[Reblog] The hospital that will remain nameless

One person’s journey through an unhealthy health care system.  Definitely not patient centered. Have had similar insurance problems, mostly because of errors in the insurance company erring in my personal identifiers.

From the 19 February 2015 item  By LISA SUENNEN at The Health Care Blog

Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.

I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly.

…

And from one of the comments…

William Palmer MD says:

February 19, 2015 at 9:45 pm

You sound true and authentic to me too. I am embarrassed as to how often we do screw up. The only excuse I think is that we have so much internal and external regulation that we become nervous nellies, unable to relax and enjoy what we are doing. You should go to a Pharmacy and Therapeutics meeting in a hospital and listen to the barrage of complaints from everyone to everyone. Wrong dose, wrong timing, wrong drug, wrong patient. I have walked out of these meetings because of the hostility. We would all do better if we could start some little village clinic in the Congo, without the interminable watching from a thousand eyes.

Related articles

• Experts warn 2015 could be ‘Year of the Healthcare Hack’

[Reblog] Fatal Error (in Health Care)

 

The VA Palo Alto Health Care System in Palo Alto, California. (Photo credit: Wikipedia)

From the 4 April 2014 post by Rob Lamberts, MD at The Health Care Blog

The janitor approached my office manager with a very worried expression.  ”Uh, Brenda…” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh…well…I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer….”  He cleared his throat nervously, “Uh…his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on the screen?” she asked, growing more curious.

“On the screen.  It said something about an ‘illegal operation.’  I was worried that he had done something illegal and thought you should know,” he finished rapidly, seeming grateful that this huge weight lifted.

Relieved, Brenda laughed out loud, reassuring him that this “illegal operation” was not the kind of thing that would warrant police intervention.

Unfortunately for me, these “illegal operation” errors weren’t without consequence.  It turned out that our system had something wrong at its core, eventually causing our entire computer network to crash, giving us no access to patient records for several days.

The reality of computer errors is that the deeper the error is — the closer it is to the core of the operating system — the wider the consequences when it causes trouble.  That’s when the “blue screen of death” or (on a mac) the “beach ball of death” show up on our screens.  That’s when the “illegal operation” progresses to a “fatal error.”

The Fatal Error in Health Care 

Yeah, this makes me nervous too.

We have such an error in our health care system.  It’s absolutely central to nearly all care that is given, at the very heart of the operating system.  It’s a problem that increased access to care won’t fix, that repealing the SGR, or forestalling ICD-10 won’t help.

It’s a problem with something that is starts at the very beginning of health care itself.

The health care system is not about health.

……

For any solution to have a real effect, this core problem must be addressed.  The basic incentive has to change from sickness to health.  Doctors need to be rewarded for preventing disease and treating it early. Rewards for unnecessary tests, procedures, and medications need to be minimized or eliminated.  This can only happen if it is financially beneficial to doctors for their patients to be healthy.

Infographic (Institute of Medicine) – What’s Possible for Health Care Costs?

From http://iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America/Infographic.aspx

References for “What is Possible for Health Care” Infographic

Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.

Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.

Donchin, Y., D. Gopher, M. Olin, Y. Badihi, M. Biesky, C. L. Sprung, R. Pizov, and S. Cotev. 2003. A look into the nature and causes of human errors in the intensive care unit. Quality & Safety in Health Care 12(2):143-147.

Pham, H. H., A. S. O’Malley, P. B. Bach, C. Saiontz-Martinez, and D. Schrag. 2009. Primary care physicians’ links to other physicians through Medicare patients: The scope of care coordination. Annals of Internal Medicine 150(4):236-242.

Classen, D. C., R. Resar, F. Griffin, F. Federico, T. Frankel, N. Kimmel, J. C. Whittington, A. Frankel, A. Seger, and B. C. James. 2011. ‘Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs (Millwood) 30(4):581-589; Landrigan, C. P., G. J. Parry, C. B. Bones, A. D. Hackbarth, D. A. Goldmann, and P. J. Sharek. 2010. Temporal trends in rates of patient harm resulting from medical care. New England Journal of Medicine 363(22):2124-2134; Levinson, D. R. 2010. Adverse events in hospitals: National incidence among Medicare beneficiaries. Washington, DC: U.S. Department of Health and Human Services, Office of Inspector General.

Jencks, S. F., M. V. Williams, and E. A. Coleman. 2009. Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine 360(14):1418-1428.

Goodman, J. C., 2006. Transparency in Health Care. Washington, DC: National Center for Policy Analysis.

Goodman, J. C., 2006. Transparency in Health Care. Washington, DC: National Center for Policy Analysis.

Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.

Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.

Degner, L. F., L. J. Kristjanson, D. Bowman, J. A. Sloan, K. C. Carriere, J. O’Neil, B. Bilodeau,
P. Watson, and B. Mueller. 1997. Information needs and decisional preferences in women with breast cancer. Journal of the American Medical Association 277(18):1485-1492; Fagerlin, A., K. R. Sepucha, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund-Fisher. 2010. Patients’ knowledge about 9 common health conditions: The decisions survey. Medical Decision Making 30(Suppl. 5):S35-S52; IOM. 2011. Patients charting the course: Citizen engagement in the learning health system (a workshop summary). Washington, DC: The National Academies Press; Lee, C. N., J. Belkora, Y. Chang, B. Moy, A. Partridge, and K. Sepucha. 2011. Are patients making high-quality decisions about breast reconstruction after mastectomy? Plastic and Reconstructive Surgery 127(1):18-26; Lee, C. N., Y. Chang, N. Adimorah, J. K. Belkora, B. Moy, A. H. Partridge, D. W. Ollila, and K. R. Sepucha. 2012. Decision making about surgery for early- stage breast cancer. Journal of the American College of Surgeons 214(1):1-10; Sepucha, K. R., A. Fagerlin, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund-Fisher. 2010. How does feeling informed relate to being informed? The decisions survey. Medical Decision Making 30(Suppl. 5):S77-S84.

Degner, L. F., L. J. Kristjanson, D. Bowman, J. A. Sloan, K. C. Carriere, J. O’Neil, B. Bilodeau,
P. Watson, and B. Mueller. 1997. Information needs and decisional preferences in women with breast cancer. Journal of the American Medical Association 277(18):1485-1492; Fagerlin, A., K. R. Sepucha, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund-Fisher. 2010. Patients’ knowledge about 9 common health conditions: The decisions survey. Medical Decision Making 30(Suppl. 5):S35-S52; IOM. 2011. Patients charting the course: Citizen engagement in the learning health system (a workshop summary). Washington, DC: The National Academies Press; Lee, C. N., J. Belkora, Y. Chang, B. Moy, A. Partridge, and K. Sepucha. 2011. Are patients making high-quality decisions about breast reconstruction after mastectomy? Plastic and Reconstructive Surgery 127(1):18-26; Lee, C. N., Y. Chang, N. Adimorah, J. K. Belkora, B. Moy, A. H. Partridge, D. W. Ollila, and K. R. Sepucha. 2012. Decision making about surgery for early-stage breast cancer. Journal of the American College of Surgeons 214(1):1-10; Sepucha, K. R., A. Fagerlin, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund- Fisher. 2010. How does feeling informed relate to being informed? The decisions survey. Medical Decision Making 30(Suppl. 5):S77-S84.

Farrell, D., E. Jensen, B. Kocher, N. Lovegrove, F. Melhem, L. Mendonca, and B. Parish. 2008. Accounting for the cost of US health care: A new look at why Americans spend more. Washington, DC: McKinsey Global Institute; IOM. 2010. The healthcare imperative: Lowering costs and improving outcomes: Workshop series summary, Learning health system series. Washington, DC: The National Academies Press; Wennberg, J. E., E. S. Fisher, and J. S. Skinner. 2002. Geography and the debate over Medicare reform. Health Affairs (Millwood) (Suppl. Web Exclusives):W96-114.

Improving Access to Mental Health Care and Psychosocial Support within a Fragile Context: A Case Study from Afghanistan

While American service men and women are being treated for war related traumas, let us not forget the effects of war on civilians…

From the PLos Absract 

• After the fall of the Taliban, the rebuilding of the Afghan health care system, from scratch, provided opportunities to integrate mental health into basic health services through the use of funds that became available during this complex humanitarian emergency.
• Practice-oriented mental health trainings for general health workers and ongoing clinical supervision in the basic health care system led to substantially increased demand for and access to basic mental health care services.
• Treatment of mental disorders within the health care system needs to be accompanied by a community-based approach that focuses on psychosocial problems.
• Addressing service delivery needs in a fragile state has to be accompanied by capacity building and policy development in order to foster structural changes within the health care system.

….

Looking to the Future

The experience in Nangarhar shows that, even within a fragile and resource poor context, it is possible to develop integrated services for mental health and psychosocial support, to rapidly cover an area of more than a million people. It is important to use funds available during a humanitarian emergency to pursue lasting improvements in the health care system [28]. There is an urgent need to develop a system of routine outcome measuring tools that includes both symptom reduction and improvement of social functioning. It is challenging to develop context-specific and low-cost outcome measures, but recent evidence for child psychosocial programmes in post conflict areas demonstrates that it can be done [29]. People with a limited background in mental health care can deliver integrated services, once their tasks are integrated within a system of care that includes focused, competency-based trainings, regular supervision, and refresher training [30]. It is important to strengthen the psychosocial elements of treatment within the health care system, and to ensure that the social context in which the symptoms occur and are maintained, are considered in the treatment plans of health care providers. The most recent version of the BPHS includes the addition of psychosocial counsellors at the district hospitals and comprehensive health centres. Preliminary evidence on the effectiveness of adding psychosocial counselling in primary health care settings in Afghanistan is encouraging [31] Apart from health system–based interventions, the authors have learned the importance of addressing psychosocial problems through activities outside the formal health care sector to strengthen self-help and foster resilience.

Related articles

• Community and health system approaches improves mental health in Afghanistan (eurekalert.org)
• Community and health system approaches improves mental health in Afghanistan (medicalxpress.com)
• Providing psychosocial assessment and support for migrants: A critical urge (icmhd.wordpress.com)
• Combatting Mental Illness Stigma in Society (psychcentral.com)
• Adolescent Suicide Prompts Look at Mental Health System: Ontario, Canada (jeanettebartha.wordpress.com)

• PTSD outcomes improve as US Army adds behavioral health screening to primary care (EurekAlert)

For those interested in health system indicators (statistics)

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The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed views broken out by population characteristics such as age, sex, income level, and insurance coverage status.

Not only can one view data, but one can customize graphs and tables

From the About Page

The Project focuses on ten critical dimensions of our health care system covering the availability, quality, and cost of care, the overall health of Americans, and the dynamism of the system. The Project examines the evolution of these aspects of our system over time. It also assesses the status of these dimensions of the system with respect to subgroups of the population, with a particular emphasis on vulnerable populations.

About the Topical Areas

The measures are divided into the following ten topical areas:

• Access to Care
• Cost and Affordability
• Coverage
• Health Information Technology
• Innovation
• Population Health
• Prevention
• Quality
• Vulnerable Populations
• Workforce

About the Functionality

With this web tool you can:

• Quickly view data on a given topic from multiple sources
• Compare national metrics with the same metrics measured at the regional and state level
• See time trends for up to 10 years
• Compare data across variables such as income, race, age, and insurance coverage type
• View data in both graphical and table format

Related articles

• HCD Announces Meaningful Use Dashboard for Health Systems (prweb.com)
• The Health Wonk Review, Come Back, We”ll Leave The Light On For You Edition (diseasemanagementcareblog.blogspot.com)
• Canadian Health Care System Provides Poor Value for Tax Dollars Spent (theepochtimes.com)
• The Myth of the Free-Market American Health Care System (theatlantic.com)