Check out this article on the 2010-2011 Best Hospital Rankings from the U.S. News and World Report. These rankings, which include 152 hospitals of the 5000 considered nationwide, help guide patients who need “high-stakes” care because of the complex and urgent (often life-or-death) nature of their conditions. 16 specialties, from cancer and heart disease to respiratory disorders and urology, were considered. A hospital made it onto the list of 152 if it appeared in the rankings for at least one of the 16 specialties.

As far as ranking overall “best” hospitals, the 14-hospital “honor roll” included in the Rankings may be as close as you can get. Highly detailed criteria were used to determine which hospitals made the list and in which order, which is further detailed in the article. Here, a run-down of the 10 hospitals that are arguably America’s best:

1. John Hopkins Hospital, Baltimore
2. Mayo Clinic, Rochester, Minn.
3. Massachusetts General Hospital, Boston
4. Cleveland Clinic
5. Ronald Reagan UCLA Medical Center, Los Angeles
6. New York-Presbyterian University Hospital of Columbia and Cornell
7. University of California, San Francisco Medical Center
8. Barnes-Jewish Hospital/Washington University, St. Louis
9. Hospital of the University of Pennsylvania, Philadelphia
10. Duke University Medical Center, Durham, N.C.

It’s my last day at SmithGroup. I can’t believe it! As an outgoing intern, I asked myself the same questions as I have of other SmithGroup interns. Here’s my interview with myself. (No, I’m not schizophrenic.)

Sum up your internship in 10 words or fewer.
SmithGroup’s a great place to have your first “real” job.

What is your most memorable SmithGroup experience (for whatever reason)?
One afternoon Vanessa had planned to attend a “Meet the Press” marketing event but couldn’t make it, and so she sent me to attend and take notes. I got to hear John King speak – he’s an urban design writer for the Chronicle whom I really admire.

What is the biggest lesson you have learned here?
Put yourself out there and ask questions. Other interns have already said this, but it can’t be stressed enough. No one will fault you for not knowing the answer, and you can learn what you need to and move on.

What was the most surprising thing to you about your internship?
How relaxed and friendly people are here! Before I started I worried I would somehow be in over my head in the “corporate world,” but the people I worked with this summer were helpful and understanding, not to mention fun.

What advice would you give an incoming SmithGroup intern?
Put yourself in the places of the people you’re working with/for. What do they need from your end? What would they appreciate seeing from you?

What specifically is the coolest thing you’ve gotten to do this summer?
I’ve loved blogging for The Water Cooler, as well as writing for my external blog on issues of design and health. Attending the full range of office events – Bagel Design Reviews, BrownBag and GreenBag presentations, SGU Special Presentations  – and blogging about them has given me a great inside look at this company and the world of design.

This is design, in a way; this is health, in a way, and in all ways this is a postworthy organization. Last Thursday here at SmithGroup, Ann Kappes of the visual arts center Creativity Explored came to give a presentation on “Leveraging Socially-Responsible Local Art.” But before she got into that, she showed a series of photographs of the artwork coming out of the Creativity Explored studio. Abstract explosions of shapes, playfully painted cupcakes and bright swaths of color burst onto the projector screen, and I liked what I was seeing. It was only after Ann had showed us these images and shared a little about the artists who had created them that she mentioned that each of the studio’s artists is developmentally disabled. 

"Cupcakes" by Camille Holvoet

I had walked into the SGU Presentation knowing nothing about Creativity Explored, and so I was surprised to discover that the art I was admiring was created by adults with disorders ranging from severe autism to Down’s syndrome to cerebral palsy. 125 artists overall work at the CE studio. They range in age from 22 to 80, speak a total of 7 languages, are white, African-American, Asian and Latino. Some come in to the studio once a week, some every day, but each would identify with the declaration “I am an artist and I work at Creativity Explored.”

"Frida & Diego" by Kelly Clark

The artists’ creativity and talent combined with encouragement and training in all mediums from the center’s approximately 60 volunteers combine to produce stunning artwork. Various publications have described this work as “sophisticated, amusing, inspired, beautiful;” “joyful, chaotic;” and “fearlessly vulnerable.” What’s more, much of the artwork is sold: to individuals, corporations, curators and more. Half of the proceeds goes to the artists, a cut similar to that of any other art gallery, and these earnings have changed the entire financial situations of some of the more successful artists. One in particular, John Patrick McKenzie, who is autistic, has received international recognition for his text-based artwork, which is sold for thousands of dollars and displayed in solo and international exhibitions. 

"French" by John Patrick McKenzie

His success story is one of many. To see the artwork and learn the artists’ stories in person, visit the CE Studio and see the artists in action five days a week, 8:30 AM to 2:30 PM, or stroll through the gallery to view finished artwork on Monday, Tuesday, Wednesday and Friday 10:00 AM to 3:00 PM; Thursday 10:00 AM to 7:00 PM; or Saturday 1:00 PM to 6:00 PM. The main CE studio and gallery is located at 3245 16th Street (at Guerrero Street), San Francisco. Check out CE online at http://www.creativityexplored.org/

"Orange Abstract" by Anne Connolly

A few weeks ago at the office I saw a presentation by Carrie Strahan, Studio Director at the San Francisco office of the Architectural Energy Corporation. Through her overview of how AEC works with its clients to achieve energy efficiency, environmental responsiveness, and use of renewable energy in clients’ new and existing buildings, I learned a lot I hadn’t known about green design.

Carrie began by touching on the sustainability imperative: dramatic oil and climate change require dramatic change in how we design and operate our buildings. The construction and operation of buildings is the biggest contributor to the rising of our planet’s C02 levels (buildings account for 48% of our country’s total energy consumption; hospitals alone are responsible for a whopping 4% of this total consumption). Earth’s temperature is currently at .7°C above pre-industrial levels, and scientists warn that we must keep this difference under 2°C if we are to avoid dangerous climate change.

And so we look to energy engineering. Energy engineers (energeers?) team with architects to ensure that focus on sustainable design goals and implications is maintained throughout the design and construction process. The breadth of what can go into making a building energy-efficient is incredible: site selection, orientation of a building, shape, configuration, lighting systems, the role of daylight are only a few of the building elements that play key roles in a building’s sustainability (or lack thereof). You can’t just slap on a few solar panels once a building has been constructed for it to attain LEED status: you have to be energy-conscious from the very beginning, from pre-design to schematic design to design development to construction documentation.

To that end, AEC has developed a list of goals it pursues in each of its projects. The first of these goals is integrated energy design. Every design element affects every other: if the building site must be changed, how does the resultantly different exposure to sunlight affect approaches to fenestration? How might a adjusting a building’s shape influence which materials are used for its envelope? The second goal is to understand the climate of the building’s location, through such methods as studies of wind, sunshine and cloud cover. The third goal is Aggressive Load Deduction, the process of optimizing the energy-saving potential of those features that are “built into” a building – such as building orientation, massing and geometry, daylighting and percent of window area, shading, lighting, and envelope. Carrie presented a list of building attributes proven to reduce load, which included a slender floor plan along an east-west axis; daylight in perimeter areas; window-glazing specifications and shading according to orientation; and window glazing divided by function (for example, glazing used for “vision” glass, which is intended to be looked through, is different from glazing used for “daylight” glass, the primary function of which is to allow sunlight inside a building).

Energy engineering is cool. And it’s just one of the steps we’re going to have to take if Earth is going to keep its cool.

Former pediatrician Karen Li wrote a great article for Newsweek on why, after 10 years as a pediatrician in private practice, she said goodbye to the career she loved. The article offers a revealing look at the consequences of managed care, a paradigm (and, as Li attests, a blight) of American healthcare for the past 20 years. An excerpt of her article:

“No longer did we have extra time to spend with our patients. No longer could we prescribe the best medication. No longer could we send our patients to the best specialist or hospital. No longer could we order all the necessary tests to make a diagnosis. No longer did medicine make any sense. Why would a businessman or, worse yet, the HMO secretary with a treatment algorithm on her desk have any right to tell us what was best for our patients? After all, who had the medical training?”

(Li also happens to be the doctor who pounded my back immediately after I was born. I hope that if I had been able to, I would have looked her in the eye and said thank you.)

I like the direction we’re headed with Obama’s recently passed healthcare reform bill, but the fact remains that the American healthcare system is still a mess. To understand where we are right now, we have to look at where we’ve been. The healthcare crisis didn’t pop up overnight: it’s been brewing for  over a century. PBS produced a healthcare timeline that lays out, decade by decade, the evolution of American healthcare since 1900. Here I summarize it and define its more technical terms.

1900s

In 1901, the American Medical Association (AMA) reorganizes as the national organization of state and local associations, and over the next decade membership increases from 8,000 physicians to 70,000. Drumroll please…“organized medicine” has begun.

1910s

Progressive reformers advocating for more health insurance seem to be gaining public support until the 1917 entry of the US into WWI undermines their efforts. (At this point, people usually just pay doctors for individual visits and services. You could call it a “pay-as-you-go” system.)

1920s

Prosperity + political complacency à no strong efforts to change healthcare

General Motors signs a contract with Metropolitan Life to insure 180,000 workers

1930s

The Depression à greater focus on unemployment insurance and “old age” benefits than on health insurance

Social Security Act is passed but does not include health insurance

Against the advice of insurance professionals, Blue Cross begins offering private coverage in many states

1940s

Prepaid group healthcare, which is seen as radical, begins

During WWII, wage and price controls are placed on American employers, who begin to offer health benefits to entice potential employees. This gives rise to the employer-based system in place today.

Truman pushes a national health program plan that would include all Americans, but it’s shot down by the AMA and called a Communist plot by a House subcommittee. (Just like how Obama’s plan is labeled Communist, Socialist, fascist, etc. today: incorrectly.)

1950s

The price of hospital care DOUBLES. Those outside the workplace are having a harder and harder time affording insurance.

1960s

There are now over 700 healthcare insurance companies

President Johnson signs Medicare and Medicaid into law

Things aren’t looking good for supporters of  “Compulsory Health Insurance”

1970s

President Nixon renames prepaid group health care plans “health maintenance organizations” (HMOs)

Unexpectedly high cost of Medicare + economic inflation + rising hospital expenses (and profits) + greater use of technology & medications à skyrocketing healthcare costs. The words “healthcare” and “crisis” are first used in the same sentence. 

1980s

Corporations begin to integrate the hospital system, previously a decentralized structure. Overall shift to privatization & corporization of healthcare.

Under President Reagan, Medicare shifts to payment by diagnosis instead of by treatment. Patients are classified into one of about 500 groups (diagnosis-related groups, or DRGs) expected to have similar hospital resource use. Private plans quickly do the same.

Insurance companies complain that doctors are exploiting the traditional fee-for-service reimbursement, which encourages a doctor to over-prescribe, over-diagnose, and over-treat because he earns a net profit on each visit and procedure. Capitation payments become more common, with a doctor paid a set amount for each patient assigned to him – encouraging a doctor to reduce the effort spent on each patient.

1990s

Health care costs rise at double the rate of inflation

Expansion of managed care (techniques intended to reduce the cost of providing healthcare) moderates increases in health care costs – at first.

Federal health care reform legislation fails again to pass in the U.S. Congress. (Remember “Hillarycare”?)

By the end of the decade there are 44 million uninsured Americans. 44 million too many.

2000s

Health care costs still rising. Duh.

People start realizing that Medicare is doomed.

Direct-to-consumer advertising for pharmaceuticals and medical devices is on the rise. (“Ask your doctor if ____ is right for you!”)

2010: Obama healthcare reform bill passed…but THAT’s a whole other post.

Anca Lungu, summer intern in the Healthcare studio, takes a break from her day to talk to me about her SmithGroup experience.

H: In one sentence, describe your internship.
A: It was a great learning experience that made me realize school does not teach you half of the things that you actually need to know.

H: What is your most memorable SmithGroup experience (for whatever reason)?
A: I think that my most memorable experience here was when they gave me a task that when I started my internship they did not think I was ready for. It made me think I improved myself over the course of my internship.

H: What is the biggest lesson you have learned here?
A: The communication between people is very important to create a good and productive environment.

H: What was the most surprising thing to you about your internship?
A: How people at SmithGroup work really hard but they also have the opportunity to have fun.

H: What advice would you give an incoming SmithGroup intern?
A: Never be scared to ask questions, even when everybody looks intimidating. They were all, at one point or another, in your shoes. Don’t ignore any chance that comes your way and also never think that you are not capable of doing something.

The Story of Stuff: an eye-opening and depressing (as eye-opening things often are) video that is definitely, definitely worth a watch. Drop whatever you’re doing and go check it out.

Another of the SmithGroup summer interns (although in an architecture studio rather than marketing) and a friend of mine, Sharon, finished her SmithGroup stint recently. Before she left I gave her a mini exit interview:

H: What one word would you use to describe your internship?
S: Awesome!

H: What is your most memorable SmithGroup experience (for whatever reason)?
S: So I called in sick Monday because I had a cold. Got a little better and came in Tuesday morning. Was told I would be going to the presentation meeting 15 minutes before leaving. I was excited but freaked out because I was mess and wasn’t dressed properly (I’m a girl, it does matter what we wear!). All in all, it was a rush, but very surreal and great experience. Got to do behind-the-scenes task and set up the materials on site.

H: What is the biggest lesson you have learned here?
S: No question is a stupid question. It’s stupid if you don’t ask it.

H: What was the most surprising thing to you about your internship?
S: My coworkers at SmithGroup were so supportive of me learning as much as possible about every aspect of architecture and interiors. I learned a lot more about the field and how many different tasks there can be. Glad I was able to learn so many bits and pieces!

H: What advice would you give an incoming SmithGroup intern?
S: Don’t be afraid to take any opportunity you get. You may feel uncomfortable, but if you’re comfortable, you’re not learning.
____________

My takeaway from her interview and from my own intern experience: New to a company/school/class/subject/city/any other setting?
THEN ASK QUESTIONS. Be confident, but don’t pretend you know it.
Because you don’t.

This is recycling at its best: Containers to Clinics (C2C), a nonprofit that provides primary healthcare to underserved women and children, retrofits portable shipping containers into mini-health clinics – complete with equipment, medicines, and medical staff. In one 8-by-20-foot metal box, C2C designers fit a small consultation room, small laboratory, office for staff, and storage and inventory space. Wow. From these mini-clinics (minics?), local medical professionals provide vaccinations, treatment for infectious diseases, safe pregnancy and delivery, and health education to those who otherwise have little or no access to them.

I’m all about the women’s health issues (not just because women make up half the population but because their health is inextricably, intimately linked to the health of the other half…women’s health is EVERYONE’s health, period.). Of 8 Millennium Development Goals, 3 are dedicated to women or children. MDG3: promote gender equality and empower women; MDG4: to reduce child mortality; MDG5: to improve maternal health. Now old shipping containers are helping do all three – not to mention MDG6 (combat HIV/AIDS, malaria and other diseases) and MDG7 (ensure environmental sustainability).

They remind me of something slightly more frivolous but also ingenious: those dumpster swimming pools in New York City. Dani Simons, coordinator of the dumpster-to-pool project, describes the project as “taking something we’re used to seeing in one particular way and really inventing them and using them in this totally creative and new way.” Shipping containers, dumpsters – what else could we reinvent?

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