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Hey Iowa, Nice Job Being a ‘Least-Stressed’ State!

More and more often, other states are catching on to the great things we have going on in the Hawkeye State1! Our state and communities continue to receive many national accolades from various publications, many of which are quite flattering, such as:

A recent national benchmark ranking, coming from WalletHub, suggests that Iowa is the fourth LEAST-stressed state when compared to all other states (including the District of Columbia). Iowa’s placement follows only (in order), Minnesota, North Dakota and Utah. For comparison purposes, Iowa was the third least-stressed state in 2017 (Minnesota and North Dakota were No. #1 and No. #2, respectively). There appears to be something magical about the upper Midwest.

To determine the rankings, WalletHub compared the 50 states (and D.C.) across four dimensions (and 38 relevant metrics). The four dimensions were:

  1. Work-related stress (7 metrics)
  2. Money-related stress (10 metrics)
  3. Family-related stress (6 metrics)
  4. Health- & safety-related stress (15 metrics)

As we know, stress is related to both external and internal factors that affect each of us. Sometimes we are unaware of how stress can impact our health. External factors may include our job, relationships with others, our home, other physical environmental situations, challenges, difficulties, and expectations we are confronted with on a daily basis. How we respond to, and deal with, the external stress-inducing factors affects our nutritional status, emotional well-being, overall health and fitness levels, and the amount of sleep we get. Each of us deal with stress differently, but if we are not careful, it can wreak havoc on our personal (and professional) lives.

For each of the four dimensions mentioned above, the state of Iowa ranked as having the 16th least work-related stress, sixth least money-related stress, fifth least family-related stress, and third least health- & safety-related stress. Metrics that relate to the work-related dimension, the lowest scoring of the four dimensions, include:

  • Average hours worked per week
  • Average commute time
  • Average leisure time spent per day
  • Job security
  • Unemployment rate
  • Underemployment rate
  • Income growth rate

The economy can have a big influence on this particular dimension. Iowa has a very low unemployment rate (2.9% in 2017), a factor that causes employers to struggle with finding qualified workers in jobs difficult to fill. According to the Iowa Workforce Development, the weekly wage increase in 2016 was below two percent (2017 data will be available very soon), showing that wages are depressed.

Iowa Healthiest State Initiative

To help Iowa avoid resting on its’ laurels, a wonderful ‘movement’ occurring in Iowa is the Iowa Healthiest State Initiative (HSI). Executive Director Jami Haberl, and her team are working to make a meaningful difference in how Iowa communities and employers can improve the daily lives of how we live, work and play. One HSI approach attempts to address the stresses we face in our environments, and will annually monitor this stress through our resiliency. Resiliency is an often-used term that describes the ability to overcome challenges of all kinds – such as trauma, tragedy, personal crises, everyday problems – and our ability to bounce back stronger, wiser and healthier. If you are not aware of the HSI resources, please check them out here.

Receiving national accolades are wonderful, but these don’t just happen out of sheer luck. It takes hard (and smart!) work and perseverance, coupled with the belief that implementing new initiatives and approaches to positively impact our communities and those living in it will be best for all of Iowa. 

As the saying goes, “Prepare and prevent, not repair and repent.”

Let’s keep it up, Iowa!

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1Sorry Cyclone fans, but the official state nickname for Iowa is ‘The Hawkeye State.’  Honestly, I’m trying to be as impartial as possible!

Malpractice Caps Won’t Protect Harmed Patients

Medical-malpractice reform bills currently moving forward in both the Iowa House and Senate (SF 465) attempt to place a $250,000 cap on non-economic damages, such as “pain, suffering, inconvenience, physical impairment or mental anguish.” The push to limit non-economic damages comes from the provider community, which includes doctors and hospitals.

Both sides of malpractice reform offer persuasive arguments on the merits of these reforms. Injured individuals and their lawyers argue against malpractice reform, saying patients won’t be protected against negligent providers. Because of errors, healthcare costs are higher.  Botched care requiring fixes often happens without patient knowledge and involves additional patient and insurance payments. The social and economic costs of medical errors are also enormous.

Doctors and hospitals, on the other hand, usually push for reform, saying it will protect patients from having to pay the high costs of malpractice insurance and help curtail defensive medicine practices – presumably through lower health insurance premiums – and perhaps increase accessibility to some healthcare services.

Interestingly, a recent report from personal finance website, WalletHub, indicated that Iowa is the best state for doctors to practice medicine, when comparing 14 different relevant metrics, and Iowa is the fifth least-expensive state for annual malpractice liability insurance.

But here’s the fundamental question that gets lost: Will capping non-economic damages provide the necessary incentives for providers to alter their practices enough to eliminate avoidable medical errors? This should be the most critical question regarding malpractice reform being debated in Iowa and elsewhere. Unfortunately, the Iowa bills fail to address this issue.

Patients expect to be safe when they receive healthcare from the providers they trust. Yet, solid evidence suggests this trust is routinely violated. We’ve made relatively little progress in reducing preventable medical errors since 1999, the year the Institute of Medicine released their book, ‘To Err is Human.’ In the last year, using national estimates on preventable medical errors, my organization extrapolated that a mid-range estimate that 85,000 patients are harmed in Iowa hospitals yearly due to preventable medical errors. This number does not include harm occurring in physician clinics, outpatient surgery centers, nursing homes and other care locations.

I don’t represent trial lawyers nor healthcare providers and I have become rather apostate regarding political parties. In my opinion, tort reform should be about reducing medical errors – the root cause of why we have malpractice issues in the first place. By working toward the elimination of the root cause – medical errors – malpractice and its negative side effects will also disappear. This more logical approach will benefit patients, providers and our overall healthcare system. Adopting safe care practices would substantially reduce the costs of botched-care fixes and defensive medicine – in addition to enhancing the quality of life for patients and their caregivers.

As the Iowa bills demonstrate, we continue to seek ‘quick fixes’ that gnaw at the edges of the problem. But these laws seldom address the core reasons of why many medical errors happen.  Medical errors are, unfortunately, a fact of life.  But many are avoidable. In our healthcare world, we have well-meaning and very capable caregivers. Too often, however, we also have broken organizational cultures that inadequately address patient safety protocols and burned-out physicians and staff who are required to “produce” at unsustainable levels. Any meaningful reform must begin at the healthcare organization level, ensuring we all receive appropriate and safe care. Organizations providing impactful interventions to help promote safe cultures of care can greatly improve safe care practices.

Misguided malpractice reform can actually exacerbate rather than eliminate medical errors. Placing caps on damages, economic or otherwise, insulates the medical community from high monetary awards, yet offers little, if any, incentives for healthcare organizations to establish clear and genuine protocols to ensure a culture of safety. The right incentives matter, especially when it comes to the safe care we trust we’ll receive.

Isn’t it time for provider organizations to adopt a culture of safety, rather than seek malpractice caps that do nothing to protect us as patients?

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