Join us on Community Possibilities as John Silver, a registered nurse, shares his vision of a future where healthcare operates as a hybrid public utility, emphasizing the need for multidisciplinary approaches and political advocacy to address systemic issues like access and resource distribution.
John and his collaborators establised Nurses Transforming Healthcare, an organization rallying the nursing community to tackle systemic challenges head-on. The mission of Nurses Transforming Healthcare is "to transform healthcare to a model based on wellness and disease prevention which is affordable and accessible to all." John shares his vision for a future with accessible, well-funded community health centers. Innovative initiatives like the "Flip the Zip" campaign highlight the potential for community engagement to create enduring health improvements. Tune in to learn how individual commitment and community-driven solutions can pave the way for a more equitable and efficient healthcare system.
Bio John Silver
After 24 years in healthcare, including 14 years as a Registered Nurse, Dr. Silver was drawn to the essential problem facing nursing- Why couldn’t Nursing ensure safe levels of practice in facilities, and why was the healthcare system we had so dysfunctional in terms of Public Health outcomes and the neglect of so many communities. John soon realized that the problems were linked. If nursing could not ensure safe levels of practice, and were not actively engaged at the decision tables as to where resources were allocated in the systems, how could Nursing ensure the maximum benefit for our patients would be realized?
The answer lay in the political relationship of nurses to the facilities, and Nursing to the political process. Embarking on a journey of research and discovery in his Public Intellectual Ph.D in Comparative Studies, John published a book just a union…of nurses (2013) about the history of how the California nurses brought about staffing legislation, which he hoped would provide an example of how nurses could become politically effective in their states. He advised several nursing groups on this, including NP’s as they worked towards independent practice and prescriptive authority.
He traveled abroad to study other healthcare systems and developed what he thought the goals of a healthcare system must be. From there he began advocating for the only system design that truly met those goals and addressed the needs of providers, patients, and all our communities- an adapted Public Utility model. Dr. Silver has been working with an innovative interdisciplinary team of people forming Nurses Transforming Healthcare and working to implement the model in the Unites States.
Like what you heard? Please like and share wherever you get your podcasts!
Join us on Community Possibilities as John Silver, a registered nurse, shares his vision of a future where healthcare operates as a hybrid public utility, emphasizing the need for multidisciplinary approaches and political advocacy to address systemic issues like access and resource distribution.
John and his collaborators establised Nurses Transforming Healthcare, an organization rallying the nursing community to tackle systemic challenges head-on. The mission of Nurses Transforming Healthcare is "to transform healthcare to a model based on wellness and disease prevention which is affordable and accessible to all." John shares his vision for a future with accessible, well-funded community health centers. Innovative initiatives like the "Flip the Zip" campaign highlight the potential for community engagement to create enduring health improvements. Tune in to learn how individual commitment and community-driven solutions can pave the way for a more equitable and efficient healthcare system.
Bio John Silver
After 24 years in healthcare, including 14 years as a Registered Nurse, Dr. Silver was drawn to the essential problem facing nursing- Why couldn’t Nursing ensure safe levels of practice in facilities, and why was the healthcare system we had so dysfunctional in terms of Public Health outcomes and the neglect of so many communities. John soon realized that the problems were linked. If nursing could not ensure safe levels of practice, and were not actively engaged at the decision tables as to where resources were allocated in the systems, how could Nursing ensure the maximum benefit for our patients would be realized?
The answer lay in the political relationship of nurses to the facilities, and Nursing to the political process. Embarking on a journey of research and discovery in his Public Intellectual Ph.D in Comparative Studies, John published a book just a union…of nurses (2013) about the history of how the California nurses brought about staffing legislation, which he hoped would provide an example of how nurses could become politically effective in their states. He advised several nursing groups on this, including NP’s as they worked towards independent practice and prescriptive authority.
He traveled abroad to study other healthcare systems and developed what he thought the goals of a healthcare system must be. From there he began advocating for the only system design that truly met those goals and addressed the needs of providers, patients, and all our communities- an adapted Public Utility model. Dr. Silver has been working with an innovative interdisciplinary team of people forming Nurses Transforming Healthcare and working to implement the model in the Unites States.
Like what you heard? Please like and share wherever you get your podcasts!
Community Possibilities is Produced by Zach Price Music by Zach Price: Zachpricet@gmail.com
Ann Price:
Hi everybody, welcome back to Community Possibilities. Today my guest is John Silver. John is a registered nurse and may I say he is a deep thinker. And today we're going to be talking about the healthcare system in the United States and how it works, or maybe how it doesn't work. When I say John is a deep thinker, I mean that he has thought deeply about the healthcare system so dysfunctional and the fact that we just can't reach, or seem to reach, our public health outcomes and why so many of our communities don't have access to healthcare access to health care. So John soon realized that all of these problems were really linked and nurses might be able to help solve this problem. He did a deep dive, and by deep I mean he got his PhD and he's traveled all over the world studying healthcare systems. He and a couple of colleagues have started NursesTransformingHealthcareorg and he continues to advocate for changes in our healthcare system. So we're going to be talking about that today. This is all about equity at the deepest level and all about community change and what we in our communities can do to start chipping away at a system that just doesn't work for so many. So I hope you enjoy this conversation. It's a great story about the power of one. Thanks everybody. Don't forget to hit that like and subscribe button and be sure to leave a review. That would help. So much Now on to the show.
Ann Price:
Hi everybody. Welcome back to Community Possibilities. I am here with John Silver. Welcome, john.
John Silver:
Thank you very much, anne Price. Yay, pleasure to be here.
Ann Price:
Yeah, thank you so much. So we were just chit-chatting about all the rain you were getting in South Florida and you're about to go on vacation next week.
John Silver:
Yeah, I mean nature rewarded us yesterday with the most fantastic rainbow I've seen in 40, 50 years.
Ann Price:
Oh, that's, so nice, yep.
John Silver:
I think it was saying I think it was saying I'm sorry.
Ann Price:
I'm sorry for all the rain 10 inches, I think you said, yeah, that's crazy. Okay, well, john, I think we met on LinkedIn. Is that correct?
John Silver:
That would be correct.
Ann Price:
Yeah, awesome. So yeah, you reached out and we started chatting and we have something in common. You are a nurse, correct. My sister is a nurse. So there you go. That kind of scares the heebie-jeebies out of me. To tell you the truth, if I make a mistake, john, nobody dies. I haven't hurt anybody. I might get a number wrong in a report. Do you know what I Does? That Right, so I admire the heck out of you guys.
John Silver:
Well, you know, there's a sense of that in the acute things we deal with as nurses in hospitals. I was in critical care for a long time. But then there's the longer term harm we do by, you know, not being able to fulfill our missions as health care professionals.
Ann Price:
Yeah, and that's what we're here to talk about today. But before we get into all the fun stuff, why don't you introduce yourself to folks? And I always say don't tell me your business bio. Tell us how you came to be who you are.
John Silver:
Well, I never even thought of healthcare. To be honest with you. I needed a job and I saw a job as a security guard, northern Virginia Hospital. I was a semi-pro linebacker at the time, so I went in and I figured I'm big enough. But within a month or so I'd just been fascinated by what I saw and the hospital hired me as an orderly back in those days and the nurses kind of adopted me and then trained me and showed me stuff and I just climbed up the ladder EKG tech, er tech, respiratory therapist for six years and an RN for the last 30 plus.
Ann Price:
Wow, you really have climbed the ladder.
John Silver:
Yeah, and you know I got out of. It's not that I stopped practice halfway through my PhD, I was still a frontline emergency room nurse. Uh, that's why.
John Silver:
That's why I came out with that debt, oh yeah, I feel you there at a certain point in the school with the masters I, I realized that I thought anyway, the problems were political. Um, so I started getting internships in Washington and worked with a rep in Florida and really looked at the political relationships in healthcare between as many you know, a lot of the parties. And then I got lucky. I was at a school that brought in a multidisciplinary PhD. It was called the Public and Electual PhD in Comparative Studies and it let me step out of healthcare completely and look back at it to see, you know, if I could see something Using pulling from multiple disciplines, because we've all gotten so siloed, we kind of just listen to ourselves. So you know history, english rhetoric, art, literature, global affairs, public affairs and democracies. I spent an inordinate amount of time studying all of those things and then came out and put out a book on political effectiveness. And then came out and put out a book on political effectiveness. How do you become politically effective in a society so that's me.
Ann Price:
Yeah, I'll have to remind me. I need to introduce you to David Shore. He has a podcast called Battles we Pick and he was on my podcast sometime last year. And David is an evaluator, but he also works in the advocacy space and he's been a politician. I bet you guys would have an interesting conversation for sure. So, before I get us down a big rabbit hole, I wanted to share this because I pulled this off your LinkedIn profile and I thought it was so interesting, so I want to read it to everybody and then I'm. Then I want to talk about why I thought this was so interesting.
Ann Price:
It says I envision healthcare transitioning into a hybrid public utility. This would drastically reduce costs and solve the problems of access, distribution of resources, system redesign, administration and the rural-urban divide. I'm concerned that we have lost the ability to talk together and live in a world of bumper stickers, sound bites and obscure academic articles. And I pulled that and wanted to share that because what I love it? I you know. I think it's deep and profound. Um, it's the. It's where you say I'm concerned that we've lost the ability to talk together, because that's really why I started this podcast. I was so frustrated with the yelling and screaming that was going on, that is still going on, frustrated with the yelling and screaming that was going on, that is still going on, and that we've all, like kind of gone to our respective corners or stuck our thumb in the pie and we won't, you know, pull our thumb out of our own pie. So, yeah, I, yeah, that just really hit me, john, that that, that that's. You're a deep thinker.
John Silver:
Oh, thanks. You know I try to simplify things. I think when, at a certain level, when you look at even what we think of as unsolvable social problems, I think it's because we've built into it so much complexity that we can't see simplicity sometime. And how that works, you know, the adapted or the hybrid public utility model. You know, I just didn't wake up one night at two in the morning and start talking about it. I studied healthcare systems on three continents directly. This was, you know, all based on systemic goals for what a healthcare system should be, and to me that was the biggest challenge when I started off was we had no clearly defined set of goals of what we wanted our health system to do and be. So I developed seven goals and then just studied as many coherent models around the world as I could and brought them up to the goals to see what, you know what met and what didn't meet all seven this was the only one that met all seven. Ours didn't meet any of them.
Ann Price:
Yeah, and I want you to share those seven goals, but I'm curious which three countries?
John Silver:
I went down and studied the Argentinian system directly. I was down there for 10 days anyway, so I went to a whole bunch of different hospitals, lived with a family in Cordoba, so I got to talk to neighbors, business people. Then I went to Berlin and gave a talk at a conference a design conference, believe it or not. At a conference, a design conference, believe it or not. Spent over a week there talking to doctors and nurses and hospital administrators and people in the street. And I went and gave a talk in Cardiff, wales, where I met nurses from all over Europe it was the first Honor Society meeting in Europe. And then I went back to Scotland I have a good friend that lives there and talked to people in Cardiff, wales, and what they thought about it. And then the US, and I've studied the Canadian system.
Ann Price:
I think that's. Is that four or five? Yeah, yeah give or take. Give or take two. So how did they rank on these seven goals compared to us?
John Silver:
Well, a lot of them got to five, but none of them met all seven.
Ann Price:
Never met. Okay, all right, so tell us what these seven are.
John Silver:
Okay. So the first one was equitable, targeted, data-driven access appropriate to every community's needs. Every community's needs, and this is what one of the things that kind of fascinates me about talking to you is, because the community is the focus of this model, and we can get talking later about what all this means, because each of them has a deeper meaning. So if you say you know it's data-driven access, then you have to be assessing what you need to assess. So I had to come up with a different community assessment tool than what I'd seen in public health, for example, which was very allopathic.
John Silver:
The second goal was quality, evidence-based care.
John Silver:
It takes us an inordinate amount of time to get evidence-based into practice, but in the administrative scheme I have, the universities are actually part of the regional councils.
John Silver:
What I found when I went to different states is that even in big cities, even in the same university, public health doesn't talk to nursing, nursing doesn't talk to medicine, medicine doesn't talk to public health, and yet we're all kind of part of the same piece of pie and it seems to me we should talk. The third one was equitable, targeted and evidence-based distribution of resources. Again, you have to define what resources, and those would be the resources needed to meet the community's needs. We can't build a trauma hospital every 50 miles, but we do have an awful lot of innovative professionals that would just jump at joy at the opportunity to bring that innovation to bear on community health delivery. So, anyway, that this is one of the fourth goals, one of the goals that hardly any country meets, which is having an interdisciplinary practitioner-led administration, so that the system itself is congruent with their values, and then we can maximize everybody's skill sets to fill the needs. No country has that.
John Silver:
It's all either politically controlled or privately controlled. That's a problem. And when I say that interdisciplinary practitioner-led, I'm also talking on the state-based regional councils, ems, public health, mental health, addiction services, the experts. You need to be making informed decisions and being able to justify or explain why they want to bring certain resources to bear or whatever. Plus, having that interdisciplinary council with the university system opens up the entire health system of that state-based region to not only clinical practice for all the providers, so that our graduates coming out of these professions have seen rural health, they've seen ex-urban health, they've seen suburban health, inner city health, so that they come out holistically trained, but also that the whole system becomes like a research base for these professionals so we can really get a faster pace of development and cross-analysis for things that work, best practices.
John Silver:
Goal five was equitable and positive outcomes. It seems to me if you go into the health system at any level, you should expect a positive outcome as possible, given what you're coming in with. The sixth one was one that a lot of countries are having problems with, which was cost efficiency. So because we no longer have the need for insurance overhead on the system because, remember, the public utility will just pay a monthly bill. There'll be no insurance premiums, nothing Medicare deducted from your check. Your business won't have to pay your hidden costs in healthcare. Everybody's costs we're all going to pay. It's just we're all going to pay a lot less and we're going to get an actual health system. So and by that I mean we'll start looking at things like the social and economic determinants of health and then start, you know, petitioning the state or the federal government whatever's needed to address those needs.
John Silver:
The social, you know healthcare can't solve every problem, but what it can do is allow access into communities, using our footprint to bring a host of services into, I would say particularly rural areas, which some of them may not even have internet or Wi-Fi, no-transcript. So that kind of sense of opportunity also contributes to the health of communities that they feel engaged with society. So cost efficiency was one of the key goals, and then the last one is social accountability and a mandate for direct public reporting. Doing the analysis of the data we're seeing from communities, it seems to me we have an obligation and talk to those communities and come in and say you know, this is what we've seen over the last six months or year. How can we work together to start addressing this problem in your community. What resources do you need from us? Or what resources do you need from the state or law enforcement or whatever you feel that you know better EMS access? I don't know. Whatever they identify.
Ann Price:
So, if I'm following, what you're saying is these seven goals will lead us to this new imagined health care system? Is that correct, correct, gotcha, gotcha.
John Silver:
And you know you're the first person that's caught on to that. The whole key of the solution are the goals.
Ann Price:
Right, exactly, and I heard a lot of community, I heard a lot of equity. Right, if you think about, like, maternal and child health outcomes, right, if we had an equitable system, black women and their babies would not be dying at a higher rate than white women and their babies or Hispanic women and their babies. Right, we would. There would be this hope. Right, we would level that, level all of that. So, yeah, not that that's a simple solution, because I know it's really complex. So where does the seven goals come in with your organization? Because I know you have partners the Nurses Transforming Healthcare. I think you came up with the seven goals as a result of all your study and working on your PhD and then you found partners. So tell us a little bit about because you and I have talked, but tell us a little about the Nurses Transforming Healthcare.
John Silver:
Well, coming up with the seven goals was the first thing I did.
Ann Price:
Okay.
John Silver:
It just didn't make sense to start looking at things when I had no idea where I was trying to get to.
Ann Price:
Yeah, and then you just invited other people to your party to your party.
John Silver:
No, I started, I don't know, around 2011 or 12. I started I tried to do my own kind of podcast thing Zoom thing but we kept getting, you know, zoom bombed or whatever that was, and I couldn't really with my job, I couldn't get a really good time that was conducive for it. So I kind of gave up on that and I started talking about it and there was, you know, some people would go, yeah, I guess, but some people would say, well, I don't think the US is ever going to want to give up what we have. So I'm like okay, so I kind of backed up. Then, when COVID hit, I started doing podcasts again explaining a little bit better, I guess, this model and one of the podcasts I did was Once a Nurse, always a Nurse, with Leanne Meyer, and she hooked me up with Kathleen Bartholomew who's been working, as she would tell you, at the process level, trying to fix things.
John Silver:
She's a healthcare culture expert for 15, 20 years and she goes. Once I heard your podcast I was going holy cripe. Yes, it's the system design. That's the problem. You can mess around at the process level all you want, but the system's still going to tell you what you can do and can't do process level all you want, but the system's still going to tell you what you can do and can't do.
John Silver:
And the other nurse she hooked me up with was an integrative provider from Louisville, kentucky, kim Evans nurse practitioner. She's owned her own practice for over two decades and she'd written a book on transforming healthcare. So the three of us connected and we said you know, we've got to bring this forward somehow. So we formed Nurses Transforming Health Care and the goal always for me was to get us empowered enough to be able to get into the national discussion, because I think once the American public hears this option, you know there's no more co-pays or deductibles or bankruptcies. Again, we all pay, but we pay a lot less than we are now. Total health care costs should drop somewhere over 40% and that's a huge savings to things like Medicare and Medicaid, corporations, companies, states, cities, counties and us as individuals. Gotcha.
Ann Price:
So why nurses?
John Silver:
Why nurses? Well, because you know you go to war with the army you have, you know, One that was really joining in. Well, it was these two other nurses and me and Leanne, and it was really joining in with these two other nurses and me and Leanne, who's a nurse. And then we started bringing nurses in and at that time there was a lot of public discussion on the part of nurses about how dissatisfied they were with the health system and burning out, and I thought you know there's over 4 million of us.
Ann Price:
Oh, my goodness.
John Silver:
That's a voting block right there somewhere down the road, so the bedside nurses are just kind of all over the place. We have kind of one union that's really kind of potent, but it's into the Medicare for all tunnel and then we'll, you know, kind of take that blinder off.
John Silver:
But if I thought, you know, if we can just get like 10% of the nurses, we'd be the largest nursing organization in the world and we'd have the funds then to get these three commercials that are being produced right now in Los Angeles. We have enough to be able to get them aired in a couple of key markets and start that discussion.
Ann Price:
Get them aired in a couple of key markets and start that discussion. Mm-hmm, I think I may have mentioned when we talked maybe I did, maybe I didn't that I don't think I've seen. You know no shade on doctors, but I don't think I've seen a doctor other than my cardiologist in years. I only see the nurse practitioner. Right, I prefer to see the nurse because they know me, they know me, they've known me for years, they know my story, they know you know. You know the issues that I've had. It's such a different relationship and you, yeah, you really are at the front line. Think about if you, if, for those of us who have ever had to be in the hospital, who takes care of you? It's the nurses.
John Silver:
Best majority of time. I also try to make this point to physicians that don't take it personally. You know, women in this country are the overwhelming determinant of how a family relates to the health care system, and nurse practitioners and nursing are still overwhelmingly kind of women. Well, they are women. You get what I'm trying to say? Yeah, they are women, they're. You get what I'm trying to say? Yeah, they are women. Yeah, and nursing at its core is tries to be holistically focused and I think that appeals to women in a lot of ways. Um, beyond just the personal identification with the issues of being a woman period in this society right, yeah, and I didn't mean to say that nurse practitioners are not also men, obviously.
Ann Price:
Yes, of course. Right, it's just mine happens to be like a woman, but it's the care and it doesn't really matter. It's the care that a nurse provides, that I'm I just sorry. I just sorry to all the doctors out there, not sorry, they just don't have that level of care. So it makes sense to me that you all would feel that, because it's not just I mean, obviously you're very intelligent, you've given this a lot of thought and study, but there's also a care and a deep passion and commitment to this idea. There's a reason because you've seen people struggle unnecessarily, yeah, and caring is at the heart of've seen people struggle unnecessarily, yeah, and caring is at the heart of nursing.
John Silver:
It always has been. Yeah, you know, none of this community outreach that we're talking about, none of this is new to nursing. We were doing this in the 1880s. You know public health and nursing are married at the hip. It's just somewhere somebody did a surgical separation and public health drifted into medicine and kind of. You know they hire nurses, but it's really much more.
John Silver:
You know like they measure success, like CMS and public health. They measure success by hospital reductions at a facility 20 miles away. Let's just take that as an example. But is that what the health of a community is? Does that mean the community is healthy? Are we measuring that by how many COPD cases we get, or are we using, as I do, an expanded definition of what constitutes a healthy community, more along the World Health Organization definition, where you feel inclusive in the society, where you're engaged, you have the same opportunities as people that live in the suburbs or the same access to benefits of living in a tech society. And here we have. For the last 60 years, 70 years, we've just been strangling our rural communities in a lot of inner city areas of this country.
Ann Price:
Well being. Based in Georgia, I can tell you for sure we've had a lot of our rural health hospitals close. We have counties that do not have OBGYNs and we have big counties. It can take you 45 minutes to drive across a county. So if you've got to go to the next county to see, you know, an OB or a pediatrician and let's not that doesn't even touch like mental health and mental health providers, which is also healthcare, or dentists.
Ann Price:
Thank you right, Because a lot of people don't realize that dental health and cardiovascular health are closely tied.
John Silver:
Over 40% of the counties in Texas don't even have a primary care provider. So you know, this is just such a massive escalation. The canaries in the coal mine have been maternal child health and pediatrics. They are the canaries in the coal mine and they've been trying to tell us for 15, 20 years. We're hurting and yet what do we get? We get HRSA grants or a university study, and now they're talking about some kind of interventions at the upper political levels. But you know, is that just electioneering? Is that just something they're going to put in legislation and never budget, which has happened many times before?
Ann Price:
Right, yeah, the old unfunded mandate. Yeah, the other thing that kind of bounced around my head as you were talking about silos earlier is and I don't know if I told you this when we talked a week or so ago my husband had a stroke. I want to say 10 or 12 years ago he had a PFO, threw a clot, all the things. He's very lucky, very lucky. And I just remember thinking, you know, because the neurologist comes in and the general practitioner comes in and the uh, yeah, all the physical therapist comes in and I'm like, do you people ever talk to each other? Like, do you ever, like, get in circle up in the hall and talk about the patient? I mean, I asked them, like, do you know? We just we have the notes like that. Like that boggles my to your point about when you were talking about. Like nursing doesn't talk to public health, they don't talk to medical students in the medical school.
John Silver:
right, that just blows my mind but in the, the facilities that in within this model, physicians should feel very comfortable because they're based on teaching hospital models. So you will be doing ground rounds on your patients. Everybody will be there. A lot of the time we are talking in front of the patient or with the patient and that's the way, kind of it should be. There should be no secrets, everybody giving their contributions. You know, I get it that medicine has this big issue with scope of practice. I get it.
Ann Price:
So we'll say a little more about that. What does that mean?
John Silver:
Well, medicine emerged out of the 1800s to kind of solidify, being the single voice of all things health and health care. And when the Medical Practice Act passed in the 20s and 30s that solidified it into legislation. You could not practice medicine without a license anymore. Well, one of the consequences of that was it cut nursing off at the knees who is already engaged in, you know particularly remote rural areas in West Virginia, arizona, new Mexico, colorado, but also New York City with Lillian Wald. So it kind of stopped nursing from being able to reach that plateau level of practice. If that makes sense.
John Silver:
We could do the nursing kind of things, but not step up into that realm of diagnosis or prescribing. Yeah, but you know this isn't 1920 anymore. These professions that will be sitting at this table are practicing at the doctorate level of their practice. You know, I can almost guarantee you that that doctor of physical therapy knows more about physical therapy than most 99.9% of physicians. Same thing for the doctor of pharmacy. Just go down the disciplines occupational therapy, nutrition, right yeah, physical therapy.
John Silver:
We're all practicing a PhD and doctorate level practice or clinical doctorates in the field. So let us do what we're trained to do. But that means the concession to allow people to practice independently, and in particular, nurse practitioners. Where organized medicine, shall we say? A lot of state medical societies have deliberate roadblocks in the legislature to prevent it. Now 27 states do, and there's, you know, they keep throwing these kind of I would call them unsound studies up to try to prove that there's a lot of harm being done. But the simple truth is there's not gotcha again at our core. We're nurses. You know we're trying to take. This isn't a zero-sum game. We're not trying to steal something from medicine.
Ann Price:
Yeah.
John Silver:
We're trying to deliver health services to people that need it.
Ann Price:
Right, when I hear you talking, I hear you describing we call it the healthcare system, but it's almost like a sick care system. Yeah, yeah, we call it the disease care system, the disease care system. Yeah, yeah, we call it the disease care system, the disease care system, and what you envision is a health care system, a real health care system, where nurses are doing what they're trained to do and providing that service in rural communities.
Ann Price:
But not, just not just not just rural communities, but I can see I can see that very clearly I can also see an urban community. So I'm not saying it's not, but so let's just kind of like what would that look like? And you can pick whichever setting you want. I'm just trying to like give people a real picture. If we, these, these seven goals, were met, what would that look like for a person, either in the maybe inner city who now does not have access, or out in rural, wherever? What would that look like? What would they feel like? Who would be involved? How it would, how, how would it be different?
John Silver:
well, for one thing, they'd know where their community health center was.
Ann Price:
Oh, is there one.
John Silver:
There would be one, there would be some format of that, at whatever level. They would know where that was. They would know then to be able to that they could go there, would not have to worry about taking wads of money with them, be seen by somebody that can competently either address what their problem is, refer them and get the referral done and arrange the transportation. If that's what we have to do to get them to the place they need to be and that may be EMS, it may be Uber, who cares? It's just get people where they need to be to see the level of provider they need to see. Get people where they need to be to see the level of provider.
Ann Price:
They need to see Gotcha and you were talking earlier about the cost would be less. How would the cost be less? How does the finance part work?
John Silver:
Sure. So for one thing, between the insurance system over the top of this and all the complexity that that requires, and the removal of the for-profit business presence from healthcare, which is a lot of overhead on the system, that itself is somewhere 35, 36% of healthcare of what we're paying now. So those two profits actually remember you're not just paying. You know everybody says, well, the CEO of this hospital gets $15 million or whatever. Oh my God. But that's not the only issue of administrative cost. There's also this sprawling administrative network underneath that provides data up to these, you know these corporate executives and tries to kind of manage these individual billable interactions. And then on top of the CEO you've got the corporate structure which is taking money out. The corporate structure has boards of directors that they're paying money out, and then the corporation pays dividends on their stocks that they're paying out.
John Silver:
Well, where does all that money come from? From a facility? It comes from your community. So in the public utility model the money would actually stay within that regional system. And as the system evolves and looks at the budgets for the next year, it becomes much more predictive of what it's going to require. It may have excess that it holds on to and then gets budgeted for less the next year. I do have an MBA certification from Tulane. I took two years off my PhD to get that, but I'm not an economist. The two economists I work with died, unfortunately, so I'm always willing to talk to one that wants to kind of lay this out. We get the numbers and we get somewhere around a $50 billion surplus nationally.
Ann Price:
Oh my gosh. Yeah, that would buy a lot of Q-tips.
John Silver:
Yeah, well, and that's just one of the advantages. You know these regional systems are no longer competitive, so that means they can share resources if they want to. You know there's a disaster 20, 30 miles away. Two or three systems can mobilize resources to come in and help them. It's like the electric company in a hurricane you get people from Tennessee coming down here to help us. Why can't these regional health care systems help each other? They would. But here's the most important thing they can group negotiate. They can buy supplies, equipment, expensive equipment in mass, in group and get significant reductions in the cost for doing volume business. They can also since Congress can't, or Medicare I should say Medicare can't they can also negotiate drug prices and we can end up with drug pricing like Canada.
Ann Price:
Which is what?
John Silver:
A lot less than ours is a lot less than ours is a lot less. That's why americans drive over into canada to get the medications if they can because they negotiate costs differently, because they negotiate in bulk and that's why drug prices are a lot lower in other countries. Uh is because this is the national systems negotiate drug pricing.
Ann Price:
Would that take care of any of the shortages that we've seen in the last couple of years?
John Silver:
This is not my area, so I don't understand that at all. You know, if you could get some standardizations and stuff, I think that would help. But we had a shortage of normal saline for a while in the country. It wasn't anything anybody could have predicted. It was a hurricane in Puerto Rico and the majority of the production was being done in Puerto Rico. So I think, like we found out with masks during COVID, we need to decentralize some of these things so that we always have ramp-up capacity in an emergency.
Ann Price:
Yeah, I wanted to get back to the nurses transforming healthcare and get into a little bit about what you guys are trying to do, whether that be policy or activities or strategies or whatever it is. What are you trying to do, or what are you doing?
John Silver:
The first attempt for a year was to try to just get out and talk and meet people and do podcasts. And you know, I thought we'd kind of keep working our way up the podcast level, maybe get a break and get into a national one or something we could talk to or get picked up by media or we get enough nurses, we could do it on our own Kind of that kind of game. But you know, my partner Kathleen, said people kept saying, well, you got to prove this model works. We're not interested in this, we can prove it works. Well, to prove it works you'd have to actually have the entire financing budget done in an area. But what I can tell you is everything this system and these goals unleash all the innovation potential, all the resources, all the benefits to that community. Those are well proven all around the world. Those are well proven all around the world.
John Silver:
Atul Gawande, for example, did an article in the New Yorker several years ago on Costa Rica and what they found is just doing one little thing reconnecting public health with the physicians. Because they don't have nurse practitioners saw a huge increase in health benefits. Now, that's just one little R. Other countries have, you know, different projects going on Singapore, but you got to remember that Singapore is like smaller than West Virginia. You know some of these countries they try to compare our systems to are smaller than US states. One of them that gets a big ranking is actually smaller than three of New York's boroughs. So geography does matter. Our system design challenges are much closer to countries like Canada and Australia.
Ann Price:
Yeah, countries like Canada and Australia, yeah yeah, people are so afraid of like socialized medicine. When you say right, they immediately go oh my God, we don't want socialized medicine here. I don't know if you want to talk about that or not, are?
John Silver:
they off base. Talk about opening up a sore. Yeah, we were in legislation in Minnesota Mayo Clinic backed out of rural communities and we were talking to the reps in Minnesota and we said look, just give us two counties and let us show you that what we're talking about will deliver the outcomes. We say they will. You know, your state associate, your state agency, can handle the funds. We're not after, you know, fancy money. We don't make anything. We just want to go in and show that this works. So we got into the legislation and two Republican legislators ended up knocking this out. One of them was a gentleman who said yeah, I went to your website and it looks like a backdoor for single payer. Well, it's not a backdoor for single payer. This is.
John Silver:
You know, public utilities are kind of sitting in the middle between for-profit and a right. That's why public utilities came about from the electrical issue of the 20s where electricity was emerging. Industry was responding to it, but the electrical systems were privately owned. They charged what they wanted. They didn't go where they didn't want to go, where people couldn't afford it, they thought. And the monopolies FDR went after them, structured the public utilities and they worked pretty good for 75 years until we opened them up again for competition and government interference, in which case we ended up with Enron and the Texas collapse. So anyway, this model will deliver the result.
John Silver:
The other legislator that blocked us was a female legislator who's married to a physician, and she wanted to know where the physician oversight on all this was. Well, of course the public health department does employ physicians, but you know, three, four years before that, minnesota had passed independent practice for nurse practitioners. So I don't know what your definition of independent is, but mine is, you know, independent. Does that mean that we don't follow health protocols when we're doing? Of course we do. It's crazy. Follow health protocols when we're doing them? Of course we do. It's crazy. But you don't need micromanagement at that level of the delivery of service like that.
Ann Price:
Yeah, there's so many systems barriers to putting this into place. Do you ever get discouraged?
John Silver:
No, because you know as complex as they've tried to make this entire system. At its core, healthcare is just the delivery of health services to people in need of health services. You find people that need help and you help them. You try to make access to these systems as easy as possible for people. We try to provide some kind of standardized voice of health, of looking at other things in the community that could be causing disease or maybe the community doesn't know about, or finding things that are causing the problems we're seeing, and then working with those communities to try to solve them yeah, well, that brings me to my, um, my next question, which is how can uh, community coalitions, community-based organizations or non-profits get in, engaged in that, in that work, in that vision for transforming healthcare?
John Silver:
Well, one of the projects we're talking about now with my partner Kathleen is called the Flip the Zip campaign. Oh, that's cute. Well, you know, you got to make some kind of dividing line things and zip codes are pretty convenient things and zip codes are pretty convenient. Voting districts look like some kind of bizarre modern art pictures when you look at most states. So I don't think that would make much sense, but the zip codes would.
John Silver:
In my mind, I'd take like three rural counties or something where you've got a fair amount of heart disease or whatever the issue is, and you approach these counties and you say, look, let's do a competition for a year. We're going to see who gets the best outcomes and when you you know County A, if you're the one that wins, we're going to bring in a Travis Scott concert and put it right in the middle of your county. I mean, these things are so easy to arrange these kinds of rewards for you know, especially rural areas, it's a big deal. They're going to attract people from other counties, they're going to be the center of talk and a lot of these artists will donate a lot of their time for benefit-type concerts. Plus, the state has some resources they can throw. But if you could do this, it doesn't have to be, it can just be one zip by itself that goes, you know, yeah, we really want our help and you end up with some kind of Blue Zone, focus on just one smaller area. That's another idea.
Ann Price:
And Blue Zone. To say a little more about Blue Zone for those who may not know.
John Silver:
So what Blue Zone would do would be to go in and work with typically a small town and talk about nutritional health. And they'd work with businesses in the community. They'd work with people. They do educational programs and people you know, I think, essentially don't want to have to think too much about what they do to make their health better. So if you can get everybody in this area kind of working together and being educated about nutritional health, they've just shown dramatic results Thousands and thousands and thousands of pounds lost okay gotcha.
Ann Price:
So even though maybe um, uh, the the health care industry isn't gonna like roll out the red carpet and and make changes, right, the system will not. Will will work to maintain its status quo. You feel like there are some points of intervention that the community can take control of their own healthcare in these ways.
John Silver:
Yeah, sure, and let's work with the healthcare community and let's work with the specialists and nutritionists and physical therapists and do the right assessment. Again, back to that assessment tool. I use a nursing-based assessment tool from I'd like to think she's a friend Dr Jean Watson, the University of Colorado, who designed a caring-based community assessment tool for nursing and it just you know, to be perfectly honest, like 90, 95% of the healthcare needs in communities are nursing care needs. They're not medicine care needs and on a consistent basis over time the volume of nursing services far exceeds, like you saw from the hospital right, 23 hours of nurses an hour if you're seeing three doctors.
Ann Price:
Maybe that's being very generous.
John Silver:
And listen. I don't slam doctors, because I know multiple physicians. The throughput demands on them from this system is killing them too.
Ann Price:
Yeah, oh, absolutely 100%.
John Silver:
And I'm working right now with, I think, a very progressive group of physicians and I think we're starting to see some growth in that they're, you know, willing to say look, yeah, we're okay with the compromises. We want to get back to being able to practice medicine.
Ann Price:
Yeah, really yeah, I think that's how nurses feel too. Well, I'm sure I'm sure the doctors didn't go to medical school thinking I'm happy spending 10 minutes with the patient and on to the next day. That's got to be exhausting and frustrating 35, 40 patients a day.
John Silver:
It's absurd, yeah, absolutely. And then they're pressured. Not only that, but since a lot of them are employees of the hospitals now they're no longer private providers coming in to see you in the hospital, they're employed by the hospital. They're also under a lot of pressure to utilize the high profit return diagnostic stuff that that hospital paid off. It's been a lot of money, yeah.
Ann Price:
All right, rapid fire questions. What's the best thing about being a nurse, and the hardest?
John Silver:
The best thing, I think, is really seeing human beings. We don't see facades. We don't see facades, we don't see avatars. We get to really meet and connect with actual human beings and I think that's one of the great pleasures of nursing we don't put up a pretense. I think people know we're there to help them. I think they trust what we say, as long as we keep true to ourselves.
Ann Price:
And the hardest the same we see people as human beings.
John Silver:
The hardest is to keep. That focus system has been trying to make us do more and more patient tasks at the expense of the nursing value that we bring into the equation, because we're seen as a profit loss to these facilities. We're overhead, we might as well be file clerks, so they try to skim the staffing. At the same time, since 1980, the acuity of the American public has drastically increased, and so those two slopes have been confronting nursing for a long time now.
Ann Price:
What do you wish people knew about being a nurse?
John Silver:
time. Now, what do you wish people knew about being a nurse? I really, you know. I made up a phrase one time and I said our ends, we're not just at your side in healthcare, we're on your side, and I think that's an important message for people to understand is we have no hidden agenda. To understand is we have no hidden agenda. Read our code of ethics, study our history. Look at the nurses around you that you interact with. We're not complex. We're there to do one thing, which is help you, and writ large socially in our code of ethics is our challenge to find people that need help, to help. So not just wait in a facility for you to come in be engaged in the communities within our practice expertise with other people.
John Silver:
There's no false pride in nursing and working with other people and educating and bringing the value that nurses bring.
John Silver:
Yeah, so this is kind of related to that One piece of advice you have for nurses and or community leaders related to health care in the US. Well, I think the big thing I would say is don't be fooled by the fact that we only before the PPAC. So I would say keep optimistic, look critically at people that come out and say there are solutions. I invite anybody to critically look at what I'm advocating for and presenting and NTHs Again, we're right in your face. There's no hidden agenda. We're a 5013C. Nobody takes a dime for all the stuff we've done over the last three years. We just want to get politically empowered enough to bring this option.
Ann Price:
Yeah, to have people be able to have a conversation. So I'm an evaluator, so I have to sneak a data question in how does, how does data inform your work and how can we use it to? Also can communicate to communities about how, how a different kind of system could help them well, I'm not sure what you mean by data.
John Silver:
Well, for example, we just completed a project in Spicewood, texas. It's the first chance we've had. We had some really close hits in Utah, minnesota, but the first real project we initiated and worked with was in Spicewood, texas, and one of our partner NPs drove through this town and saw that there were a lot of poverty there retired vets, people like that and saw a church that had a food pantry that was handing out canned food. Now that's probably not the best food choice if you've got hypertension, coronary heart disease and all that stuff. But she saw seven vegetable beds behind the facility. Those beds are now, I think, 19 or 20. They produce like 4,000 pounds of healthy food that we're now getting up. And then we tag teamed into the food bank bringing in a nurse practitioner once a week and then got to the point, with donations from some people, that we could put a full-time RN in there.
John Silver:
We did a modified because we don't have the workforce.
John Silver:
We did a modified kind of community assessment to identify needs, and some of the needs are just so pathetically insignificant keeping people from at least being able to manage their disease states.
John Silver:
So one gentleman just you know, didn't have the 10 bucks he needed for gas to be able to drive to the closest pharmacy to get his medication. So one of the things my NP partner down there I never remember I know her as Candice as can do you know Candice did was she developed an app that kind of sets up that community as an ecosystem and it allows people to communicate directly with each other. So if you're laid up in bed and you need some laundry done, somebody may want to come over and get some points for doing your laundry or driving you somewhere or walking your dog, how do I know. But whatever the issue is, it allows people to maybe join up and say, hey, I got to go to the VA too. Let's make our appointment on the same day. It's just some way to get a community engaged with itself Right and start getting out of this pathos that we see in so many of these smaller communities.
Ann Price:
Yeah, I love that. That is such a great example of implementation and evaluation.
Ann Price:
And we just got the year-end survey and again the anecdotal stories are just and the data is just overwhelmingly positive yeah, I mean now I have the kind of the image of my you know, because I love to hike, so I have an image of like water just trickling through a rock, right, that's what forms a crevice, that's what forms the split. So, even if the system wants to maintain itself in the status quo, if enough communities did little micro interventions like that, imagine how things would be different.
John Silver:
And we're willing to work with any community to help them. You know, kind of implement this team. There are generally schools of nursing and nursing colleges in areas to offer up that workforce. If you will, to come in and, you know, set up those assessment camps or I don't want to call them camps, assessment opportunities. Take advantage of what the resources within that community is, See how we can get some kind of small footprint in there and then, you know, see what other groups might be interested in joining us. There's a lot of professions in healthcare that I think would love the opportunity to kind of holistically train their students, including med students.
Ann Price:
So, speaking of opportunities, I've got to ask you the question I ask everybody when you look to the future, what community possibilities do you see?
John Silver:
When you look to the future, what community possibilities do you see? Well, I think the community level of care is going to absolutely take over. I think, when people find out the benefits of this level of focus because you can't really focus on individuals, I know, you know there's this value-based care that we focus on the individual. Well, you can't focus on 368 million foci, but the community level gives you a cohesive unit that is reasonably accessible and easy to assess. It gives you enough quantifiable data that you can do accurate analysis and it gives you a lot of qualitative data, which I think is just as important as the quantitative.
Ann Price:
Oh, absolutely, we love mixed methods around here. Yeah, yeah, you got to have stories, because we're wired for stories. Well, john, thank you so much for joining me today. How can people get in touch with you to either talk to you or learn more about Nurses? Transforming Healthcare.
John Silver:
Sure you can come to our website nursestransforminghealthcareorg. There's some articles I wrote. One of them in particular that might be interesting is the completing the circle of nursing, where, to me, nursing is designed to be a social agent of change, a social force, say. But that family of nursing just like in a hurricane, where it gets its max strength when the bands wrap around it. And nursing is not just RNs, it's not just nurse practitioners, it's LPNs, it's community health workers, it's people who go in and do care for grandpa or grandma in the house, the family members themselves, because that's where the majority of care is being given in this country, is by family members. That is all the family of nursing. And when we reconnect that family, if we can kind of get onto this same page, we're going to be a really potent, not just voting block but mouth block.
Ann Price:
Yeah, social transformation block.
John Silver:
Yes.
Ann Price:
Awesome, John. You speak my love language.
John Silver:
Oh thanks. Yeah, I really loved your education on community psychology. I just thought, holy mackerel, this is somebody we got to work with, because you know, I'm not a psychologist.
Ann Price:
Yeah, well, I am so glad you reached out on LinkedIn.
John Silver:
Or I'll tell people you can just email me directly at. Forrester F-O-R-R-E-S-T-E-R 2232, at gmailcom. I'm more than happy to talk to groups, people, because we have to start effecting change.
Ann Price:
Yeah, absolutely. Hey, John, thank you so much for joining me.
John Silver:
It's been a great pleasure. Thanks for having me on.
Ann Price:
Hi everybody. Thank you so much for joining me on today's episode of Community Possibilities. If you've liked what you've heard, maybe it's helped you think about something that you weren't aware of. Maybe this conversation has helped you think about something that you weren't aware of. Maybe this conversation has helped you think about something a little differently, or maybe you've just been inspired. Could you do me a favor? Could you like and share the podcast wherever you listen? And if you could take that extra step of posting a comment, that would be so helpful. Thanks so much, everybody. See you next time.
