Apology to Voices of Central Pennsylvania

Apologies should be short and to the point. Sadly, my won’t be. There are times when anger gets the better of me.

Anger is never useful. I see a future where my teeth will fall out because of neglect and radiation treatment. My course in life did not lead me to money. “The difference between the rich and poor,” an apocryphal comment attributed to Ernest Hemingway, was his response to F. Scott Fitzgerald. “Yes, they have more money.”

Twenty five percent of adults age 65 and older have no teeth. The number of dentists graduating is less than those retiring. The countless (a word deliberately used) figure of children suffering from dental pain con not be calculated.

The founders of Voices believed in a progressive America. I have no cause for fingering you for contributions for my rotten teeth. My rotten teeth are among other things a casualty of my generation, the largest, best educated (if money spent on education is a reasonable yardstick) in U.S. and indeed world history.

My generation supported our parents in their old age. I remember the day my stroke-ridden father entered the Miami Home for the Aged and the day with the help of my toddler daughter and my former wife took the long drive we could little afford to Florida to clear out his papers. At the Home, four-year old Joanna was intrigued by the cups next to the water fountain. She filled each cup and handed them to the residents. A long line ensued. One resident asked, “Why is there such a long line for water?” Before he could receive an answer, Joanna handed him a cup. He cried. “It has been decades since I saw a child so young.”

Later, when I was a paraplegic, I begged my mother in North Carolina to give me and my sister the power of attorney that made it possible for her to leave the hell hole to which a physician with too many credentials and too little sense had her committed. She was able, as a consequence, to die 10 years later in a facility that would put Center Crest to shame.

With two young children to support, I did everything I could to pay the mortgage and put bread on the table. On one sad occasion, I even worked briefly for the liquor lobby in Washington, for a company in North Carolina which went bankrupt because it did not believe in the Internet. I worked in the Silicon Valley of California writing documentation for start-up companies which had no software to sell. I did what I could.

Pension plans, in such instances were a joke for which I paid excessive penalties to support two generations. Now, I live on my monthly social security check which arrives too late and lasts not nearly long enough.

++++

Today, it is the rich who can afford to fix their teeth.

The term “income inequality” seems a joke to me coming from the mouth of a President I had hoped would be a progressive, but whose leadership is sadly lacking.

The most recent news–not really news given the way the media cycle turns–is that Obama has abandoned the last shred of dignity to those Americans whose insurance policies do not meet the minimal requirements of his own paltry Affordable Act minimum requirements.

The excuse is that the President is concerned that when midterm elections take place, holders of substandard policies will take revenge on Democratic members of Congress too [expletive deleted] to stand up for what is right.

I would be remiss in NOT denouncing the cuts in Medicare durable medical equipment which the President (I am told from the Oval Office) decided are a luxury those of us on mobility devices, such as the one on which I am sitting. Most appalling are cuts in home medical oxygen which make residents prisoners in their own homes unable to exercise their Constitutional right to travel to other states.

++++

The difference between the wealthy and the poor is that the wealthy can afford care and the poor cannot.

The only credible answer is universal, socialized medicine for all residents in the U.S.

Consider, for example, the President’s limp refusal to denounce the Supreme Court decision which would have mandated equality between Medicare and Medicaid and the consequences it has had in this once progressive Commonwealth of Pennsylvania.

In keeping with this conclusion, in less than ten years dental coverage must be available to everyone who lives in the U.S. It may be too late for me. Recognizing that the pain I will have to endure I will have to endure with grace, but I have had to learn harder lessons in my life.

That socialized medicine and socialized medical care will come in my lifetime is clear. My Baby Boom generation will insist on it and vote into office someone who understands and who will use the bully pulpit to convince dentists and primary care physicians to go to school.

++++

The understanding required is that Baby Boomers have talent the country cannot afford to waste. We cannot afford to waste it on unnecessary pain, on infections that can be prevented, on medical procedures that will restore us to productivity.

The sin we face is that the elderly and disabled DO have the talent, when judiciously developed, to achieve the productivity to develop the wealth required to rid America of its economic distress.

++++

I am angry. Anger is a crippler.

My hero Martin Luther King, Jr. preached the virtue of love. “You can bomb our homes and spit on our children,” he said “and we will still love you.”  I have not yet learned to integrate love into the daily problems that confront me.

Please forgive me Voices.

–Joel Solkoff

Copyright 2014 by Joel Solkoff. All right reserved.

 

 

 

 

 

 

 

 

 

 

 

“Considering the issue of death and value of life is a prudent way of investing my time.”

Grateful but absent

I am writing to express my gratitude to Congregation Brit Shalom and Rabbi David Ostrich for the comfort you have given me during my recent cancer ordeal. In April, I was diagnosed with kidney cancer. Despite my age and health problems,  Dr. Jennifer Simmons, the diagnosing urologist said, “You look better than your medical chart.” She urged me to go to Memorial Sloan Kettering Cancer Center in New York to seek immediate surgery before the malignant tumor spread. “Speed,” she said, “is essential.”

At first Dr. Paul Russo was reluctant to operate for fear my heart would not stand the pressures of an operation. After two trips from State College to New York and back for extensive cardiac testing, in August I returned to New York for a successful operation. Dr. Russo expertly removed the tumor, saved my right kidney, and ensured that for the next 10 years at least I will not die of kidney cancer.

I can always die of something else—the issue of death and the value of life seemed like a prudent way of investing my time. Rabbi Ostrich’s solace included giving me a lovely edition of The Psalms in Hebrew which as I slowly translated provided comfort. The Hebrew is so intensely beautiful. Funds from you in this Jewish community made the trips to save my life possible.

I have been absent from services and from Friday morning breakfasts with the gender neutral Bagel Boys (despite the name). In October my elder daughter Joanna married in North Carolina and I gave her away. As a paraplegic, flying out of State College airport is difficult because the small planes at a regional airport cannot accommodate my heavy mobility equipment which I had to rent upon arrival. My former wife Diana, who sat next to me, began crying at the ceremony and I handed her a clean handkerchief which she used with gratitude. The ceremony ended with the chaplain reciting in Hebrew “May the Lord shine HIS [HER] face upon you and be gracious unto you.” I wept without control. Diana handed me back my handkerchief.

++++

The trip to North Carolina and back to State College exacerbated the recovery process from major surgery. I have recovered physically, but I am back at Congregation Brit Shalom only spiritually. A friend sent an article advising that there is a difference between ruminating and meditation (to which I include prayer). Ruminating over the past is deleterious to one’s health, the article said; meditation and prayer are good. This is nonsense. How can I not reflect upon an experience as intense as surviving cancer? What have I learned? I am 66 years old. What does God want me to do with my time here on Earth?

During these months, I have transferred out of bed to my wheel chair, gone to my computer, and have been writing prolifically. I have not otherwise been reliable, but words keep appearing published on my website www.joelsolkoff.com. On one blog posting, I thank the Jewish people (who else).

At the heart of my efforts is the solution for the problems of low-income elderly and disabled individuals for whom I am an advocate. During adolescence and college, I was active in the civil rights movement where I met Rabbi Abraham Heschel as we marched together with Dr. King.

I am proud of the role of the Jewish community in ending the overt barriers to racial segregation and hope to participate in Jewish efforts to promote disability rights.

I am equally proud of the Jewish community for the flowering of Hebrew that has developed noticeably in my lifetime.

Soon, I will return to you physically praying to God in Hebrew as well as English. There is an interpretation of Genesis that holds God did not create Heaven and Earth. God created the Hebrew alphabet and Hebrew created Heaven and Earth.

Until then, please accept my thanks.

–Joel

Copyright 2014 by Joel Solkoff. All right reserved.

Note: The above expression of thanks to Congregation Brit Shalom, State College, PA, was published March, 2014 in the synagogue’s newsletter The Scroll.

Today’s haircut and Abraham Lincoln

 

Before
Before

 

Undaunted stylist Carrie Thompson at State College PA's Super Cuts location
Undaunted stylist Carrie Thompson at State College PA’s Super Cuts Beaver Avenue location

NewAfter

After

++++++++

The transition from March 4, 2014, the date of my haircut to Abraham Lincoln.

On March 4, 1861 Abraham Lincoln, after taking the oath of office, became President of the United States. Following is the text of his first inaugural address:

Fellow-Citizens of the United States:
IN compliance with a custom as old as the Government itself, I appear before you toaddress you briefly and to take in your presence the oath prescribed by the Constitution of theUnited States to be taken by the President “before he enters on the execution of this office.”
   1
 I do not consider it necessary at present for me to discuss those matters of administrationabout which there is no special anxiety or excitement. 2
 Apprehension seems to exist among the people of the Southern States that by the accessionof a Republican Administration their property and their peace and personal security are to beendangered. There has never been any reasonable cause for such apprehension. Indeed,

the most ample evidence to the contrary has all the while existed and been open to their

inspection. It is found in nearly all the published speeches of him who now addresses

you. I do but quote from one of those speeches when I declare that—

I have no purpose, directly or indirectly, to interfere with the institution of slavery in the

States where it exists. I believe I have no lawful right to do so, and I have no

inclination to do so.

3
 Those who nominated and elected me did so with full knowledge that I had made thisand many similar declarations and had never recanted them; and more than this, theyplaced in the platform for my acceptance, and as a law to themselves and to me, the

clear and emphatic resolution which I now read:

Resolved, That the maintenance inviolate of the rights of the States, and especially

the right of each State to order and control its own domestic institutions according

to its own judgment exclusively, is essential to that balance of power on which the

perfection and endurance of our political fabric depend; and we denounce the

lawless invasion by armed force of the soil of any State or Territory, no matter

what pretext, as among the gravest of crimes.

4
  I now reiterate these sentiments, and in doing so I only press upon the public attentionthe most conclusive evidence of which the case is susceptible that the property, peace,and security of no section are to be in any wise endangered by the now incoming

Administration. I add, too, that all the protection which, consistently with the Constitution

and the laws, can be given will be cheerfully given to all the States when lawfully demanded,

for whatever cause—as cheerfully to one section as to another.

5
 There is much controversy about the delivering up of fugitives from service or labor.The clause I now read is as plainly written in the Constitution as any other of its provisions:No person held to service or labor in one State, under the laws thereof, escaping into

another, shall in consequence of any law or regulation therein be discharged from such

service or labor, but shall be delivered up on claim of the party to whom such service or

labor may be due.

6
 It is scarcely questioned that this provision was intended by those who made it for thereclaiming of what we call fugitive slaves; and the intention of the lawgiver is the law.All members of Congress swear their support to the whole Constitution—to this provision as

much as to any other. To the proposition, then, that slaves whose cases come within the terms

of this clause “shall be delivered up” their oaths are unanimous. Now, if they would make

the effort in good temper, could they not with nearly equal unanimity frame and pass a law

by means of which to keep good that unanimous oath?

7
There is some difference of opinion whether this clause should be enforced by national or byState authority, but surely that difference is not a very material one. If the slave is to besurrendered, it can be of but little consequence to him or to others by which authority

it is done. And should anyone in any case be content that his oath shall go unkept on a

merely unsubstantial controversy as to how it shall be kept?

8
 Again: In any law upon this subject ought not all the safeguards of liberty known in civilizedand humane jurisprudence to be introduced, so that a free man be not in any case surrenderedas a slave? And might it not be well at the same time to provide by law for the enforcement

of that clause in the Constitution which guarantees that “the citizens of each State shall be

entitled to all privileges and immunities of citizens in the several States”?

9
 I take the official oath to-day with no mental reservations and with no purpose toconstrue the Constitution or laws by any hypercritical rules; and while I do not choose now tospecify particular acts of Congress as proper to be enforced, I do suggest that it will be much

safer for all, both in official and private stations, to conform to and abide by all those acts

which stand unrepealed than to violate any of them trusting to find impunity in

having them held to be unconstitutional.

10
 It is seventy-two years since the first inauguration of a President under our NationalConstitution. During that period fifteen different and greatly distinguished citizens have insuccession administered the executive branch of the Government. They have conducted

it through many perils, and generally with great success. Yet, with all this scope of precedent,

I now enter upon the same task for the brief constitutional term of four years under great and

peculiar difficulty. A disruption of the Federal Union, heretofore only menaced, is now

formidably attempted.

11
 I hold that in contemplation of universal law and of the Constitution the Union of these Statesis perpetual. Perpetuity is implied, if not expressed, in the fundamental law of all nationalgovernments. It is safe to assert that no government proper ever had a provision in its organic

law for its own termination. Continue to execute all the express provisions of our National

Constitution, and the Union will endure forever, it being impossible to destroy it except by

some action not provided for in the instrument itself.

12
 Again: If the United States be not a government proper, but an association of States in thenature of contract merely, can it, as a contract, be peaceably unmade by less than all theparties who made it? One party to a contract may violate it—break it, so to speak—but does

it not require all to lawfully rescind it?

13
 Descending from these general principles, we find the proposition that in legal contemplationthe Union is perpetual confirmed by the history of the Union itself. The Union is much olderthan the Constitution. It was formed, in fact, by the Articles of Association in 1774. It was

matured and continued by the Declaration of Independence in 1776. It was further matured,

and the faith of all the then thirteen States expressly plighted and engaged that it should be

perpetual, by the Articles of Confederation in 1778. And finally, in 1787, one of the declared

objects for ordaining and establishing the Constitution was “to form a more perfect Union.”

14
 But if destruction of the Union by one or by a part only of the States be lawfully possible,the Union is less perfect than before the Constitution, having lost the vital element of perpetuity. 15
  It follows from these views that no State upon its own mere motion can lawfully get outof the Union; that resolves and ordinances to that effect are legally void, and that acts of violencewithin any State or States against the authority of the United States are insurrectionary or

revolutionary, according to circumstances.

16
 I therefore consider that in view of the Constitution and the laws the Union is unbroken,and to the extent of my ability, I shall take care, as the Constitution itself expressly enjoins uponme, that the laws of the Union be faithfully executed in all the States. Doing this I deem to be only

a simple duty on my part, and I shall perform it so far as practicable unless my rightful masters,

the American people, shall withhold the requisite means or in some authoritative manner direct

the contrary. I trust this will not be regarded as a menace, but only as the declared purpose

of the Union that it will constitutionally defend and maintain itself.

17
 In doing this there needs to be no bloodshed or violence, and there shall be none unlessit be forced upon the national authority. The power confided to me will be used to hold, occupy, and possess the property and places belonging to the Government and to collect the duties

and imposts; but beyond what may be necessary for these objects, there will be no invasion,

no using of force against or among the people anywhere. Where hostility to the United States

in any interior locality shall be so great and universal as to prevent competent resident

citizens from holding the Federal offices, there will be no attempt to force obnoxious strangers

among the people for that object. While the strict legal right may exist in the Government to

enforce the exercise of these offices, the attempt to do so would be so irritating and

so nearly impracticable withal that I deem it better to forego for the time the uses of such offices.

18
 The mails, unless repelled, will continue to be furnished in all parts of the Union. So far aspossible the people everywhere shall have that sense of perfect security which is most favorableto calm thought and reflection. The course here indicated will be followed unless current events

and experience shall show a modification or change to be proper, and in every case and

exigency may best discretion will be exercised, according to circumstances actually existing

and with a view and a hope of a peaceful solution of the national troubles and the restoration of fraternal sympathies and affections.

19
 That there are persons in one section or another who seek to destroy the Union at all eventsand are glad of any pretext to do it I will neither affirm nor deny; but if there be such, I needaddress no word to them. To those, however, who really love the Union may I not speak? 20
  Before entering upon so grave a matter as the destruction of our national fabric, with allits benefits, its memories, and its hopes, would it not be wise to ascertain precisely why wedo it? Will you hazard so desperate a step while there is any possibility that any portion of

the ills you fly from have no real existence? Will you, while the certain ills you fly to are greater

than all the real ones you fly from, will you risk the commission of so fearful a mistake?

21
 All profess to be content in the Union if all constitutional rights can be maintained.Is it true, then, that any right plainly written in the Constitution has been denied?I think not. Happily, the human mind is so constituted that no party can reach to the

audacity of doing this. Think, if you can, of a single instance in which a plainly written

provision of the Constitution has ever been denied. If by the mere force of numbers a

majority should deprive a minority of any clearly written constitutional right, it might in a

moral point of view justify revolution; certainly would if such right were a vital one. But

such is not our case. All the vital rights of minorities and of individuals are so plainly

assured to them by affirmations and negations, guaranties and prohibitions, in the

Constitution that controversies never arise concerning them. But no organic law can ever

be framed with a provision specifically applicable to every question which may occur in

practical administration. No foresight can anticipate nor any document of reasonable length

contain express provisions for all possible questions. Shall fugitives from labor be

surrendered by national or by State authority? The Constitution does not expressly say. May

Congress prohibit slavery in the Territories? The Constitution does not expressly say. Must

Congress protect slavery in the Territories? The Constitution does not expressly say.

22
 From questions of this class spring all our constitutional controversies, and we divide uponthem into majorities and minorities. If the minority will not acquiesce, the majority must,or the Government must cease. There is no other alternative, for continuing the Government

is acquiescence on one side or the other. If a minority in such case will secede rather than

acquiesce, they make a precedent which in turn will divide and ruin them, for a minority

of their own will secede from them whenever a majority refuses to be controlled by such

minority. For instance, why may not any portion of a new confederacy a year or two hence arbitrarily secede again, precisely as portions of the present Union now claim to secede from it? All who cherish disunion

sentiments are now being educated to the exact temper of doing this.

23
 Is there such perfect identity of interests among the States to compose a new union as toproduce harmony only and prevent renewed secession? 24
 Plainly the central idea of secession is the essence of anarchy. A majority held in restraintby constitutional checks and limitations, and always changing easily with deliberate changesof popular opinions and sentiments, is the only true sovereign of a free people. Whoever

rejects it does of necessity fly to anarchy or to despotism. Unanimity is impossible. The rule

of a minority, as a permanent arrangement, is wholly inadmissible; so that, rejecting the

majority principle, anarchy or despotism in some form is all that is left.

25
 I do not forget the position assumed by some that constitutional questions are to be decided bythe Supreme Court, nor do I deny that such decisions must be binding in any case upon the partiesto a suit as to the object of that suit, while they are also entitled to very high respect and

consideration in all parallel cases by all other departments of the Government. And while it is

obviously possible that such decision may be erroneous in any given case, still the evil effect

following it, being limited to that particular case, with the chance that it may be overruled and

never become a precedent for other cases, can better be borne than could the evils of a

different practice. At the same time, the candid citizen must confess that if the policy

of the Government upon vital questions affecting the whole people is to be irrevocably fixed

by decisions of the Supreme Court, the instant they are made in ordinary litigation

between parties in personal actions the people will have ceased to be their own rulers,

having to that extent practically resigned their Government into the hands of that eminent

tribunal. Nor is there in this view any assault upon the court or the judges. It is a duty from

which they may not shrink to decide cases properly brought before them, and it is no

fault of theirs if others seek to turn their decisions to political purposes.

26
 One section of our country believes slavery is right and ought to be extended, while the otherbelieves it is wrong and ought not to be extended. This is the only substantial dispute.The fugitive-slave clause of the Constitution and the law for the suppression of the foreign slave

trade are each as well enforced, perhaps, as any law can ever be in a community where the

moral sense of the people imperfectly supports the law itself. The great body of the people

abide by the dry legal obligation in both cases, and a few break over in each. This, I think,

can not be perfectly cured, and it would be worse in both cases after the separation of the

sections than before. The foreign slave trade, now imperfectly suppressed, would be

ultimately revived without restriction in one section, while fugitive slaves, now only partially

surrendered, would not be surrendered at all by the other.

27
 Physically speaking, we can not separate. We can not remove our respective sections fromeach other nor build an impassable wall between them. A husband and wife may be divorced andgo out of the presence and beyond the reach of each other, but the different parts of our country

can not do this. They can not but remain face to face, and intercourse, either amicable or

hostile, must continue between them. Is it possible, then, to make that intercourse more

advantageous or more satisfactory after separation than before? Can aliens make treaties easier

than friends can make laws? Can treaties be more faithfully enforced between aliens than laws

can among friends? Suppose you go to war, you can not fight always; and when, after much loss

on both sides and no gain on either, you cease fighting, the identical old questions, as to

terms of intercourse, are again upon you.

28
 This country, with its institutions, belongs to the people who inhabit it. Whenever theyshall grow weary of the existing Government, they can exercise their constitutional right ofamending it or their revolutionary right to dismember or overthrow it. I can not be ignorant of

the fact that many worthy and patriotic citizens are desirous of having the National Constitution

amended. While I make no recommendation of amendments, I fully recognize the rightful

authority of the people over the whole subject, to be exercised in either of the modes prescribed

in the instrument itself; and I should, under existing circumstances, favor rather than oppose

a fair opportunity being afforded the people to act upon it. I will venture to add that to me the

convention mode seems preferable, in that it allows amendments to originate with the people

themselves, instead of only permitting them to take or reject propositions originated by others,

not especially chosen for the purpose, and which might not be precisely such as they would wish

to either accept or refuse. I understand a proposed amendment to the Constitution—which

amendment, however, I have not seen—has passed Congress, to the effect that the Federal

Government shall never interfere with the domestic institutions of the States, including that of

persons held to service. To avoid misconstruction of what I have said, I depart from my purpose

not to speak of particular amendments so far as to say that, holding such a provision to

now be implied constitutional law, I have no objection to its being made express and irrevocable.

29
 The Chief Magistrate derives all his authority from the people, and they have referred none uponhim to fix terms for the separation of the States. The people themselves can do this if also theychoose, but the Executive as such has nothing to do with it. His duty is to administer the

present Government as it came to his hands and to transmit it unimpaired by him to his successor.

30
  Why should there not be a patient confidence in the ultimate justice of the people? Is anybetter or equal hope in the world? In our present differences, is either party without faith of beingin the right? If the Almighty Ruler of Nations, with His eternal truth and justice, be on your

side of the North, or on yours of the South, that truth and that justice will surely prevail

by the judgment of this great tribunal of the American people.

31
 By the frame of the Government under which we live this same people have wiselygiven their public servants but little power for mischief, and have with equal wisdom providedfor the return of that little to their own hands at very short intervals. While the people

retain their virtue and vigilance no Administration by any extreme of wickedness or folly

can very seriously injure the Government in the short space of four years.

32
 My countrymen, one and all, think calmly and well upon this whole subject. Nothing valuablecan be lost by taking time. If there be an object to hurry any of you in hot haste to a step whichyou would never take deliberately, that object will be frustrated by taking time; but no good object

can be frustrated by it. Such of you as are now dissatisfied still have the old Constitution

unimpaired, and, on the sensitive point, the laws of your own framing under it; while the new

Administration will have no immediate power, if it would, to change either. If it were

admitted that you who are dissatisfied hold the right side in the dispute, there still is no single

good reason for precipitate action. Intelligence, patriotism, Christianity, and a firm reliance on

Him who has never yet forsaken this favored land are still competent to adjust in the best way

all our present difficulty.

33
 In your hands, my dissatisfied fellow-countrymen, and not in mine, is the momentous issue ofcivil war. The Government will not assail you. You can have no conflict without being yourselvesthe aggressors. You have no oath registered in heaven to destroy the Government, while I shall

have the most solemn one to “preserve, protect, and defend it.”

34
 I am loath to close. We are not enemies, but friends. We must not be enemies. Though passionmay have strained it must not break our bonds of affection. The mystic chords of memory,stretching from every battlefield and patriot grave to every living heart and hearthstone all

over this broad land, will yet swell the chorus of the Union, when again touched, as surely

they will be, by the better angels of our nature.

Because of an assassination plot in 1861, Lincoln entered DC in costume. The cartoonists had a field day.
Because of an assassination plot in 1861, Lincoln entered DC in costume. The cartoonists had a field day.
35

See: http://www.bartleby.com/124/pres31.html

–30–

Joel Solkoff

Copyright 2014 by Joel Solkoff. All rights reserved. [Note. Clearly I cannot copyright Abraham Lincoln’s First Inaugural Address, much as I would like.]

 

Categories
Food

Backround: Why the 2014 farm bill makes poor food and social policy: really bad policy

  HaiphonghaStream of consciousness:
No Choice But to Sell the Russians Grain at the same time as we were mining the Harbor at Haiphong. The war ended in 1976. I heard the news while I was reporting on a hearing  before House subcommittee on Oil Seeds and Rice.  It came as especially bad news to rice growers. 

2014 Food policy update:

Going on the valid assumption that what is past is prologue, I present to you background for understanding the disaster President Obama’s decision to sign the farm bill represents. obamasignsfarm

February, 2014 with the Secretary of Agriculture and key Democratic players in Congress (Republicans boycotted the ceremony), President Obama signs into law the 2014 five-year farm bill.

USA Today notes: “The five-year bill — approved by Congress this week after years of fierce debate — expands federal crop insurance. It also changes the food stamp program, cutting it by $800 million per year — about 1% — and raising the automatic eligibility requirement.”

Translation, the new farm bill is meaningless when it comes to making food policy. Farmers no longer pay attention to what the Secretary of Agriculture tells them. Fat cats, most significant producers of SUGAR, are getting handouts they do not deserve and in the process defy our plans for International trade agreements.

Sadly, unnecessary handouts are traditional. They do not affect food policy; they just cost the government too much.

As for social policy, which perversely is really what the Department of Agriculture’s budget is really about, the poor are being hurt by cuts in food stamps and low-income pregnant women continue to be at high risk for infant mortality.

The fact that the Secretary of Agriculture is the official in the federal government with the highest budget targeted to reduce infant mortality is alarming. The high infant mortality rate is indicative of the Secretary of Agriculture’s failure in this regard. The fact that the Secretary of Agriculture should have any role at all in the campaign to reduce infant mortality is indicative of the bizarre nature of farm bills such as Obama just signed.

++++ newRepublic ++++

In 1975, I was writing a book for Marty Peretz. Martz Peretz was in the process of creating an important journalistic empire at The New Republic.  Never cautious about anything, Marty was forced into a legal contract where caution was presumably and certainly legally required.

To understand the situation, it is required to have an understanding of The New Republic's role in the 20th Century as the jewel of American journalism. If you are not familiar with Walter Lippman, more New Republic praise is required. 

 

Once Is Not Enough

by Joel Solkoff

While Americans  mined the entrance to Haiphong harbor and bombed railroad lines  to  prevent Soviet goods from entering North Vietnam, the Soviet Union reacted by secretly negotiating the sale of 19 million metric tons of American grain. Later that year [1972], when the deal had become public and was already being called, “The Great Grain Robbery.”

John Rarick, then a member of Congress, said to Earl Butz, who is still the Secretary of Agriculture,

As a farm boy, I  can remember my dear old Hoosier grandmother telling me to watch out for some American businessmen, they will trade with the Devil if they can make a profit.”

Secretary Butz quipped, “If he has dollars.”

Early in his Administration, Richard Nixon had proposed abolishing the Department of Agriculture. Sectary of Agriculture Butz told me he accepted the job on the condition the Department not be abolished. Early in his Administration, Richard Nixon had proposed abolishing the Department of Agriculture. Secretary of Agriculture Butz told me he accepted the job on the condition the Department not be abolished.

++++

Last month, memories of 1972 returned as the headlines reported he controversy surrounding the Soviet Union’s mammoth new purchases of American grain. Longshoremen in Houston refused to load the wheat until a federal judge ordered them back to work.

longshore

Longshoreman at the Port of Houston

++++

After skiing, President Ford answers questions from reporters. Photo courtesy Colorado Ski and Snowboarding Hall of Fame

After skiing, President Ford answers questions from reporters. Photo courtesy Colorado Ski and Snowboarding Hall of Fame

++++

September 6, 1975 Irate wheat farmers met with President Ford, inter­rupting his golfing vacation in Vail, to tell him that they depend upon exports for survival.

++++
AFL-CIO Meeting in Washington
President Jimmy Carter addressing the AFL-CIO run by George Meany shown with iconic cigar. Without Meany’s support, Carter would never have been elected President.
++++
The price of food in July rose at an annual rate of 22.4 percent for the second month in a row. AFL-CIO President George Meany blamed the 10.3 million metric tons of Soviet grain purchases for rising food costs, warning con­sumers of “more bad news.”
In July a bag of groceries that last year cost a resident of Washington, DC $10, cost $13.90.
Secretary Butz blamed the featherbedding practices of union-working middlemen for much of the rise, but admitted Soviet grain sales would cost Americans 1.5 percent in additional food costs.
When it is all over, the Russian wheat deal of 1975, in which more corn has been sold than wheat, may be considerably larger than 1972. The principal difference is in 1972 the United States did not have to sell grain to Russia; in 1975 we do.
The wheat deal of ’72 changed American agriculture dramatically and probably irreversibly. In one quick and unexpected move, surplus became scarcity .
 ++++

Grain storage bin

Grain storage bin
++++
No  longer was the government paying high storage costs, at one point ran to more than a million dollars a day. Instead the government sold all the wheat and corn it had in storage and then it sold all the storage bins.
No longer are farmers paid not to grow . By 1973 President Nixon had signed a  new agricultural act passed by a Democratic Congress that was unaware  of its implications and because of the Secretary of Agriculture’s enthusiasm for exports. Butz boasted 50 million acres that had been lying fallow were put into production.
Today [1975] we have a  policy insiders in the department call “wall to wall farming.” This  year’s  wheat crop  is the largest in American history, and the corn crop may set a record  too.
++++
https://www.youtube.com/watch?v=CAKrIdSPkHI
This video provides an overview of Wallace, who after ruling USDA, served as Vice President to Franklin Roosevelt for Roosevelt’s second and third term. In 1948, Wallace ran as an Independent candidate for President.
++++
 On August 20, Butz, the most powerful Secretary of Agriculture since Henry A . Wallace, gave a speech in which he explained America’s new farm policy is designed to meet the food needs of the world ‘s exploding population.
“By the year 2000, if we continue to multiply at present rates, there will be between 6.5 to seven billion people living on earth. This means in the next two-and-a-half decades we must learn how to feed as many people as we have learned  to feed since the dawn of history. Even now, we aren’t feeding the 3.9 billion nearly as well as we should.”
In 1933, Henry Wallace changed American agriculture by implementing the farm programs the Great Depression had made necessary. Earl Butz has been changing American agriculture by destroying the programs Wallace had implemented.
Butz’s predecessor, Nixon-appointee Clifford Hardin, took over Butz’s seat on  the Ralston Purina Board.
Butz is an extremely clever Secretary who has not always bothered about legal niceties . He talks about feeding the hungry while his policies make it even more difficult to do so.
While the participants may be talking about bread, they are thinking about meat.   the Russians had a choice. Their political leaders could renege on their promise to increase the protein content of the Soviet diet and slaughter the stock of their developing livestock industry.
Or they could feed their livestock American corn and soybeans and Soviet wheat, using superior American wheat for making bread. The political leaders were reluctant to tell their people they must be content to continue eating grain, potatoes and beets. In order to increase their meat supply, they were required to do something their agriculture was unable to do–produce bumper crops year in and year out to feed the livestock.
That is why, three years later the Russians are back on the world grain market with even larger needs, causing prices to skyrocket by the sudden and unexpected manner in which they make their purchases.
In 1972, when weather interfered with their plans, the Russians were able  to take advantage of political circumstances in the United States and buy a quarter of our wheat crop and much of our corn and soybeans.
Richard Nixon needed détente.
His foreign policy required while fighting a war in Indochina aimed at preventing the spread of Soviet influence, he convince the American public that he was simultaneously easing Cold War tensions. He had to give the Russians something to make it worth their while to ignore such provocations as the mining of Haiphong harbor. At the same time, domestically, his Secretary of Agriculture was eager to pursue Butz’s policy of “getting the government out of agriculture.”
Perhaps there was some hope that farmers would not realize what they had lost at least until after the election and would vote for an administration that had raised farm prices.
The Department of Agriculture’s Commodity Credit Corporation (CCC) loaned the Russians the money under extremely favorable credit arrangements. The Russians used the money to make secret transactions with private grain trading firms.
The US government does not have the legal authority to export commodities. That can only be done by private  companies.
America ‘s grain trade is dominated by six multinational corporations with monopolistic power similar to the Canadian Wheat Board and the Soviet Union’s ministry of agriculture. The power of the big six is greater and they operate for private rather than public interest.
The companies sold the Soviet Union grain they had purchased from USDA’s CCC storage bins and from American farmers. This grain was sold to the Russians at prices significantly lower than the domestic price and the companies were paid the difference by the US government–$160 million in subsidies. Meanwhile the grain companies-operated on tips provided rom USDA by USDA officials who later came to work for the grain companies
–30–.
++++
Originally published in the New Republic after the Labor Day weekend, 1975.
The magazine provided the following biographical information: “Joel Solkoff is a Washington writer specializing in Agriculture.”
Copyright 2013 by Joel Solkoff. All rights reserved.
++++

What follows is President Obama’s lengthy explanation in which he eventually explains why he signed the farm bill. Stay tuned for why doing so was a bipartisan mistake.

http://www.youtube.com/watch?v=cH00_o24Odc
Categories
Food

Cornering the wheat market in fiction and reality

Reconsideration: 

The Pit by Frank Norris

“Norris, who easily grasped the drama of the sales on the floor of the pit, . , .had difficulty comprehending how a man could sell a thousand bushels of wheat when he did not own them,” Franklin Walker writes in the only full-length biography of Frank Norris.

The reason Norris worked so hard—he said it was the most difficult task he had ever performed—to understand commodity futures trading was because he was writing a novel about a man who succeeds in cornering the wheat market.

++++

++++

The problem Norris had in understanding how a man can sell wheat he does not own is the problem most people have when they attempt to understand commodity future trading. What takes place on future exchanges such as the Chicago Board of Trade is not that people buy and sell wheat and other commodities. Rather they buy and sell the future delivery of commodities.

When Norris’s hero realized he could corner the wheat market, it was April. The wheat he was buying in the octagonal pit of the Chicago Board of Trade was wheat to be delivered to Chicago in May.

For about 99 percent of the sales taking place today on the floor of the Chicago Board of Trade, wheat “buyers” do not want it delivered to them; wheat sellers have no actual wheat to sell.

Rather, buyers and sellers are hoping to make money on price fluctuations from the time the May wheat contract is first traded until the month of May. In May, when it comes time for delivery, traders who have bought wheat frantically “sell” it; those who have “sold” wheat frantically buy. By the deadline for delivery of May wheat, buyers and sellers resolve their contracts. As a consequence virtually all buyers and sellers have offset their positions; nobody has to deliver any wheat to anybody.

“It’s a case of gamble, but it’s legal and faro isn’t,” one trader told the Chicago Tribune in 1892.

“The late 1900s were filled with incidents of public outrage against alleged speculative abuses in commodities . . . markets,” a publication of the Chicago Board of Trade says. “The self-regulatory efforts of the exchanges went far to correct the problems.” Today futures trading is a form of insurance.

When the market is not being manipulated—an occurrence that takes place more frequently than generally known—the farmer has the opportunity to make a decent living by selling his wheat at a reasonable price; the miller has the opportunity to make a decent living by paying a reasonable price; the speculator assumes the risk the price will change considerably after the farmer has sold it and before the miller receives it. The speculator has the opportunity to profit from his risk.

The farmer’s risk is if he waits to sell his wheat until the miller actually needs it, there may, for example, be good weather resulting in an unexpectedly large crop and in disastrously low prices.

The risk to the miller is if he waits to buy wheat until he actually requires it, there may, for example, be a drought wiping out half the wheat crop resulting in disastrously high prices. So, the speculator in wheat futures protects the farmer against low prices, the miller against high prices, and the consumer against paying too much for a loaf of bread.

The speculator’s function is socially desirable only if he is taking risks with natural market forces. If he attempts to act not as an insurance man but as a manipulator of the market, he becomes a menace to society.

In The Pit, Frank Norris took an example out of history and described dramatically and with remarkably up-to-date accuracy the manipulation of commodity futures markets:

“Why, look here,” he cried. “Don’t you see? Don’t you see . . . “

“See what?” demanded the broker, puzzled by the other’s vehemence. . . . “

” Great Scott! I’ll choke in a minute. 

“See what? Why, I own ten million bushels bushels of wheat already, and Europe will take eighty million out of the country. Why, there ain’t going to be any wheat left in Chicago by May!

“If I get in now and buy a long line of cash wheat, where are all these fellows who’ve sold short going to get it to deliver to me? Say, here how are they going to get it? Come on now, tell me, where are they going to get it?” 

Let me explain.

A man who sells May wheat—wheat he does not own—is required to deliver it to the buyer when the month of May rolls around.

The requirement that the commodity be delivered—”It keeps the contract honest” one broker told me—is a contractual.

At the turn of the Twentieth Century, courts overturned laws in Iowa, Massachusetts, Texas, and other states where irate agrarian interests had succeeded in outlawing future contracts by redefining them as a form of gambling. Courts ruled they were not wagering contracts because a person who buys a wheat future can demand delivery on the due date.

Suppose a man holding a significant number of contracts promising delivery of May wheat to him were to tell each of the traders he is not interested in having them settle their obligation with money—as takes place with about 99 percent of the contracts—but with wheat.

Suppose, at the same time the May contract comes due, the man demanding delivery of wheat also happens to own all the wheat there is. Then, those people who have legally obligated themselves to sell him wheat (“these fellows who’ve sold short”) can only buy from one source.

From him.

They have to buy the wheat from him at whatever price he demands because they have a contractual obligation to sell it to him. He has them in a corner.

That is what the hero of Frank Norris’s novel does. Actually, Curtis Jadwin does not need to own all the wheat in the world to corner the market. He simply has to own all the deliverable supply,” i.e. all the wheat that can conceivably be shipped to Chicago in time for the contract to come due.

The real character on whose life Curtis Jadwin was based was loseph Leiter. In 1897, Leiter bought up all the nation’s known supply of wheat.

By doing so, he raised the price so high the Russians ate rye and shipped their wheat to Chicago. Throughout the United States and the world, wheat not thought to exist appeared suddenly as if by magic.

Using tugs with steel prows, Armour plowed up the ice in the Great Lakes and moved six million bushels of wheat into Chicago in the middle of winter. Though Leiter finally owned 50 million bushels of wheat, he did not have “absolute control of the deliverable supply.” When Leiter could no longer afford to buy any more, the wheat flooding Chicago lowered the price; his corner was destroyed.  He was ruined financially

Even though Leiter failed to corner the wheat market, he succeeded in “squeezing ” it, a term used to describe what is today an illegal manipulation of the market for the purpose of artificially raising the price. The hero of The Pit succeeded in his attempt to corner the market the following year only to discover the manipulation of price had so stimulated production there was too much wheat:

“The Wheat had broken from his control. For months, he had, by the might of his single arm, held it back; but now it rose like the upbuilding of a colossal billow.”

Critics of The Pit have uniformly failed to deal with the book as a fictional but true to life account of how the price of the wheat is determined. The Pit is the second novel in The Epic of the Wheat.

The third and final book in the trilogy Norris had decided to call The Wolf. The Wolf, left uncompleted by Norris’ sudden death would have described how the wheat produced in California and created in Chicago is used for, in Norris’s words, “relieving of a famine in an Old World community,”

What Norris could have done with grain companies such as Cargill, Continental, and Cook in their shipments of grain to Russia or towns like those in Bangladesh make us mourn the loss of this final book in the trilogy.

Realistic novels are supposed to provide us with a version of truth which we cannot get from works of nonfiction. The PIT is, Norris’s best novel. Wheat—capitalized and made the central character of the book—controls the action.

In The Epit of thf Wheat, Norris tries to show how the most elemental of powers—food—affects those who come into contact with it.

In Volume I, The Octopus. there are too many characters and digressions. The author cannot resist the temptation to take sides. The Pit succeeds as The Octopus doesn’t because Norris has more clearly defined what he is trying to do.

The mystical question, asked in The Octopus—When does wheat become Wheat?—is answered in The Pit. When the price is high enough.

A successful speculator is one in touch with the forces of nature who can anticipate how much the world will need. (Aren’t laws of supply and demand natural forces?)

Curtis Jadwin’s rivals, the Bears, had been  artificially manipulating the price so it would go down, so farmers would go out of business, so wheat would not be planted, and so the hungry would not have food to eat.

Jadwin becomes a hero because —unlike the corrupt speculators around him — he believed that people required wheat and he was successful in predicting when they required it. Jadwin believed the price should go up. He believed more wheat had to be planted and more people needed for food. He was correct.

Jadwin was at one with the conditions of the time, fighting against the manipulators and for the Wheat.

Power was on his side but the power possessed him. It nearly destroyed his marriage. Fortunately for the marriage, his wife Laura could never quite find it in herself to love Jadwin’s artist-rival Sheldon Corthell.

Corthell was a dilettante—dabbling at creating stained glass windows —while Jadwin worked in the real world of power. Yes, Laura is tempted to commit adultery with the available dilettante. Norris makes clear, tempted though she might be, Laura’s only real choice was to be faithful to her husband–a real man in a real world.

Still, Jadwin became so obsessed by power he attempted to corner the market a second time. This time he was fighting against nature.

His friend and broker says, “I see that the farmers all over the country are planting wheat as they’ve never planted it before. Great Scott, J., you’re fighting against the earth itself.”

It is a fight comprehensible to those who understand the love for power. It is a fight which an obsessed man cannot help but make and which he is bound to lose. This is what makes The Pit a great novel.

Post Script. One reason for the failure of  the critics to approach Norris’s work as an accurate picture of the forces that come into play when the government does not regulate agriculture is from 1933 to 1972 the government DID regulate agriculture and the role of the futures market  was limited when it came to determining the livelihood of farmers and their productivity.

During that period, the commodity ticker in the farmer’s office did not determine what he planted. Recently, however, when the Secretary of Agriculture was asked by the House Agriculture Committee how farmers decided how much to plant, he opened up The Wall Street journal and read off the previous day’s future prices for wheat, corn, and soybeans at the Chicago Board of Trade.

William T, Bagley, Chairman of the Commodity Futures Trading Commission, created by Congress as a consequence of the future-market scandals following the 1972 Russian wheat deal, told me his agency is too busy getting organized to effectively regulate the $598 billion a year commodity industry.

In May 1976 the impossible happened in the potato futures at the New York Mercantile Exchange. There were more contracts than there were Maine potatoes. The market went crazy as owners of potato futures insisted on delivery of potatoes they presumably owned but did not exist.

The Commodity Futures Trading Commission (CFTC) had to close down the exchange temporarily and try to sort out the mess. In April 1977, the CFTC filed suit in federal court against members off the Hunt family of Dallas and “a company controlled by one of them for holding soybean futures” on the Chicago Board of Trade representing about a third of the country’s crop. (Soybeans are a primary ingredient in the production of meat, poultry, and milk.)

“Maybe I ought to read the book, “Bagley said when I told him about The Pit. He said he had never heard of Frank Norris.

Joel Solkoff

loel Solkoff was a Washington writer specializing in agriculture when this article was first published.

Published on November 19, 1977 by The New Republic.

Copyright 2014 by Joel Solkoff. All rights reserved.

Relevance to February 2014. This month President Obama signed into law a farm bill. For years the House and Senate had different versions of farm bills each of which was a waste of taxpayer dollars and a sham at pretending USDA would have, as a consequence any significant role in determining our country’s food supply.

About two thirds of USDA’s budget goes for food stamps and nutritional feeding programs. Most USDA employees work for the forest service conserving trees. The press to fund food stamps is what finally caused Congress to come to agreement. Under the law signed in February, the livelihood of our country’s wheat farmers is dependent, as described above, on the price of wheat at the future pit (now replaced by computer screens) at the Chicago Board of Trade.

Truly, the more things change, the more they stay the same. Sadly, the bill Obama signed into law provide subsidies to sugar farmers who do not require subsidies. The subsidies artificially manipulate the future market in sugar and are being objected to strenuously by indignant European countries furious the U.S. does not abide by the free trade principles we espouse.

Meanwhile, during the period from 1977 to 2014, there has been an explosion of epic proportions of the use of future contracts. Future contracts have been extended to the equity market. Now you can get speculate on whether the price of a share of IBM will go up or down.

Hedge funds make it possible to speculate not only on the price of a share of stock, but on the option to buy or sell a share an option new future markets make possible. Using powerful computers, it is now possible to win or lose fortunes on minute price fluctuations between actual stock prices and future prices.

The Commodity Futures Trading Commission has been made impotent in its ability to regulate by the sheer volume of futures markets. My prediction is if you set out to corner the wheat market and have the money and skill to do so, the Commodity Futures Trading Commission would never catch you.

Categories
Architects for Change

Chapter 5. Dr. Kumar’s thesis on virtual reality modeling

Chapter 5: CASE STUDY- HERSHEY CHILDREN’S HOSPITAL

This chapter introduces the healthcare case study used for data collection, development and evaluation of the procedure for rapidly developing an Experience-based virtual prototype. The first part of the chapter introduces the case study, lays out the program requirements for the healthcare facility, the project description, status and context of the facility. The next section discusses the research approach and presents the timeline of the case study. The research approach includes the strategy for data collection and briefly describes the procedure for development, validation as well as evaluation of the EVPS along with a time line that shows when and how the process occurs.

The case study primarily uses focus groups as means of data collection for “Requirements analysis” of the EVPS. The focus group section describes in detail the method of data collection followed by analysis of these data to inform the development process and strategy for EVPS. Validation and strategy for development describes the rationale for design of the EVPS through identification of prioritized scenarios, spaces, end-users and overall purpose.
Development strategy for EVPS further discusses the model content, user interface and  interactive features included in the virtual prototypes as well as challenges encountered during the development process. The evaluation section discusses the first part of evaluation of the EVPS used in the design review meetings with the pharmacy staff. This section describes in detail the pharmacy program, the pharmacy’s transition planning initiative and finally the integration of the EVPS in their move planning process. Finally, lessons learned and summary provide an overview of the findings and conclusions of the case study.
5.1 CASE STUDY DESCRIPTION

The new Penn State Milton S. Hershey Medical Center Children’s Hospital is a 263,000- square-foot, five-story facility that is expected to open by end of December 2012. The state of the art facility is currently under construction and the hospital personnel are gearing up for transition planning. The new hospital is an independent facility adjoining the main hospital and the Hershey Cancer Institute. At present, the Children’s Hospital is located on the seventh floor of the main hospital.

fIG5-1 Figure 5-1. Rendering of the new Hershey Children’s Hospital (Source: Payette Architects).
The hospital design program includes a lobby and atrium with a family resource center, performance area, a café for family meals, a safety store, meditation space and an outdoor courtyard especially designed for children. The new facility will house outpatient clinics for children with cancer, and a new pediatric radiology unit.
The new Children’s Hospital will have a total of 131 pediatric beds that include pediatric medical/ surgical beds, pediatric intensive care unit (PICU) beds, pediatric intermediate care unit (PIMCU) beds and neonatal intensive care unit (NICU) beds. The integrated surgical and hematology/oncology suites have advanced equipment for infants and children.
The general medical and surgery beds will be in private pediatric and adolescent patient rooms with designated “zones” for families. The hospital has expanded space for PICU, PIMCU, five pediatric-only operating suites and a cardiac catheterization lab. The main pharmacy and state-of-the art blood bank will also be located in the ground floor of the facility.
 FIG5-2
Figure 5-2. Children’s Hospital under construction.
The owner, Penn State, and the design team decided to implement building information modeling (BIM) during the schematic design phase.
Throughout the project duration, the architect’s team updated and exchanged the Autodesk Revit models with contractors using an ftp server.
Table 5-1. Hershey Children’s Hospital facts.

Architect: Payette
Construction Manager: L. F. Driscoll
Delivery Method: CM @ Risk
Area: 263,000 square feet
Cost: $207 Million

5.2 CASE STUDY APPROACH

The Hershey Children’s Hospital case study started in October 2011, almost two years after project construction start on December 2009. The initial phase of research for requirements analysis included preliminary interviews with the nurse project manager of the Children’s Hospital. Meetings with the nurse manager, who was representing end-user needs throughout the building lifecycle, helped establish goals and scope of using the EVPS for Children’s Hospital and setting up dates for focus group meetings.
Figure 5-3 shows the timeline of the case study.
The EVPS was developed from highly detailed BIM models supplied by the architect’s team. Interviews with the architect helped in understanding the design intent and program with floor-by-floor space layouts within the facility and the current state of BIM use on the project. Discussions included permission to use BIM for developing EVPS, information exchange protocols and details on how the facility was modeled. The majority of requirements capture was done during two focus group meetings that are discussed in detail in the next section.
A draft EVPS of a part of the Children’s Hospital was developed during December 2011 and January 2012 to give the participants an idea of what to expect. After requirements analysis, the next phase was EVPS design and development. Meetings during this phase helped clarify and validate the scenarios of use identified during requirements analysis. Development took place from March through August 2012 with the final models delivered to the nurse project manager on September 7, 2012. EVPS evaluation was done in two parts.
The first analysis was done with the pharmacy leadership team and staff members where they used the EVPS for move planning during the design review meeting between February and March 2012. The next part of evaluation was user studies in July 2012 to understand the effect of embedding scenarios in virtual prototypes, which is discussed in detail in Chapter 6.

Capture  Figure 5-3. Timeline for Hershey Children’s Hospital case study.

5.3 FOCUS GROUPS

For initial requirements analysis for developing interactive virtual prototypes, focus groups were selected as a means for data collection.
Compared to one-to-one interviews, focus groups are more appropriate for the generation of new ideas formed within a social context (Breen 2006). Two focus group meeting were conducted over a span of two months.
The first meeting took place on December 09, 2011 and the second meeting took place on January 30, 2012.

5.3.1 First Focus Group – December 9, 2011

At the start of the first meeting, the researcher and facilitators welcomed participants, discussed the agenda and went through a round of introductions. The researcher presented a few slides outlining the background of the research project and outlined some goals for the meeting. Participants were shown two concept videos of the experience-based virtual prototypes; the first video showed scenarios of activities that can be performed in virtual prototypes and the second video showed the level of realism that can be achieved through use of lighting and textures. Focus groups were used to obtain data for identifying scenarios of tasks and spaces that need to be developed in the virtual prototype. Participants were split into groups of 4 to 5 so that they could discuss amongst themselves and provide feedback. Each mini group was required to discuss and work hands-on to help answer research questions.

5.3.2 Data Collection

Large 42” X 30” printouts of floor plans from levels 1-5 were used as artifacts during the focus group discussion along with the use of post-it notes to enable the participants to give feedback and answer the focus group questions. Questions asked during the meeting explored three broad themes (shown in Table 5-2) that focused on identifying and prioritizing the spaces, identifying and documenting scenarios and finally identifying modeling requirements for the development of the virtual prototypes. Table 5-2. List of questions asked during focus group 1.

Theme I. Identifying and Prioritizing Spaces
1.    What do you see as the primary purpose   of using the Experience-based Virtual prototyping System (EVPS) for your facility and why?
2.    Referencing the floor   plans of the new Children’s Hospital, identify the spaces of highest   priority that should be developed as interactive virtual prototypes using the EVPS. E.g.,   Pharmacy, Nurse’s station   to patient rooms, route between   Blood bank to OR
Theme II. Investigating and documenting scenarios
3.    What are the typical scenarios of activities that will take place within   each space/ zone identified?
4.    Identify typical routes   that will be taken by the staff in the hospital with the brief description of their purpose.
Theme III. Identifying design requirements for the EVPS
5.    What would be ideal level of detail that you would like in the virtual   prototypes? Especially with regard   to the following:
– Textures and colors   (highly realistic to abstract)
-Lighting (Highly realistic to absent)
– Interactive objects (E.g., doors that open, crash carts that move)
6.    Which of the following features would you like to see in the EVPS for a particular space:
– Minimap
– Scenario menu
– Avatars   (E.g., Nurses, Physicians, Facility managers, patients)
– Moveable objects (E.g., crash carts, wheelchairs, beds etc.)
7.    What additional features would you like to see in the EVPS?
8.    Is there any additional content that you would like modeled   in the facility?

Based on the questions asked, participants were instructed to note down their ideas and answers on post-it notes. The post-it notes were color-coded based on: end-users (blue), scenarios (green), tasks (yellow), spaces (pink) and objects or elements (purple) required for modeling the hospital. Participants reviewed different floor plans of the hospital where they marked spaces they considered important enough to be included in the EVPS and wrote them on post it notes (Figure 5-4). Similarly different colored post-it notes were used to get brief descriptions of scenarios, tasks and level of detail required.

. Capture2

Figure 5-4. Data Collection during Focus Group 1.

After collecting the post-it notes from participants (Figure 5-5), they were organized on a white board. Questions and clarifications helped reorganize and match different spaces of the hospital with certain scenarios of tasks. fig-5-5 Figure 5-5. Color-code post-it notes with end-user scenarios.

Detailed follow up discussion helped prioritize and further organize and group the scenarios. (Figure 5-6).
The goal of the first focus group meeting was to establish key areas to develop in the draft virtual prototype before final EVPS for the Children’s Hospital could be developed.
..
fg5-6i
Figure 5-6.  Scenarios generated from 1st focus group meeting.
An area of the fourth floor was identified to be developed as a draft EVPS. Within this space (Figure 5-7), participants identified and prioritized the following areas to be highlighted:
  • Clinical Care Documentation Center – This area is centrally positioned to be in proximity with the maximum number of patient rooms and is used by nurses for documentation.
  • Patient Isolation Room with Dialysis – this room is chosen because it is used for patients with more complex conditions and because it has surgical boom equipment and an anteroom. The rationale to choose this room over others was to get nurses more familiar with one of the most complex rooms in the hospital.
  • Treatment Room – Although the entire second floor is dedicated to having operating rooms, it was decided to have one treatment room per department for patients that could be easily accessible and also appear to be a pain-free area for children being treated. The treatment room has an examination table and head wall for medical air, vacuum and gases.
  • Clean Supply Room – This room generally has storage of medical supplies and medication stored in shelves or automated dispensing cabinets like the “Pyxis” medication machines.
  • Medication Preparation Room – This room is used for distribution of medicine to the patients and is close to the nurse’s station. It contains a work counter for preparation of medication, refrigerator, sink for hand washing and locked storage cabinets for biological medication and drugs.
  • Soiled Utility Lab- This room is unique as it has the eye wash station and a laundry chute. It was deemed important to include this room in the EVPS so that nurses could  familiarize themselves with the work process and know how to locate the room.

FIG5-7 Figure 5-7. Spaces identified on the fourth floor for draft EVPS development.

Apart from a part of fourth floor with the above areas, the main pharmacy of the hospital located in the ground floor of the hospital was also identified as a space for possible inclusion in the draft EVPS.

5.3.3 Participants

There were 17 participants in the first focus group meeting and 20 participants in the second focus group out of which 12 participants attended both meetings.
Table 5-3 lists the participants of the focus group. Although all participants are connected to the Children’s  Hospital, they come from diverse departments such as Safety, Infection control, Patient Transportation and Administration.
There were three physicians, six nurse managers from various departments, three clinical head nurses, and two safety officers.
Other staff included clinical nurse educators, nursing administration, anesthetics, patient transport, infection control, pharmacy staff, child life manager and family centered care specialist.
++++
Table 5-3. Participants of focus groups in December 2011 and January 2012.
Role Department Dec 11 Jan 12
Nursing Project Manager Children’s Hospital Support 1 1
Residency ProgramDirector Pediatrics 1
Residency AssistantProgram Director Pediatrics 1
Physician PICU (Pediatric Intensive Care Unit)Senior resident 2
Director of Nursing Nursing Pediatrics 1 1
Operations Director Children’s Hospital Administration 1
Leadership team Pediatric Acute Care   and Hematology/ Oncology 2 3
Clinical Nurse Educator NEPD (Nursing Education and Professional Development) 1 1
Nurse Manager OR (Operating Room) 1
NICU (Neonatal Intensive Care   Unit) 1
PICU/ PIMCU (Pediatric Intensive/ Intermediate Care Unit) 1 1
Perianethesia (nursing for patients undergoing anesthesia) 1
Float Pool /Per Diem/   NVAT (Nursing Vascular Access Team) 1
Patient Transport 1 1
Clinical Head Nurse PICU/PIMCUPerianesthesia 1 2
Manager Child Life 1 1
Coordinator Family Services 1
Pharmacy staff Pharmacy 1 1
Senior Technologist Radiology 1 1
IC Coordinator Infection Control 1
Environment Health MgrFire protection Engineer Safety 1 1
17 20

During the second focus group meeting, draft EVPS of the Children’s Hospital with interactive virtual prototypes of the fourth floor with varying levels of detail and the pharmacy were distributed to the participants. The goal of this meeting was to enable the participants to experience first-hand and interact with the EVPS model and then brainstorm ideas and goals for the next iteration of development of the EVPS.

Besides going through the same exercise of using post-it notes from the first focus group meeting, the participants were also asked to fill out a questionnaire.
The questionnaire asked the participants to fill in five questions on identifying a set of users, scenarios that they would perform, spaces that would be involved in the scenarios, detailed steps of tasks and finally level of detail of specific elements or features that would be required for the scenario.
The participants were also asked to state what they felt the overall purpose of the EVPS would be. The focus group questionnaire with detailed list of questions can be found in Appendix B. At the time, the Children’s Hospital project was in the third year of construction, had crossed the substantial completion milestone and was slated to open by January 2013.
The hospital staff was gearing up for transition planning to move from their current facilities into the new facility. At this stage of the project, most of the design decisions had already been taken as the project team had also used physical mockups patient rooms.

5.3.5 Potential Use of EVPS at Hershey Children’s Hospital

During focus groups discussions, participants envisioned using the EVPS for purposes of educating and providing a level of comfort for way finding to the entire hospital staff and possibly to patients and their families in the future. Apart from reviewing the design of the new facility, the hospital staff and project team envisioned using the EVPS in the transition process.

Participants felt that the EVPS could provide a snap shot of the new work environment and orientation of the pathways from the current facility to the new hospital thereby reducing the staff’s anxiety of moving and adapting their work processes into a new space.
They envisioned using the EVPS as a tool for training staff members or new hires to get acquainted with the building layout and use for locating life safety items and emergency evacuation drills. Another way the participants wanted to use the EVPS was to help develop new work processes and understand patient flow in the new facility layout.
Many example scenarios were discussed on how the workflow will be affected with larger distances and new locations for equipment. The participants also suggested using the EVPS as a “virtual tour” resource for patient’s families, caregivers and visitors to understand how to find specific services in the hospital. The goal was to develop interactive virtual prototypes of the chosen areas and use them for training during staff orientation at least 4-6 months before the move-in date.
5.4 SCENARIO ANALYSIS
Twenty-three total detailed scenarios were collected from the focus group studies. Using the scenario framework proposed in Chapter 4, first the scenarios were categorized based on the end-users, and then the scenarios were categorized based on the level of detail from the lowest of movement-based to detailed task-based.
The scenarios were mapped on a “type of scenario versus user” matrix. Finally, the scenarios were categorized based on the spaces they take place in to  help prioritize the model content required for development of the Children’s Hospital EVPS.
5.4.1 Scenarios based on End-Users

As a first step of requirements analysis, participants were asked to identify who they envisioned to be the ultimate end-users of the EVPS. End-users identified to use the Children’s Hospital EVPS application can be broadly classified into three categories of patients, families and staff. Table 5-4 shows a list of potential end-users identified for using the EVPS application.

Table 5-4. List of potential healthcare facility end-users who could use the EVPS. Healthcare Facility Users Patients Families. cHAPLEN

Within staff of the hospital, various categories were identified that included physicians, residents, surgical technologists and OR aides. Apart from majority of the staff, which is nursing, other staff included transport, anesthesia techs, and respiratory therapists. The nursing category was further divided into different type of nurses based on the specific duties they performed. While patients and their families were considered the most important potential users for the application, it was decided that based on the time requirements and knowing that this would be an internal pilot study, it was considered more appropriate to test the application with nurses. Content analysis using frequency of word count on the end-users of the twenty-three scenarios revealed the highest count for nurses (Figure 5-8). The next highest word frequency is for family followed by all staff. Other frequently occurring end-users are patients, transporters, physicians and pharmacy staff. Fig5-8 Figure 5-8. Users identified for scenarios during second focus group meeting.

After word frequency count of end-users, the scenarios were further analyzed to prioritize and organize them based on the context in which the end-users are mentioned.
Here again, it was noted that the maximum number of scenarios had sole or first mention of nurses followed by staff as end-users. Analysis revealed that there are specific detailed scenarios dealing with transport, pharmacy and OR staff along with some that included physicians, respiratory and radiology staff in second or third mention.
Although there was only one solely focused and one first mention scenario on patients and families, analysis revealed that most participants have patients and families as second mention end-users in their scenarios. This indicates that most of the scenarios that are developed for use of nurses and staff could also be tailored to and used by patients and families in the future.
Table 5-5 lists the end-users and indicates whether they were the sole, first, second or third mention as end-users in the twenty-three scenarios collected during the second focus group.
Table 5-5. End-users mentioned in scenarios collected during 2nd focus group meeting.
Sole mention First mention Second mention Third mention
Nursing staff 3 5 2
Staff 2 4 2
Transport staff 2 1 2
Pharmacy 2 1
Patients and   families 1 1 6
OR staff 1
Physicians 2 2
Respiratory I 2
Radiology 2
Other 3

Next the scenarios were categorized based on themes starting from types of scenarios, scale of scenarios and level of detail required to implement the scenarios.

5.4.2 Scenario Categories

The first theme of identifying and categorizing scenarios was based on the matrix developed in Chapter 4. The scenarios are mapped on the spectrum of varying levels of detail on x-axis against the end-users of scenarios identified on y-axis (Figure 5-9). Scenarios identified are classified based on way finding or movement-based, process-based (combination of way finding and set of less detailed tasks), spatial organization and finally detailed task-based scenarios.         Figure 5-9. Mapping scenarios based on category and users.

A lot of examples were categorized under way finding such that people needed to get from one place to the other in the new hospital and want to know the optimum routes to take to get from one place to another.
Some of the examples of getting from one place to another include going from the pharmacy, blood bank and radiology labs in the ground floor to the operating rooms in the second floor. Overall way finding related scenarios were concerned with locations of rooms and getting from rooms to the public services in the building like the cafeteria, courtyard and meditation room. As expected most of the scenarios that fell under the movement-based or way finding scenario category required less detailed models.
An important scenario proposed by participants from hospital safety was regarding “Fire emergency training” that envisions use of EVPS by all staff for location of emergency items fire extinguishers, exit signs and location of fire escape routes and staircases. Other healthcare emergency training related scenarios include location of gas shut off valves; crash carts and nurse alarm locations that are deemed important during patient emergencies.
On the task-based scenario spectrum, some important detailed scenarios identified include the “Code Blue”, an emergency scenario in hospitals. This scenario requires extremely high level of modeling and detail to show if multiple avatars of different specialties can fit in a patient room during heart failures and simulate activities that need to be performed in that situation such as alerting. The researchers identified that the scenario was out of scope for development as it would be very time and labor resource-intensive.

5.4.3 Scenarios based on Spaces

The next analysis of scenarios was done based on word frequency of spaces mentioned by participants in the scenarios (Figure 5-10). As most scenarios are concerned with way finding, pathways, hallways and elevators were in large numbers.

SECOND FLOOR

Registration

OR

Pre-op

1 4 5 12

PACU

5
Nurse’s station 10
Charting area 3
Medication room/ supplies 6
Cleaned utility/ med pyxis room 4
Soiled utility 3
Code cart 1
Leadership offices 3
Storage – linen 2

Lobby

1
Pathways/ hallways 10

Elevator

11
Emergency areas 4
GROUND FLOOR 5
Radiology 6
Blood bank 2
Pharmacy 7
Patient room 8
Isolation room 3
Anteroom 1
Treatment Room 3
Family waiting 4
Play room 2
Restroom 4
Staff lounge/ Breakroom 6
Resident lounge 1
FOURTH FLOOR 3

PICU

3

PIMCU

4
THIRD FLOOR 3
Acute care 1
Oncology 1
Main lobby 2

ED

3

fig5-10 Figure 5-10. Spaces identified for EVPS development.

  However, as shown in Figure 5-10, the most important and recurring spaces according to the participants were the operating rooms located on the second floor of the hospital. Most routes for way finding identified include going from the existing or main hospital as well as other parts of hospital especially ground floor to the second floor. Other routes of importance identified were within the second floor itself that houses the operating and treatment rooms. Participants were interested in knowing routes of getting from the pre-operating areas (pre-op) to the operating rooms and finally to the post anesthesia care units (PACU).
Another floor recognized for its importance based on discussions and the word frequency count was the ground floor as it houses the blood bank, radiology labs and treatment spaces as well as the main pharmacy of the hospital. Even though all these spaces also had specific scenarios with specialty end-users, all staff especially nursing was required to know their location and the way to get to the ground floor from all patient floors and treatment areas.
Certain scenarios assigned both the third floor and fourth floor that have patient rooms within different departments of hematology, oncology, PICU and PIMCU to be modeled. However, an overwhelmingly large number of scenarios recognize nursing stations, charting areas, medication supplies, utilities, storage and other staff areas as an essential part of the EVPS, thereby including the patient floors themselves to be modeled.
Apart from the spaces listed above, all patient rooms or isolation patient rooms with anterooms along with specialty treatment rooms within the third and fourth patient floors are also mentioned in the scenarios.
Other spaces mentioned in certain scenarios focused on family and staff as end-users included family waiting areas, children’s play rooms, child life areas, staff lounges and break rooms etc. The first floor, which houses the main lobby, some cancer treatment and infusion labs as well as the cafeteria was not specifically mentioned in any scenario. The fifth floor that has mechanical equipment and services was also not mentioned; therefore it was decided not to model the first and fifth floor of the hospital at all.

 

5.4.4 Validation of Scenarios

arms, booms and operating tables are required and curtains in PACU as they are not in the Revit model. Similarly, computer stations for nurses provided outside the patient rooms to enable nurses to chart and monitor the patients in the room are required. Lastly Pyxis machines in medication and supply rooms were also identified. fig5-11 Figure 5-11. Spaces identified for development in Second Floor and Ground Floor.

5.4 EVPS DEVELOPMENT STRATEGY

Based on the requirements analysis done on the data collected through focus groups and interviews, a list of features was developed and storyboarding was used to develop concepts for the EVPS. Although many more interactivity features could be added the scope was restricted based on the envisioned end goal of the prototype as well as the time and resources available to develop it.

Since the project was in construction phase, the Revit model used for the development of the virtual prototype was highly detailed. Based on the requirements, it was ensured that only the required architectural elements are included in the model. Some furniture and equipment model content not included in the model was added. Missing model content comprised of patient beds in all patient rooms, examination and operating tables in the treatment rooms and ORs. Other model content added included pyxis machines, booms, chairs for nursing and charting stations and other equipment identified during requirements analysis.

5.4.2 Level of realism

Due to the size of the models and the focus on way finding scenarios, the level of realism in textures required was relatively low in the virtual prototypes. However care was taken to incorporate the color schemes of the flooring, which was one of the main design features of the Hershey Children’s Hospital and used as an aid to way finding by the architects. Some of the important equipment identified in requirements analysis were colored red for easy identification in the virtual prototype. These included fire extinguishers, elevators, and pneumatic tube stations for blood or medication transport near the nurse’s station.

5.4.3 User Interface

End-users were provided with options to go to the main menu, select another floor to navigate in, get instructions on how to navigate the model, turn the mini-map on or off, and select a space / department within the floor to navigate in, or quit the application. On quitting the application, the Hershey Children’s Hospital web page opened in the user’s browser.

The storyboards helped design the menu of the Children’s Hospital EVPS. The opening screen of the EVPS was designed to show a rendering of the hospital and give options to the user to select the floor that they wished to navigate. The hospital was broken down into the four floors for EVPS development- Ground Floor, Second Floor, Third Floor and Fourth Floor. On selecting any of the floors, the user was shown another screen with a schematic plan of the floor depicting locations of major areas or departments on that floor. Figure 5-12 shows a snapshot of the menu developed for the Second Floor EVPS. The user could then select any space and start navigating the interactive 3D virtual prototype of that floor.

fig5-12
Figure 5-12. Second Floor schematic plan used in the menu for EVPS.

 

5.4.3.2 Mini-map

The mini-map was considered an essential element in the prototypes, as the main goal was to use the model for way finding purposes (Figure 5-13). A red arrow head was added in the controller object hierarchy that was visible in the mini-map indicating and updating in real-time, the location of the user and direction of where they are heading within the facility.

5.4.4 Interactive Objects

The developed EVPS enabled users to retrieve information such as names of different equipment throughout the hospital floors by clicking on the objects. Also similar to hospital hallways with motion sensor activated doors, the prototype simulated doors to swing open using triggers and animated door objects. Figure 5-13 shows the Unity game engine interface during EVPS development. fig5-13 Figure 5-13. Space trigger objects and mini-map camera in the second floor EVPS.

Trigger objects were placed in various departments or areas of interest throughout the hospital floors such that while navigating, when the user entered specific spaces, text was displayed on the screen to indicate the name and other information on the space entered. Another interactive feature included buttons on the user interface that allows the user to click on the names of certain spaces. Once selected the controller object instantiates in that space allowing the user to begin navigation from there.

5.4.5 Challenges in Development

Polytrans was used to further optimize the model content before transferring it to Unity game engine. It was decided to split the different floors and develop them as separate Unity projects to ensure smoother visualization. However, some of the interactive objects such as clicking on6. Type and number of doors in the second floor of the hospital.

DOOR NAME

Type Count
Door Double Wrap   Double Opposing Type G  84″ x 84″ 1

3

Door Double Wrap   Double Opposing Type V  84″ x 84″ 1

4

Door Double Wrap   Type F 4

12

48″ x 84″ 1

2

56″ x 84″ 1

5

60″ x 84″ 1

3

84″ x 84″ 1

2

Door Double Wrap   Type G   84″ x 84″ 1

3

Door Double Wrap Type   V 2

3

72″ x 84″ 1

2

84″ x 84″ 1

1

Door Single Wrap Double Acting   Type F 36″ x 84″ 1

2

Door Single Wrap Double Acting   Type G 36″ x 84″ 1

7

Door Single Wrap Side Light Type FG        36″ x 84″ 1

1

Door Single Wrap Type F 3

22

36″ x 84″ 1

18

42″ x 84″ 1

2

48″ x 84″ 1

2

Door Single Wrap Type FV 2

9

36″ x 84″ 1

8

42″ x 84″ 1

1

Door Single Wrap Type G 2

9

36″ x 84″ 1

8

48″ x 84″ 1

1

Door Single Wrap Type V 3

39

36″ x 84″ 1

16

42″ x 84″ 1

13

48″ x 84″ 1

10

Door Uneven Wrap Rev Type F 48″ (12 x 36) x 84″ 1

2

Door Uneven Wrap Type   S 66″ (18 x 48) x 84″ 1

12

Cased Opening Wrap   36″ x 84″ 1

1

Overhead rolling   11′ x 21′ 1

1

Grand Total 26 130

The door object appears as a single object including the frame in the Unity game engine.   Using either 3ds max or Revit, each door was split into separate frame and door panel objects; animation was applied to the door panel based on if the swing was clockwise or anticlockwise and a door trigger object was applied. Finally the door was taken to the desired location. There were many approaches to do this and prefabs in Unity enabled efficient and repeatable use of multiple doors once they were animated. Other interactive objects that were not implemented included arrows depicting the route to get from point A to B within a hospital floor. The draft virtual prototype fourth floor showed a scenario where the user could click on a specific space they would like to go to and the user interface displayed arrows depicting the route to take. However, in the full hospital floor virtual prototype implementation, there were far too many route options that could not be covered using this approach. An alternate method of clicking the name of the space and instantiating the controller object in that location was adopted instead.

5.5 PHARMACY DESIGN REVIEW

As per the plans of the Children’s Hospital, the main pharmacy serving the entire  Hershey Medical Center was being relocated in the ground floor where all the pharmacy staff would be consolidated. The footprint of the pharmacy would increase substantially to 7200 square feet area, which was almost double the size of present pharmacy. With the increase in size,  offices of the pharmacy staff would be in closer proximity as well. For transition planning, it was important for the staff to understand how they would adapt to a newer and larger space by configuring their workspaces and developing their work processes to be in alignment with the  new facility design. Figure 5-14 shows images of the existing and new pharmacy. Figure 5-15 shows the location of the new pharmacy. fig5-14Figure 5-14.  Existing pharmacy (left) moving into the new pharmacy (right).

Compared to the entire staff of the Children’s Hospital, the pharmacy had a relatively small leadership team and staff comprising of up to 130 members.

After the first focus group meeting, the participants distributed the interactive virtual prototypes of the pharmacy for other staff members to view (Figure 5-16).

The pharmacy staff was able to familiarize themselves with the new layout using the EVPS pharmacy model for transition planning. fig5-15 Figure 5-15. Pharmacy floor plan and snapshot of pharmacy EVPS.

The new pharmacy, located in the ground floor level of the Children’s Hospital wing, is accessible from the cancer institute and the main hospital building through interconnected pathways.
On entering the pharmacy, the main door and dispensing window open into the central pharmacy area with a compounding station tucked in the right. The narcotics and secure storage room is located across the compounding area and has a door with restricted access. The central pharmacy has the major equipment and computers on workstations for staff (Figure 5-16).
On the far left of the pharmacy, there is space for break room that leads to three rooms – the inventory personnel room with work stations against the walls, a billing room and a room for trash. Both the inventory personnel and trash room can also be accessed from outside corridors.
On the opposite end of the central pharmacy area is the entrance to the intravenous (IV) prep room that is used for storing intravenous medicine. The IV room leads to an anteroom, which is connected to two highly sensitive medicine positive pressure rooms – the chemo/ hazard prep area and the clean room. There are two additional rooms that are only accessed from the outside corridors – the first is an investigational drug service (IDS) room that has adjoining refrigeration room along with file storage room and the second is a Pyxis office/ workroom.
fig5-16
  Figure 5-16. Snapshot of pharmacy EVPS.

 

5.5.1 Design Review Meetings

Two separate meetings were held with the pharmacy leadership team to discuss the scope of using the pharmacy EVPS for their transitional planning efforts. The researcher also attended and observed a design review meeting where 10 pharmacy leadership team members explored the EVPS model of the pharmacy (figure 5-17). The model was used to design the inner layout focusing on configuration and orientation of working spaces as well as detailed design decisions on storage shelves to plan and decide on future storage organization of the pharmacy inventory.

fig5-17
Figure 5-17. Design Review meeting using the Pharmacy model.
During the meeting, the IV room was discussed in detail and one of the pharmacy staff members who had attended the focus group meeting led the discussions and also navigated the model.
The discussion in the IV room began with accessing the number of refrigerators and freezers that would be required in the room. The team decided to have a total of 5 refrigerators and 4 freezers making it a total of 9 pieces of equipment. It was noted that the plan did not clearly show the doors of the refrigerators.
The team also discussed having double doors on certain refrigerators. In conjunction with the using pharmacy’s EVPS, the team numbered each section of shelving or workspace on the plan. Navigating through the IV prep room, the team had a general   discussion on the type of shelving- open, closed or with slanted shelves that will be required in each area. After numbering the sections, each area was discussed in detail (Figure 5-18).
The team discussed the intended purpose of each workstation and which technician would be allotted a particular space to work in. The team also discussed addition of cabinets where they thought they needed printers.
fig5-18
Figure 5-18. Transition Planning and design review meeting using EVPS and floor plans.
On entering the clean room, the team identified different equipment in the room and clarified issues if it was hard to identify what equipment was as in the case of a laundry basket. With so much equipment in the room, some team members raised concerns on the size of both the anteroom and clean room.
However some team members who had visited the actual pharmacy  that was then under construction and going through fit-outs reassured that the anteroom was sufficiently sized– measuring the distance between tables and hoods to ensure that there was adequate carts  depicted in the prototype were also taken into consideration for storage planning of syringes and needles.
Another concern raised in the clean room was a row of tall shelves for storage. Several team members expressed concern on accessibility of the upper shelves and requirement of step stools that could be a potential safety hazard (Figure 5-19).
fig5-19
Figure 5-19. Snapshot of IV Preparation and Clean Room with high shelves.
5.5.2 Findings

In conclusion, the staff was really relieved to be able to use an interactive virtual prototype of the pharmacy to identify workspaces and begin developing new work procedures. They felt that the EVPS was easy to navigate and had been using the prototype in internal meetings regularly. Although they had access to the actual pharmacy space under construction and staff was shown plenty of photographs and videos of the space, they still preferred the pharmacy prototype.

“It is easier to control where you are going and stop when you have to look at something. You cannot even do that in a video where you just follow along where the camera goes” In previous staff meetings, it was found that the pharmacy virtual prototype actually helped the staff identify that they would require a mini refrigerator in the compounding area.

This requirement was overlooked in plans and previous design review meetings and had not come to light till the staff had started using the EVPS for reviewing the design. Some of the drawbacks of the pharmacy prototype were inaccuracies in the modeling of shelves and other storage cabinets. It was found that some cabinets were missing entirely or had the wrong type of shelving depicted; e.g., closed shelving instead of open or slanted shelves instead of straight. The reason for this was that the changes had been made after the update of the model that was used to develop the prototype.

As the next step for using the EVPS for transition planning, the pharmacy staff wanted to have labels on different workspaces and shelves to depict what they were going to be used for. Another thing that would have been nice to see was whether drawers and storage was open-able or closed to be able to better plan for the move.

As a future consideration, the staff expressed that it would be nice to be able to simulate certain processes that take place in the pharmacy as that could be used to train new personnel on work procedures as well as help the leadership team design more efficient processes that would work in a new facility design.

5.6 LESSONS LEARNED

scale healthcare facilities within limited resources.

Dealing with Large-scale Models: Some of the challenges that arose with the use of large-scale models in the Unity game engine (ranging from 814 MB to 1.55 GB) for real- time visualization was to maintain minimal lag time and smooth performance during visualization. It is important to ascertain the level of detail of the model content available for developing the interactive virtual prototypes and determine if more detail and content is required or if unnecessary detail and model content needs to be eliminated to make the geometric content lighter and leaner. Finally it is of utmost importance to align the resources available to develop the EVPS with the proposed virtual prototyping scope. –

Defining Scope: Focus groups proved to be an effective means to elicit requirements for the development of EVPS. Brainstorming during the focus groups helped in generating innovative ideas on the future use of the EVPS. However, it is very important to define the scope for development and continuously review this scope throughout the design and development process while identifying the resources that can be invested. Feedback from the end-users during development ensures that the process is on track and that the EVPS will meet the ultimate goals of their design review. –

Identifying Stakeholders: It is also essential to ensure that the participants for the focus group represent a mix of department so that they can represent their unique needs. It was observed that the scenarios generated during focus groups strongly reflected the departments, roles and responsibilities of the participants involved. –

EVPS Application in Training: Although this research envisioned use of EVPS for design review with the end-users of facilities during the design development phase prior to construction, this case study demonstrates that real-time visualization using interactive virtual prototypes of healthcare facilities can be used at any stage of the facility lifecycle  for design review.

Moreover, this case study also shows that apart from design review, EVPS can be very effectively used as an education tool for training, way finding and reducing the anxiety of end-users before moving into a new facility. Additionally, the EVPS can be used to design activities and working procedure around the new facility design as in the case of the pharmacy where the staff used the EVPS to determine their future workflows.

In conclusion, this case study demonstrates that the EVPS can be used effectively for collaborative design reviews and decision-making as exhibited during the pharmacy transition and move planning design review meetings. Interactive virtual prototypes of the pharmacy became an instrumental tool for pharmacy staff to seek clarifications in design and led to a better understanding of the new space.

Moreover, the pharmacy leadership team was able to leverage the EVPS as a tool to develop new work procedures that would be more befitting in the new facility environment. This unique application of the EVPS revealed added potential benefits of developing interactive virtual prototypes for healthcare facilities.

5.7 SUMMARY

This chapter begins with the description of the case of the Hershey Children’s Hospital and discusses the approach for research, data collection, analysis and development procedure for EVPS application. The pharmacy transition-planning meeting is discussed as part of the evaluation of using the interactive virtual prototypes for design review. Findings of this chapter suggest that even with large-scale healthcare facility models, EVPS can be developed and applied effectively. The next chapter discusses the evaluation of embedding scenarios in interactive virtual prototypes in more detail. ++++ Copyright 2013 by Sonali Kumar. All rights reserved. Thesis published on this site by the express permission of Sonali Kumar. Note: Under construction link to Chapter 6. ++++ Copyright 2014 by Sonali Kumar. All rights reserved. Thesis published on this site by the express permission of Sonali Kumar.