Thursday, January 4

Foundation Mission: Fixing Healthcare

The American public finally is beginning to understand that the health care system in this country is in a shambles. Millions of Americans can’t afford health insurance; the public health system is neither meeting the needs of the people it purportedly serves nor is it prepared to protect the public from health threats like an avian flu epidemic or the consequences of a health disaster like Hurricane Katrina; childhood obesity has reached epic proportions; and too many people are dying from tobacco use.

An awareness of these problems came early to Dr. Risa Lavizzo-Mourey, president and CEO of the College Road-based Robert Wood Johnson Foundation and the daughter of a surgeon and a pediatrician in Seattle. “I grew up hearing a lot about the ways in which the healthcare system did not deliver, particularly for people who were poor, had no health insurance, and had chronic health problems,” she says.

Early on she watched people attacking these issues at a grassroots level. As an adolescent she witnessed community activists starting a clinic for underserved people in the city of Seattle and realized then that systemic changes could make a dramatic difference in people’s lives. That understanding formed the trajectory of her career: “I took that experience to medical and business school,” she says, “and to the interface of medicine, business, and policy.”

Lavizzo-Mourey speaks on “Robert Wood Johnson’s Foundation’s Drive to Improve Healthcare and the Lives of All Americans” on Thursday, January 4, at 11:30 a.m. at the Princeton Chamber meeting at the Marriott on College Road. Cost: $40. To register, go to www.princetonchamber.org. For information, call 609-924-1776.

Musing about the role of the Robert Wood Johnson Foundation, Lavizzo-Mourey compares it first to the clinical work she does as a doctor, which “is focused on the one patient in front of you to make his or her life better.” The foundation, on the other hand, is a “much bigger canvas,” with roots in the philanthropy of Robert Wood Johnson, who “looked at things for the long haul, cared passionately about the acute care people received in the hospital and about having the right work force to deliver quality healthcare.”

With this vision in mind, Johnson set the foundation’s mission at its founding in 1972: to improve the health and healthcare of all Americans. “The emphasis is on improvement. We want to see results,” says Lavizzo-Mourey. Yet enduring results can come only from transformational change. For that, she says, “we need to have a large tent — it is hard for a philanthropy to make a difference without engaging nonprofits, business, and policymakers.”

The foundation affects policy not by lobbying, but with the power of information. An early initiative was its role in the implementation of the 911 emergency number and the emergency response system tied to it. In the foundation’s early days, in the absence of a national or standardized emergency medical system, people could call an ambulance or the police, but often patients died because they didn’t make it to the hospital in time.

The foundation funded a study of 14 sites, each of which had implemented standard radio bandwidths and trained EMS technicians, and had established a standard procedure for sending out ambulances. The study demonstrated that with this system people got help more quickly and lives were saved. The ultimate policy result was a standardized 911 number that can be dialed anywhere in the United States.

But developing solutions like a 911 number is a continuing challenge, even for a foundation with $9.5 billion in assets, which pays out from $250 to $400 million a year, funding about 800 to 900 grants of about $300,000 each. “The challenge is in figuring out how to have the most impact,” says Lavizzo-Mourey. “While our resources are significant, we can’t solve every problem.”

Proposals are evaluated by program staff in relevant interest areas. Here are a few examples of projects in different interest areas:

Reducing childhood obesity. A project in the state of Arkansas is collecting and analyzing body mass index data for all Arkansas children from kindergarten through high school. Early findings are showing that the process of sharing this data with parents has halted the rise in childhood obesity, and a foundation grant is analyzing the data to find out what it means, why the rise in obesity has been stemmed, and how different populations are responding.

Expanding health insurance coverage. The foundation is focusing on two aspects of health insurance coverage: ensuring that children have coverage and educating the public about what it means to be uninsured.

Again Lavizzo-Mourey emphasizes that the foundation’s role is to analyze possibilities rather than to set policy. “We are not government, and we are not business. We can’t mandate insurance for everyone,” she says. “What we can do is let people know what the consequences are and help define, by studying various options, what the implications will be of one or another policy change related to coverage.”

The State Children’s Health Insurance Program (SCHIP), enacted in 1995 to provide low-cost health insurance for kids, which is up for reauthorization in 2007, is jointly financed by state and federal governments, but administered by the states.

In support of the state programs, the foundation has supported efforts in every state to enroll more of the kids who are eligible. Lavizzo-Mourey describes one of these evidence-based programs, which examined the effects of a simpler application procedure.

In the early days, applications were long and cumbersome and children had to undergo a face-to-face interview, but the foundation’s research showed that substituting a one-page application and dropping the interview requirement yielded more qualified kids without bringing in those who did not qualify.

“We were able to convince the states to simplify the application process,” says Lavizzo-Mourey, “but they required evidence to understand what would and wouldn’t work to push changes in policy that benefited kids.”

To raise the public consciousness of the effects of being uninsured, the foundation has run a major communications campaign about the dramatic consequences to both health and financial status. Although most people believe it doesn’t matter if they are uninsured — they think they can just go to the emergency room — the research tells us that without insurance not only is people’s health poorer but they run a greater risk of bankruptcy due to overwhelming medical bills. The goal of the campaign, therefore, is to have the public realize that “this is something that doesn’t just affect poor people; anyone is a pink slip away from being uninsured.”

Reducing tobacco use and exposure. As a result of research on the effects of smoking on health and on the cost of healthcare, a new consciousness has emerged and significant new policies and laws put into place to limit smoking venues.

The foundation has supported these research efforts. Its grantees have found that reducing smoking can have significant benefits for business. Clean indoor air rules lead to less asthma, bronchitis, and missed days from work. It also tends to lead to happier customers, particularly in the hospitality industry.

Research goes hand in hand with evaluation, which is where the foundation invests about a third of its money. Evaluation includes three separate pieces: a formal evaluation component embedded in all grants and either done or managed by the foundation’s internal research and evaluation department; results reports written by grantees; and impartial third-party evaluations that analyze results in the context of related work in the field. These third-party reports are put together in a book, available at www.rwjf.org. It is internally dubbed “the anthology,” but formally called “To Improve Health and Healthcare.”

Lavizzo-Mourey earned her medical degree from Harvard Medical School, and an M.B.A. from the University of Pennsylvania’s Wharton School. She completed a residency in internal medicine at Brigham and Women’s Hospital in Boston and trained in geriatrics at Penn. Despite her work with the RWJ Foundation, she finds the time to treat patients at a community health clinic in New Brunswick.

She joined the foundation in 2001 as senior vice president and director of the health care group. Previously she was professor of medicine and health care systems and director of Penn’s Institute on Aging. In Washington, D.C., she was deputy administrator of what is now the Agency for Health Care Research and Quality.

To try to bridge the gap between research and policy, the foundation packages its information in a variety of formats.

According to Lavizzo-Mourey, once these research results do reach their intended audiences, change can be dramatic. “When research results are transmitted to the right decision-makers,” she observes, “they can cause massive social change.”

— Michele Alperin

It’s the Time (Again) To Get Organized

‘Next year we’ve really got to get organized.” You’ve heard it muttered scores of times, and here it is next year, and the office/home is still a mess. For the extremely overwhelmed, those whose insecurities lead them to hoard towers of clutter, consequences may be dire. The sheer crush of stuff can lead to depression, psychosis, and even suicide.

For most of us, however, the mess resulting from over-accumulation and disorganization means frustration, lost time and money, and missed opportunities as key memos, phone numbers, checks, and slips of paper with appointment times and driving directions are scattered hither and yon — and then buried under stacks of unread magazines and newspapers.

Cyndi Kawabata offers help to people at every stage of the disorganization spectrum at a free lecture, “How to Get Organized,” on Thursday, January 4, at 7 p.m. at the Hickory Corner Branch of the Mercer Library in East Windsor. Call 609-587-2626.

This talk is the first in a series given in celebration of January as national Get Organized month (National Association of Professional Organizers’ site, www.napo.net). Later talks throughout the month will include “Organizing the Family & Teens” (Thursday, January 11, Hopewell Library), “Organizing the Home Office” (Thursday, January 18, Washington Library), and “Downsizing Estates,” (Thursday, January 25, Mercer Library in Lawrence.)

Kawabata came to her organizing career from medicine, bringing with her a more psychological approach to the field. A native of Oahu, Hawaii, she attended the University of Hawaii earning a bachelor’s degree in human development, augmented by further studies in the University of Puget Sound in occupational therapy. Her first job as an occupational therapist forced Kawabata to create limited spaces of functionality for people with various disabilities. “I realized then how little usable space working people actually need,” says Kawabata.

Four years ago Kawabata took her skills into the business and home markets, launching her Princeton-based firm “A Home That Works For You.” Call 609-933-1550.

“First of all, you’ve got to realize what you are up against,” she says. The average person receives 28.4 pieces of mail a week. In this country alone, 1,000 books are published every day. Ten-thousand periodicals come out every month. Last year homes and offices produced 5 trillion documents — enough to paper the Grand Canyon 107 times. This flow will not be stanched. The papers and the stuff will keep on coming. The only question is: How are you going to handle it?

Search inner space. Kawabata insists that there are no cookie cutter solutions to organizing a business or home office. People react differently. One of her clients was a female attorney in a large firm. Another was a male engineer. She was creative, right-brained, and a tad flighty. To get a truly important note through to her, her cohorts knew it must be taped to her chair. He scoffed at this as pure nonsense. His linear-brain wiring insisted that one must have an inbox and an outbox on the desk. By this very logical method, it was very plain where each document would be.

Kawabata listened to their heated argument and laughed. “You’ve got to walk through your office and see what works for you,” she says. If you are a visually-stimulated person, arrange your files in meaningful color codes. If you are more kinesthetically stimulated, write a list of files and their locations to burn them into your brain.

But whatever plan you establish, be honest with yourself. If you’ve promised and failed to adopt certain sorting patterns for the past 20 years, do not count on the discipline kicking in now. Rather, admit that this method is foreign to your true nature, and labor to expand those little organizational practices that you do easily to the rest of the office.

Trace the flow. Honestly examine the path of paper and other material that enters your office or home office. Where are the stops?

Kawabata explains that most paper reaches certain resting points based on the times of decision. The earlier you can make the decision, the more organized your paper flow will be. Instant categorizing of papers at the source point is the key.

Typically, there is a small pile of papers that need to be acted upon immediately — maybe a paycheck to be taken to the bank, an urgent command from the boss for a signature on a contract, or a favorite nephew’s request for a recommendation letter. Most people are good about moving these papers quickly.

Then there is a huge pile of junk, and those without a serious hoarding problem quickly toss it.

The big problem, the one that will take over every inch of surface space, is the “maybe I’ll read this, study this, or attend this someday” pile. The organizing decision for these papers gets postponed and they swell rapidly to a huge, frightening mound. Until finally we fearfully think “best not to mess with this at all.”

Kawabata suggests taming the tower by adding one more trash bin and labeling it “to be decided on by________.” Make several boxes, if you like, one for the week, month, and three months. Then set a spot for the mail and other in-flowing papers. Write on your calendar that these decisions are due on this day. Then toss, file, or act upon them.

Priority storage. A deadline system also works for an entire filing and storage system. Date each file or clutch of papers. Set a time — two months, or even two years. Periodically thumb through all the files previous to the last spot day. If they have not been opened by then, do you really need them? You can be quite sure that your grandchildren will not be enthralled by them. Get ruthless.

Desktops typically get the low end of prioritizing. Haunted by the fear that things filed out of sight are lost forever, we keep our clutter so close at hand that actual workspace disappears. Instead of plunking the latest stuff on the desk, try setting up three or five boxes beside the desk, label them as works for you, and give a quick sort. Not only does it save time, but walking into your office in the morning, and seeing a pristine, naked desktop can provide an entire day’s worth of inspiration.

Time clutter. “Obligations, like possessions, are a trap,” says Kawabata. We may highly prioritize time to routinely exercise or read — at least we do so in our heads. But somehow, as the day ends, it’s all we can manage fill the obligations and put out the fires of the moment.

Kawabata’s solution is to carefully select a small number of those important life activities and schedule actual, regular appointments — in ink. The trick is not to over-cram the day with goals. If you plan to spend time writing a novel, playing with your children, lifting weights in the gym, and working on the new startup you’ve been dreaming, your are deluding yourself. Do the math. The hours are not there.

Rather than trying to do the impossible, set large, long-range goals, and then work in increments. If you want to run a marathon, set the date for 2008. Begin working in segments. Develop an 18-week training schedule with the realization that the weeks probably cannot be consecutive, so it will take more time. If you want the whole garage cleaned up by June 2007, set monthly increments and surprise yourself by getting things done early.

Don’t leave your romantic yearnings out of this scheme. Etch a date in stone for that trek in Alaska.

Cyber clutter. Kawabata’s first rule for using the computer is “Don’t print it out.” Stick it on a CD or zip-drive, but remember the goal of the computer is to generate less paper not more. And stickies clinging to the machine? More than four is a distraction — make them contemporary, not historic.

There are many styles of software designed to organize your desktop and other files. Kawabata refuses to push her favorites, insisting that individuals need to shop around for their personal solutions. That long list of E-mails clinging to your mail list may be filed, set on CD, and marked for later reading. The same goes for your “My Documents” file. Keep it spartan and timely with CD backups and references close at hand.

When asked to recommend special organizing tools and equipment, Kawabata’s answer is always the same: “Your best organizer is the trash basket.”

Thirty-two percent of the nation’s homeowners with a two-car garage use only one of the slots for parking — the rest is for stuff. Another 25 percent have both cars parked outside, thus keeping a roof over mounds of materials whose net worth comes to maybe one quarter of one auto.

Kawabata says that the solution lies in the 200-year-old adage of Henry David Thoreau: “Simplify, simplify, simplify.”

— Bart Jackson

Tuesday, January 9

Writing to the Top

Good business writing ain’t what it used to be. While common sense would say that a writer’s goal should be to communicate information concisely, too often good writing gets lost in the shuffle of bad grammar, unfocused ramblings, creative spelling, and high falutin’ words.

“People say that good writing jumps off the page,” says Ellen Benowitz, who has been teaching business writing three times a year for the past nine years. “While that may be true if you are writing a novel or short story, in good business writing the focus is on the message, not on the writing. I don’t want business writing to jump out as something beautiful. I want its message to come across clearly.”

Benowitz teaches her six-week non-credit course, “Effective Business Writing,” beginning on Tuesday, January 9, at 7 p.m. at Mercer County Community College (609-570-3311 or www.mccc.edu).

While technology has allowed communication to become lightning fast, good writing has become even more important. Unfortunately for many, proper business writing has gone the way of the typewriter or the dodo bird. “If your only communication with someone is via E-mail, then you really need to make sure that they understand it the very first time,” says Benowitz. “Otherwise it will lead to increased communication, more work, less time, and frustration on both sides.”

But, according to Benowitz, common difficulties many face these days when trying their hand at business writing are the things that are generally taught in elementary school — spelling, grammar, and problems getting started. “Of course, these days people have become dependent on spell-check on their computers to bail them out of the grammar and spelling muck,” says Benowitz. “But unfortunately, spell-check doesn’t solve all the problems and many people find this out too late.”

The problem of bad writing has become endemic in many fields. “Many people just don’t know how to write anymore,” she says. “They use a lot of fluff in their writing that gets in the way. Many have problems choosing the right word to convey the right meaning. Many like to use outdated, cliched expressions.”

Another common mistake for would-be business writers is the phenomenon of allowing themselves to be carried away by their own writing. “It is important to keep in mind just who you are writing for,” says Benowitz. “The writer needs to know what he or she is saying, but so does the person receiving the message. You want your communication to be understood the first time around.”

Born in New York City, Benowitz was raised in central New Jersey and is a graduate of the College of New Jersey. She has worked at Mercer County Community College for over 35 years.

Benowitz says that changes in the work world have contributed to the course’s popularity. “Many people in supervisory positions no longer have a secretary to help them with their communication problems,” says Benowitz. Students range from administrative assistants to doctors and lawyers to those who work with computers, as well as people employed in the sciences.

Benowitz offers some recommendations:

Use simple words. Writing that uses highbrow language when a simple word would do is just bad writing. “If you look at writing that has withstood the test of time, like the Lord’s Prayer or the Gettysburg Address, you will find that it is simply written, using direct sentences, and pretty much use monosyllable words,” says Benowitz. “If you compare these to something written by an attorney or the federal government you will simply be amazed.”

Keep your audience in mind. You are trying to get a message across, but you are also trying to maintain good will. “Part of business writing is using a little psychology,” says Benowitz. “In order to create some positive feeling, consider the person or people the writing is intended for. Customer support is an important part of business. You can get a message across very quickly, but think of the feelings that are going to involved as well.”

Cut away the fat. Awkward phrases are usually unnecessary. “People will start off letters by saying, ‘I am writing to tell you,’” says Benowitz. “I tell them I’m not stupid. I received your letter so therefore I already know that you have something to tell me. That is all wasted space and time. Many people have a real big problem with this.” Other examples of this form of writerly trans-fat include such phrases as “enclosed you will find” (if it’s enclosed, of course you will find it) and “past history” (all history is in the past)

Avoid “faddish” words and phrases. Good business writing, with its emphasis on being simple and concise, is a relatively stable form of communication. “In all the years that I have been teaching and doing my own business writing, very little has changed,” says Benowitz. “Using lingo is usually not a good idea.”

Hear what your reader hears. “Someone can write a letter and think that it is absolutely wonderful,” says Benowitz. “But if your reader doesn’t understand it, then it is useless. It is as simple as that.”

— Jack Florek

Career Connections

Are you making a New Year’s resolution to get a new job, change careers, enter the workforce, or advance your skills and education? Then you might want to make time to drop in on the Mercer Regional Chamber Commerce’s Career Connections Job Fair at Rider University’s Bart Luedeke Center on Tuesday, January 9, from 10 a.m. to 3 p.m.

The organizers promise that this will not be “your typical job fair.” “Right now we have representatives from over 50 companies and organizations,” said Michele Siekerka, president of the chamber, in a prepared statement, “and the number is still growing.” Siekerka has enlisted Rider University, Nassau Broadcasting, the Mercer County One-Stop Career Center, the New Jersey Department of Labor and Workforce Development, and the Trentonian newspaper as partners in this event. Attendees will have many opportunities to network and interview with agencies and companies that are seeking to fill jobs from entry to senior level.

A variety of free workshops, starting at 9:30 a.m., are designed to provide tips and information, and there will be a free resume clinic from 10 a.m. until closing. New this year is a panel discussion on the needs of the healthcare industry, conducted by Mary Jo Abbondanza of St. Francis Medical Center. A cross-section of healthcare employers will also be available.

The event is free and there is no pre-registration. Resumes are the only required form of admission, and business attire is recommended. As an added feature, a free copy service will be available for anyone needing extra resumes.

In case of snow, the fair will be held at the same time and place on Wednesday, January 10 (www.mercerchamber.org).

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