & Benefits Still Generous – California Nurses Union Keeps Striking
This time last year, on May 15, 2011, the doors to the new Mills-Peninsula Medical Center opened.
In its first year of operations – caring for people 24 hours a day, every day – an award-winning team of doctors, nurses and staff has tallied a number of accomplishments:
- 1,956 babies born
- 44,738 emergencies answered
- 18,787 rehabilitation treatments given
- 1,358,149 lab tests performed
- 10,532 surgeries
- 314,738 outpatient services
- Read More about Mills-Peninsula Medical Center Celebrates One-Year Anniversary
The California Nurses Association strike at Mills-Peninsula Health Services ended quietly at 7 a.m., on Sunday, May 6. Although the union called for a one-day strike, the Mills-Peninsula replacement staff vendor contract requires a minimum replacement period of five days.
As in each past strike, Mills-Peninsula continued to fulfill its mission to care for the community. According to Mills-Peninsula Health Services CEO Bob Merwin, the California Department of Public Health was on site every day and expressed confidence in the quality of care that was being provided.
“During the five-day replacement period, day-to-day operations continued without incident. Eighteen babies were born, 661 patients received care in the emergency rooms, and 12 people had surgery,” Merwin said. “We are very thankful to all the staff who stepped up to make sure we continued to provide excellent care for our community.”