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health, leadership, wellness, and education

Official Blog of Eliel Arrey

From Hindrance to Honor: Valuing Learners in the OR Like Jesus Valued Children

5/12/2025

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In Mark 10:13-16, Jesus’ response to the disciples’ attempt to push away the children provides a powerful lesson on the value of every individual, regardless of perceived status or usefulness. Jesus welcomed the children not because they had social standing or skills, but because of their inherent worth as God’s creation. He used the moment to teach that the kingdom of God belongs to those who approach Him with childlike faith, humility, and openness (The Bible, 2013). This principle directly applies to leadership in all fields, including healthcare. In the operating room, medical students and surgical interns often find themselves in a similar position as the children in this passage. They may be seen as inexperienced, distracting, or even burdensome by surgical technologists or other OR staff who focus primarily on efficiency or technical excellence. Unfortunately, this can create an unwelcoming learning environment that stifles growth and discourages future healthcare professionals.


As a leader in surgical education, I often draw from Jesus’ example to counteract this harmful culture. I remind the team that medical students and interns are not interruptions to our work—they are the future of medicine. They are paying to be there to learn, while the rest of us are being paid to do our jobs. This shift in perspective helps us prioritize their education and treat them with dignity and patience. Just as Jesus corrected His disciples, I find it necessary to advocate for these learners and create space for their development. By doing so, I help foster a culture where learning is valued and people are seen as precious gifts, not hindrances. This is one of the most meaningful ways I apply the teachings of Christ in my leadership practice.

By 

Eliel N. Arrey MD MBA

 Reference 
The Bible (2013). Authorized King James Version. Intellectual Reserve. Retrieved from https://www.churchofjesuschrist
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Understanding Breast Cancer Epidemiology, Screening, and Risk Factors

4/7/2024

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Today, we will be discussing a topic near and dear to me: Breast Cancer.   This is not a complete overview of all of breast cancers but an intro to helping anyone understand the epidemiology, screening, and risk factors for breast cancer.  

Breast cancer remains one of the most prevalent malignancies affecting women worldwide. Its epidemiology, screening modalities, and associated risk factors are critical areas of study and public health concern. Comprehensive understanding of these aspects is essential for early detection, effective treatment, and improved outcomes. In this article, we delve into the epidemiology of breast cancer, various screening modalities, the significance of family history, and other important risk factors. Additionally, we emphasize the importance of regular breast self-examinations, prompt medical attention for any concerns, and address the complexities of breast cancer during pregnancy.


Epidemiology of Breast CancerBreast cancer is a multifactorial disease influenced by genetic, environmental, hormonal, and lifestyle factors. According to the World Health Organization (WHO), breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related mortality among women globally. The incidence of breast cancer varies across regions, with higher rates observed in developed countries compared to developing nations.
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Age is a significant risk factor, with incidence rates rising steadily with advancing age, peaking around 50 to 70 years of age. However, breast cancer can occur in younger individuals, underscoring the importance of early detection and screening initiatives.

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Screening Modalities for Breast Cancer
Early detection through screening plays a crucial role in reducing breast cancer-related morbidity and mortality. Several screening modalities are available, including mammography, clinical breast examination (CBE), breast magnetic resonance imaging (MRI), and breast ultrasound.
Mammography remains the gold standard for breast cancer screening, recommended annually for women aged 40 and older by organizations such as the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF). Mammography has demonstrated efficacy in detecting early-stage breast cancers, allowing for timely intervention and improved survival rates.
Clinical breast examination, performed by healthcare professionals during routine check-ups, serves as a complementary screening tool to mammography, particularly in settings where access to mammography is limited.
Breast MRI and ultrasound are adjunctive imaging modalities used in specific clinical scenarios, such as screening women at high risk of breast cancer or evaluating abnormalities detected on mammography.



Importance of Family History and Other Risk Factors
A family history of breast cancer is a well-established risk factor, indicating a genetic predisposition to the disease. Individuals with first-degree relatives (parents, siblings, or children) diagnosed with breast cancer have an increased risk of developing the disease themselves. Additionally, specific genetic mutations, such as BRCA1 and BRCA2, significantly elevate breast cancer risk.
Other important risk factors include a history of radiation exposure (e.g., chest radiation therapy for Hodgkin lymphoma during childhood), previous breast biopsies demonstrating benign proliferative lesions, hormonal factors (e.g., early menarche, late menopause), obesity, alcohol consumption, and hormone replacement therapy.



Breast Self-Examination and Prompt Medical Attention

Breast self-examination (BSE) remains a valuable tool in breast cancer awareness and early detection. Women are encouraged to perform regular BSEs to familiarize themselves with their breast tissue and promptly report any new or suspicious changes to their healthcare provider. Although BSE alone is not sufficient for comprehensive breast cancer screening, it empowers individuals to take an active role in their breast health.
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Any concerns regarding breast changes, such as a palpable lump, changes in breast size or shape, nipple discharge, or skin abnormalities, warrant evaluation by a healthcare professional. Early diagnosis facilitates timely intervention and improves treatment outcomes.

Bonus Topic: ​Breast Cancer during Pregnancy

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Nothing is more devastating than a diagnosis of breast cancer in a pregnant patient.  Pregnant patients are already flooded with a myriad of emotions and challenges of the pregnancy itself and the calling of motherhood, making a breast cancer diagnosis, an emotional (and clinical) wrench in the gestational process.

Breast cancer diagnosis during pregnancy presents unique challenges due to concerns regarding fetal safety and treatment complexities. Delaying treatment in pregnant individuals with breast cancer is not advisable, as it may compromise maternal outcomes and jeopardize fetal well-being. Multidisciplinary management involving oncologists, obstetricians, and other specialists is essential to optimize treatment strategies while minimizing risks to both the mother and the developing fetus.
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In conclusion, breast cancer remains a significant public health issue globally, necessitating comprehensive strategies for prevention, early detection, and treatment. Understanding the epidemiology, screening modalities, and risk factors associated with breast cancer is crucial for healthcare professionals and individuals alike. By promoting awareness, encouraging regular screening, and fostering proactive healthcare-seeking behaviors, we can strive towards reducing the burden of breast cancer and improving patient outcomes.


Eliel Arrey MD MBA




Eliel Arrey, MD., MBA., is a health advisor, business advocate, entrepreneur, educator, and surgeon with a passion for Breast Oncology, Oncoplastic, and Cosmetic Surgery. History of Surgery series showrunner. He has been an educator for over 15 years and has vast experience teaching undergraduate students, nursing students, medical students, and resident physicians. Dr. Arrey is a physician at Grady Memorial Hospital in Atlanta and a Morehouse School of Medicine physician. He also serves as a faculty member at Kaplan, teaching Neurology and Surgery review courses to medical students worldwide. He is currently a PhD candidate in organizational leadership at Columbia International University.



References:
  1. American Cancer Society. (2021). Breast Cancer Facts & Figures 2021–2022. Atlanta: American Cancer Society, Inc.
  2. World Health Organization. (2020). Breast cancer: prevention and control. Retrieved from https://www.who.int/cancer/detection/breastcancer/en/index1.html
  3. National Comprehensive Cancer Network. (2021). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Screening and Diagnosis. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf
  4. National Cancer Institute. (2021). Breast Cancer Screening (PDQ) — Health Professional Version. Retrieved from https://www.cancer.gov/types/breast/hp/breast-screening-pdq
  5. Cardoso, F., et al. (2019). 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4). Annals of Oncology, 30(10), 1720–1729. https://doi.org/10.1093/annonc/mdz192

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Managing Blood Sugar Levels Naturally: Effective Remedies for Reduction

4/1/2024

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​In today’s fast-paced world, the prevalence of conditions like diabetes and prediabetes is steadily rising. High blood sugar levels not only pose immediate health risks but also increase the likelihood of developing severe complications over time. While medication plays a crucial role in managing blood sugar, incorporating natural remedies into your routine can complement conventional treatments and promote overall well-being.

From dietary adjustments to lifestyle changes, here are some effective natural remedies for reducing blood sugar levels:
  1. Healthy Diet: The cornerstone of managing blood sugar levels naturally starts with a balanced diet. Focus on whole, unprocessed foods rich in fiber, such as fruits, vegetables, whole grains, legumes, and nuts. These foods have a lower glycemic index, which means they cause a slower rise in blood sugar levels. Additionally, incorporating foods with specific properties like cinnamon, fenugreek, and bitter melon may help regulate blood sugar levels.
  2. Regular Exercise: Physical activity is vital for managing blood sugar levels. Regular exercise improves insulin sensitivity, allowing your cells to better absorb glucose from the bloodstream. Aim for at least 30 minutes of moderate-intensity exercise most days of the week. Activities like brisk walking, cycling, swimming, and yoga can all contribute to better blood sugar control.
  3. Stress Management: Chronic stress can lead to elevated blood sugar levels as stress hormones like cortisol interfere with insulin function. Incorporate stress-reduction techniques such as meditation, deep breathing exercises, mindfulness, and yoga into your daily routine to promote relaxation and stabilize blood sugar levels.
  4. Adequate Sleep: Poor sleep quality and insufficient sleep duration have been linked to insulin resistance and higher blood sugar levels. Aim for 7–9 hours of quality sleep each night. Establish a regular sleep schedule, create a relaxing bedtime routine, and ensure your sleep environment is conducive to restful sleep.
  5. Herbal Supplements: Certain herbs and supplements have shown promise in helping to lower blood sugar levels. Examples include berberine, alpha-lipoic acid, chromium, and magnesium. However, it’s essential to consult with a healthcare professional before starting any new supplements, especially if you’re taking medications or have underlying health conditions.
  6. Apple Cider Vinegar: Some studies suggest that apple cider vinegar may help improve insulin sensitivity and lower blood sugar levels, particularly when consumed before meals. Dilute a tablespoon of apple cider vinegar in water and drink it 15–20 minutes before meals to potentially aid in blood sugar control.
  7. Stay Hydrated: Drinking an adequate amount of water is essential for overall health and can also help regulate blood sugar levels. Aim to drink at least 8 glasses of water per day, and replace sugary beverages with water, herbal teas, or infused water flavored with lemon or cucumber.
  8. Portion Control: Be mindful of portion sizes to prevent overeating and minimize blood sugar spikes. Use smaller plates, measure serving sizes, and pay attention to hunger and fullness cues to avoid consuming excessive carbohydrates and calories in one sitting.
  9. Regular Monitoring: Keep track of your blood sugar levels regularly, especially if you have diabetes or prediabetes. Monitoring allows you to understand how your lifestyle choices impact your blood sugar and enables you to make necessary adjustments to maintain optimal control.
  10. Seek Professional Guidance: While natural remedies can be beneficial, it’s essential to work closely with healthcare professionals, including doctors, dietitians, and diabetes educators, to develop a comprehensive management plan tailored to your individual needs.
In conclusion, managing blood sugar levels naturally involves adopting a holistic approach that encompasses dietary modifications, regular exercise, stress management, adequate sleep, and the incorporation of herbal remedies and supplements. By making mindful lifestyle choices and prioritizing your health, you can take proactive steps towards achieving better blood sugar control and reducing the risk of complications associated with high blood sugar levels.

Check out our natural and scientifically proven remedies

Eliel Arrey MD MBA


References:
  1. American Diabetes Association. (n.d.). Glycemic index and diabetes. Retrieved from https://www.diabetes.org/glycemic-index-and-diabetes
  2. Mayo Clinic. (2020). Diabetes: Exercise. Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-management/art-20047963
  3. Harvard Health Publishing. (2018). Stress and your health. Retrieved from https://www.health.harvard.edu/staying-healthy/stress-and-your-health
  4. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). The link between insufficient sleep and type 2 diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/teens-young-adults/insufficient-sleep-type-2-diabetes
  5. American Diabetes Association. (n.d.). Herbs, Supplements and Alternative Medicines. Retrieved from https://www.diabetes.org/nutrition/healthy-food-choices-made-easy/herbs-supplements-and-alternative-medicines
  6. Johnston, C. S., & White, A. M. (2007). Vinegar ingestion at bedtime moderates waking glucose concentrations in adults with well-controlled type 2 diabetes. Diabetes Care, 30(11), 2814–2815. doi:10.2337/dc07–1062
  7. Mayo Clinic. (2020). Water: How much should you drink every day? Retrieved from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256
  8. Harvard T.H. Chan School of Public Health. (n.d.). Portion size: How much should I eat? Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/portion-size/
  9. American Diabetes Association. (n.d.). Checking Your Blood Glucose. Retrieved from https://www.diabetes.org/managing-diabetes/complications-and-prevention/blood-glucose-testing-and-control
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Smoothies: Your Tasty Companion on the Weight Loss Journey

4/1/2024

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Smoothies have become a staple in the diet of health-conscious individuals, offering a convenient and delicious way to pack essential nutrients into one tasty beverage. But beyond their refreshing taste, smoothies can also be powerful allies in achieving weight loss goals. Packed with vitamins, minerals, fiber, and antioxidants, they not only support overall health but can also aid in weight management when incorporated into a balanced diet and lifestyle. Let’s delve into how smoothies can be a valuable tool in your weight loss journey.
  1. Nutrient Density: One of the key benefits of smoothies is their nutrient density. By blending fruits, vegetables, and other nutritious ingredients, you can create a beverage that is rich in vitamins, minerals, and antioxidants essential for overall health. Consuming nutrient-dense foods helps to satisfy hunger and cravings, reducing the likelihood of overeating or reaching for unhealthy snacks [1].
  2. Portion Control: Smoothies offer a convenient way to practice portion control. Unlike solid foods, where portion sizes can be challenging to gauge accurately, smoothies can be easily measured and customized to fit your nutritional needs and calorie goals. By including ingredients with high water and fiber content, such as leafy greens and berries, you can create a filling beverage that helps you stay full for longer without consuming excess calories [2].
  3. Balanced Macronutrients: For effective weight loss, it’s essential to consume a balanced mix of macronutrients, including carbohydrates, protein, and healthy fats. Smoothies provide an excellent opportunity to incorporate all three macronutrients into your diet. Adding ingredients like Greek yogurt, nut butter, or avocado can boost your smoothie's protein and healthy fat content, promoting satiety and supporting muscle repair and growth [3].
  4. Hydration: Staying hydrated is crucial for overall health and plays a significant role in weight management. Smoothies, especially those made with water-rich fruits and vegetables, contribute to your daily fluid intake, keeping you hydrated and potentially reducing cravings for high-calorie beverages like sugary sodas or juices. Adding coconut water or herbal teas as the base for your smoothie can further enhance hydration while adding flavor and nutrients [4].
  5. Fiber for Satiety and Digestive Health: Fiber is a vital component of a weight loss diet as it promotes feelings of fullness, regulates blood sugar levels, and supports digestive health. Including fiber-rich ingredients such as leafy greens, chia seeds, and flaxseeds in your smoothies can help you stay satisfied between meals and promote regular bowel movements, reducing bloating and discomfort associated with constipation [5].
  6. Versatility and Variety: One of the best things about smoothies is their versatility. With countless ingredient combinations to choose from, you can create endless variations to suit your taste preferences and dietary requirements. Whether you prefer fruity blends, creamy concoctions, or green detox smoothies, there’s a recipe out there to satisfy every palate. Experimenting with different ingredients also ensures you get a wide range of nutrients, keeping your diet interesting and enjoyable [6].
  7. Mindful Eating: Incorporating smoothies into your diet encourages mindful eating habits. Taking the time to prepare and savor a nutrient-packed smoothie can help you become more attuned to your body’s hunger and fullness cues, making it easier to avoid mindless snacking and overeating. Additionally, the act of chewing and sipping your smoothie slowly can enhance satisfaction and enjoyment, fostering a healthier relationship with food [7].

​In conclusion, smoothies offer a convenient and delicious way to support weight loss efforts while nourishing your body with essential nutrients. By incorporating nutrient-dense ingredients, practicing portion control, and staying mindful of your eating habits, smoothies can be a valuable tool in achieving your weight loss goals. So blend your favorite ingredients and sip your way to a healthier, happier you!
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Check out our Smoothie Diet for weight loss.

Eliel N. Arrey MD MBA is an expert author, health advisor, business owner, and surgeon
​
References:
  1. Harvard T.H. Chan School of Public Health. (2021). The Nutrition Source — Vegetables and Fruits. Retrieved from https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vegetables-and-fruits/
  2. Kaiser Permanente. (n.d.). Healthy Eating: Portion Control. Retrieved from https://healthy.kaiserpermanente.org/health-wellness/eat-well/nutrition/portion-control
  3. Harvard T.H. Chan School of Public Health. (2021). The Nutrition Source — Protein. Retrieved from https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/protein/
  4. Mayo Clinic. (2021). Water: How much should you drink every day? Retrieved from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256
  5. Mayo Clinic. (2021). Dietary fiber: Essential for a healthy diet. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983
  6. University of California San Francisco. (n.d.). Eating Well with Canada’s Food Guide — Beyond the Basics. Retrieved from https://www.ucsfhealth.org/education/eating-well-with-canadas-food-guide-beyond-the-basics
  7. Mindful Eating. (n.d.). The Principles of Mindful Eating. Retrieved from https://www.mindful-eating.com/mindful-eating-principles/
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Is there a business case for quality in health care?                                            Eliel Arrey, M.D., Tracy Kenney, BA., Cameron Knox, BS., Diane Pham, BS., and Aurelio Vargas, BS.   Texas A&M Corpus Christ - College

10/24/2017

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The answer to there being a business case for quality in healthcare is a long, complex, and somewhat controversial one. Quality in health care as it pertains to optimal patient outcomes, safety, and efficient service are pivotal to patient centered care and one any human will agree to its improvement. On the same token, improving quality in health care is the fiduciary responsibility of all medical providers. So yes, we contend that there is a business case for quality in health care. The inability to truly quantify a positive financial return for quality improvement (QI) initiatives and the variety of reimbursement systems in healthcare are a couple of strong reasons why the business case for quality in healthcare is not as widespread as one would expect.1, 2  This short narrative will discuss how several issues in the healthcare business sector affect the business case for quality, and review a few suggestions of our own on why quality improvement programs in healthcare are more than just another expense but are programs that have a good return on investment that benefit all interested parties, with patients being at the forefront.  

Quality seen as an expense:
The current situation in the healthcare business sector is that QI projects are hard to quantify and define. In a 2007 survey administered to chief medical officers (CMO) at four urban nonprofit, acute care teaching hospitals, there was great variability in how each of these hospitals allocated their funds for QI projects.  Inpatient QI projects ranged from $2 million to as high as $21 million.3 Thus, QI projects are widely seen as an expense or in some cases, a necessary cost to maintain accreditation or respond to regulations.3, 4  With an increasing number of quality metrics, and regulatory and accreditation agencies, there is growing support for the business case of quality in healthcare.

The return on investment (ROI):
No matter how well-intended QI projects may be, the difficulty in sustaining many of these projects as mentioned above lies in the time for the QI to result in an economic benefit to the investor and the beneficiary.9  Naturally, the earlier the ROI occurs, the greater the value of the QI and the stronger the business case for said QI program.10  In regards to the relationship between investor and beneficiary, Dr. Gross elaborates in his article, “when the ROI goes to the same party, the business case is self-evident.”9 The dilemma in the past was that hospital institutions spending money on new QI projects in order to be in accordance with departments such as Joint Commission (JCO) never were able to quantify any economic return. The beneficiary, according to some, was “the patient and society.”9  Nevertheless, in 2013, Swensen et al. made the case that beneficiaries to QI programs were the patients, insurers, employees, and providers.4  The institution of payment services like pay-for-performance helps reward hospital institutions that invest in QI programs that lead to better safety outcomes. We will discuss this in more detail under reimbursements.

Measuring Quality in healthcare:
Quality in healthcare is generally patient focused. It's a never ending process where quality criteria is set, data is gathered, data is reviewed using statistical tools, and then used to develop quality improvement efforts or identify issues. New criteria may evolve and the process starts over again. While quality concerns does not prevent all poor outcomes, it does increase more positive outcomes on desired care.12

Avedis Donabedian,5 the “father of quality assurance”, described the aspects of quality as: 

1. Resources used in care
2. Activities involved in providing care
3. Outcomes as consequences of care
He further identified attributes of quality which are efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy, and equity.5 Many models have been developed to measure quality based on Donabedian’s work;6, 7 however, it's also important to consider case variety, patient illness, and conditions when evaluating quality measures.

Quality and its potential effects on provider liability:
We agree with Swensen et al. that clinical QI can deliver “net operating income if managed appropriately.”4  In their four year administrative date examination of the relationship between safety outcomes in hospitals and malpractice claims against providers in California, Greenberg et al. were able to demonstrate that a decrease in adverse safety outcomes from QI programs was associated with a decrease in the volume of malpractice claims.8 Their report supports the business case for quality in health care to not just improve patient safety outcomes, but to lower liability costs to providers.

What role do reimbursements play in the business case for quality?
​Reimbursements affecting the business case for quality: Fee-for-service reimbursement encourages overuse waste (provider related).  Reimbursements received from length hospital stays due to preventable complications have been captured in fee-for-service payment systems.  Value-based purchasing and pay-for-performance reimbursement models have become significant in supporting the business case for healthcare.  Providers need to be concerned with quality as it is directly related to receiving payments. The government implemented a Pay-for-Performance program and Hospital Value-Based Purchasing Program.12  Pay-for-performance (P4P) requires providers to submit data on an initial set of 10 quality indicators. If hospitals fail to submit, they will receive reduced payment. In return, the Hospital Value-Based Purchasing Program offers incentives with higher payments to providers for higher performance and/or improvements. While research to date does not suggest the effects of P4P, it obviously affects the bottom line of most organizations.12

What makes a strong business case for quality in healthcare?
In 2002, Michael D. Pugh stated that the business case for quality “varies by the type of improvement.”  He went on to describe a very strong case for QI: projects that readily decrease unit cost or projects that lead to higher productivity.  He described moderate cases for quality as those that only add value to products or services (an example will be employee bonuses for improved quality) or increased customer and patient satisfaction.9    

Reducing Waste:
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In their very elaborative review of “The Revolution in Health Care Delivery,” Swensen et al. declared emphatically that as much as “40% of healthcare dollars” spent is waste, specifically provider-related.11   We have previously mentioned one form of this waste, which is overuse. Other forms of provider-related waste include inefficiency and preventable harm.4  Swensen et al. do caution on the difference between waste and cost, and make the point that simply removing workers in an area to reduce cost will always erode quality.4  Reducing waste through effective QI programs results in direct benefit to patients, insurers, providers, and hospitals.

In conclusion, the business case for quality is a very broad and complex topic. Mainly because quality is complex and in some cases, depends on perspective. From a business perspective, resources are limited and the difficulty to quantify quality in healthcare or define how much of an institution’s revenue should be allocated to QI programs hurt the business case for quality.  Nevertheless, the business case for quality has more pros than cons as we have elaborated on, from patient safety, decrease in provider liability, ROI, pay-for-performance systems, and maintenance of accreditation.  Continual improvement of quality in healthcare will benefit all parties, the hospital institution, healthcare providers, employees, and above all, the patients, to whom we owe a fiduciary responsibility.




References:
1)Brown SES, Chin MH, Huang ES. Estimating costs of quality improvement for outpatient healthcare organizations: a practical methodology. Qual Saf Health Care. 2007;16:248Y251.

2)Leatherman S, Berwick DM, Iles D, et al. The business case for quality: case studies and an analysis. Health Affairs (Millwood). 2003;22:17Y30.

3)Chen LM, Rein MS, Bates DW. Title costs of quality improvement: a survey of four acute care hospitals. Jt Comm J Qual Patient Saf. 2009;35:544Y550

4)Swensen SJ, Dilling JA, McCarty PM, et al. The Business Case for Health-Care Quality Improvement. J Patient Saf 2013;9: 44Y52

5)Donabedian A. Evaluating the quality of medical care. Milbank Memorial Fund Q. 1966;44(3)(suppl):166‐206. Reprinted in Milbank Q. 2005;83(4):691‐729

6)Berwick D, Fox DM. “Evaluating the Quality of Medical Care”: Donabedian’s Classic Article 50 Years Later. The Milbank Quarterly. 2016;94(2):237-241. doi:10.1111/1468-0009.12189

7)Ayanian JZ, Markel H. Donabedian's Lasting Framework for Health Care Quality. N Engl J Med. 2016 Jul 21;375(3):205-7. doi: 10.1056/NEJMp1605101.

​8)Greenberg MD, Haviland AM, Ashwood JS, Main R. Is better patient safety associated with less malpractice activity? Evidence from California. Santa Monica, CA; Rand Corp, TR-824-ICJ. As of January
16, 2011: http://www.rand.org/pubs/technical_reports/TR824 2010.


9)Gross PA, Ferguson JP, DeMauro P, et al. The business case for quality at a university teaching hospital. Jt Comm J Qual Patient Saf.2007;33:163Y170.

10)Weeks, W.B., Bajian, J.P. Making the business case for patient safety. Jt Comm J Qual Patient Saf. Jan. 2003;29:51–54.

11)Swensen SJ, Meyer GS, Clancy CM, et al. Cottage industry to postindustrial care - the revolution in health care delivery. N Engl J Med. 2010;362:e12, February 4, 2010.

​12)Finkler, Steven A., Jones, Cheryl B. & Kovner Christine T. (2013). Financial management for nurse managers and executives FOURTH edition. St. Louis, MO: Saunders Elsevier.





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Singer Yolanda Arrey drops an Epic Anthem on 'The Essentials' from EA Music - Press Release

4/21/2016

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The Cameroonian-born singer known as Yolanda Arrey is a prominently featured artist on the new LP record from EA Music Group and mastermind musician Eliel Arrey.  Yolanda Arrey happens to be the second Cameroonian-born talent holding nothing back as she steps unto the world stage on the track 'Your Highness.'  The new long-playing album featuring Yolanda and other artists such as Nasomi, Steve Owner, and Melissa Otero, “The Essentials,” is available for download online [link provided below].

Early rumors of Yolanda's involvement in this full length album initially broke out in the February 2016 press release for Eliel Arrey's "End of Days" which listed her as a vocalist in EA Music Group.  Eliel Arrey never responded to any comments in regards to the extend of Yolanda's collaboration and that was kept a mystery until now.    

Something that certainly was not a mystery then or now, is Yolanda Arrey, the singer. Described in an article as "Salt Lake City's finest," Yolanda is no novice to the music scene. She has been singing and writing her own songs since she was seven years old and is well known by many  Cameroonians around the world. She cites Whitney Houston as one of her main artistic influences, a singer well known for her strong vocal presence, an attribute that marks Yolanda's own style.

 Another well known fact is her love for old school Jazz and Soul music.  Her songs bring a soothing memory of what some would say 'real music used to be.'  When asked about Yolanda, Eliel Arrey said "She is just too good. She gives her all into every song and her type of music definitely fits into what any would call the trademark 'Motown sound.'' 

Yolanda has been known to step out of the Jazz scene from time to time, making the idea of a collaboration with a near genre-free music composer such as Eliel Arrey not so far fetched.  In December 2013, she collaborated with the acclaim rapper Prince of Cats on a Hip-Hop/Rap song titled "When You Loved Me."  That magnificent piece was a success and  garnered numerous audiences worldwide.

'Your Highness' is a track that demonstrates the evolution of both Eliel Arrey and Yolanda over the short courses of their musical careers:
- On the one hand, we see that Eliel Arrey is not shy to step away from his traditional EDM zone that has celebrated him for so long.  Nor is he shy to step away from the new symphonic scene that seems to be his new identity.  He demonstrates, with emphasis, that he can walk into a brand new universe and still keep us dancing.  Time after time, Eliel Arrey has shown us he is "...broadly varied [and] emotionally evocative."  McCauley 2016.
-On the other hand is the Diva in the room,  Yolanda Arrey.  Her works just never cease to amaze.  Although she launches into the song with a soft and warm vocal, it does not take long for her to leap into her full range of strong natural tones and pitch perfect precision. The sweet, short, and catchy melodies of 'Your Highness' will keep many listeners hitting 'repeat' all year long. This song arguably might be this summer's most played anthem. 

Like everything else we are presented with on 'The Essentials,' it is world-class writer McCauley who describes it best: "With nearly every emotional hue coloring this striking example of unbridled innovation and musical alchemy, it's improbable that the music fan won't hear himself in it somewhere." 
McCauley 2016.

“The Essentials” by Eliel Arrey from EA Music Group is now available online worldwide featuring Salt Lake City's finest, Yolanda Arrey on 'Your Highness.'
 

https://itunes.apple.com/us/album/the-essentials/id1097226089

Website –

www.elielarrey.com

Download album today
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Singer Nasomi featured on 'The Essentials' from EA Music - Press Release

4/15/2016

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SUMMARY:

The Cameroonian-born singer known as Nasomi is a prominently featured artist on the new LP record from EA Music Group and mastermind musician Eliel Arrey.

PRESS RELEASE:

The Cameroonian-born singer known as Nasomi is a prominently featured artist on the new LP record from EA Music Group and mastermind musician Eliel Arrey. The new long-playing album featuring Nasomi, “The Essentials,” is already available for pre-order online [link provided below].

While Eliel Arrey's “The Essentials” has been garnering no end of attention from music lovers and game aficionados alike, Arrey himself stresses that Nasomi's performances are among the album's best qualities.

“Nasomi is definitely an artist I'd like to emphasize on my album,” writes Arrey, who is renowned for writing evocative, highly narrative compositions. “She is the lead singer on 'Rise,' 'Brand New Day/Dance with Me,' and 'Sunset Love 2.0.' Nasomi has one of the most powerful voices of any artist I know. She has the ability to listen to any melody I write and complement it with the perfect vocals. She is masterful at conveying emotions through music. Her lyrics have touched many souls and have inspired many people, including me.”

The Holland-based Nasomi cites as main artistic influences Toni Braxton and Aaliyah, two singers well loved for strong natural tones and a surgically precise pitch, both of which are marks of Nasomi's own style.  

“Nasomi is an artist who takes her music very seriously and is one of the most hardworking people I know,” says Eliel Arrey. “She sets goals and executes on them. She puts a lot of effort and dedication in all her work. She has never been it for money or fame, she just loves to sing and loves music!” 
​
Nasomi's first taste of fame came in 2012 when one of her underground singles, an original called “Whatever It Takes,” went viral on SoundCloud. Arrey heard the track and got in touch to suggest a collaboration. Today, he is proud to announce the three songs included on “The Essentials,” as well as several other tracks the duo will release later this year.

Since 2011 The “Whatever It Takes” singer-songwriter has performed at various events in the Netherlands and Germany, as well as at the 2012 Esamba Esamba festival in Belgium. “The Essentials” feat. Nasomi by Eliel Arrey is available online for pre-order worldwide now.  

-S. McCauley

Lead Press Release Writer

www.MondoTunes.com

“The Essentials” feat. Nasomi –

https://itunes.apple.com/us/album/the-essentials/id1097226089

Website –

www.elielarrey.com
Download album today
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The Cameroon National Anthem by Eliel Arrey

4/15/2016

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Download track today
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The Essentials - Available Now

4/15/2016

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Picture

Music has always been influenced by cultures.   Every society/culture has a unique style to their music and different instruments trademark some cultures. Our album, "The Essentials," is meant to draw music lovers from all backgrounds, cultures, and styles.  Our listeners will sometimes notice our use of a variety of instruments not conventionally used in your everyday music. From Bagpipes playing the African Cameroonian National Anthem, or Kalimbas laying the down the verses in Far Cry, to our rendition of the violins and woodwinds of the Celtic Hills.  The Essentials is going to take every listener on an international journey. We hope that all our listeners can feel and appreciate the diversity we sought after when we compiled this album.  Our vocalists are nothing short of world-class, featuring the powerful Dutch star artist -Nasomi, Salt Lake City's finest -Yolanda, internationally acclaimed songwriter and engineer -Steve Owner, and the extended instrumental rendition of Melissa Otero's "Angels and Demons."  Our listeners will also notice that "The Essentials" contains songs from a variety of genres such as New Age, Modern Classical, Electro House, Dance, Hip-Hop, R&B, Orchestral, and World.  We ourselves had a hard time picking what genre to list the overall album under.  We also pay special tribute to the life and memory of the great movie score composer, James Horner. The entertainment world still mourns the loss of this legend and there exist a void that can never be filled.


Finally,  we love the diversity of the tracks in the project as it symbolizes the diverse influences we have had in our lives and the different cultures that have influence us.  Our goal is that everyone can find something they can relate to when they turn on this album.  So much love and hard work has gone into this project, and it is our deepest honor to share this project with you and the rest of the world.


Sincerely, 


Eliel Arrey & EA Music Group   ​
Download album now
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Hands Up High // Brazil 2014  - single by Eliel Arrey

7/2/2014

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Post by El Arrey.
Tis the season for soccer. Put on your supporter jersey shirts, put on your game face, and put yours Hands Up High, its Brazil 2014.
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