[Reblog] How Many Patients Did We Hurt Last Month? Learning (But Not Too Much) From The Best Hospitals

From the 6 November 2013 HealthCare Blog post by ASHISH JHA, MD

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A few years ago, I was working on a strategy for improving the quality and safety of VA healthcare.  As part of this effort, I called up senior quality leaders of major healthcare organizations across the nation.  One call is particularly memorable.  Because I promised anonymity, I will not name names but this clinical leader was very clear about his responsibility: every month, he met with his CEO, who began the meetings with three simple questions: “How many patients did we hurt last month? How many patients did we fail to help? And did we do better than the month before?”

The CEO and the entire hospital took responsibility for every preventable injury and death that occurred and the culture of the place was focused on one thing: getting better.  When I looked them up on Hospital Compare, they too had excellent outcomes and they regularly get “A” ratings for patient safety from the Leapfrog Group.

 

How do the BIDMCs and these other super-high performers pull it off?  How do they build a culture of quality when so many organizations seem to struggle?  High performance is complex, of course, and I won’t try to be overly simplistic.  But a few things seem common among many high performing institutions. They seem to be focused on three things:  timely, clinically relevant outcomes data; transparency within (and usually outside) the organization; and a constant focus on getting better.

You can see the kinds of data that BIDMC posts on its website – it’s not just the standard Hospital Compare stuff (which everyone has to do) but other data on a series of outcomes which are not required.   When I hear Kevin Tabb, their current CEO talk about quality – it’s obvious that quality is not a platitude.  He is genuinely focused on getting better.

So what’s the lesson from BIDMC, Mayo and other high performing institutions? There is no substitute for great leadership.  Each of them seems to have been blessed with leaders who, despite all the wrong incentives in the healthcare system, prioritize patient care and drive their organizations to great performance.  They are internally motivated and do all the things I describe above, despite the fact that our primary payment systems incentivize them to do more, not better.  They are extraordinary leaders- with not only great vision but also the ability to execute that vision.

But here’s the risk:  too many policymakers believe that all we need to do is figure out what BIDMC or Mayo or Kaiser does and just get everyone else to do it. Such an approach, while seemingly perfectly good on paper, fails to account for the human element.  The strategies that they have used have been executed by individuals unusually focused on improving care.  Barring substantial improvements in cloning technology, we can’t expect that each hospital will have a great leader.

We don’t expect that every technology company will have a Steve Jobs.  In every industry, there are a few visionary leaders, but the rest of the organizations?  They are run by mortals – and mortals respond to incentives.  And here lies the problem:  the incentives in the system are not motivating the typical CEO to improve care.  Whatever strategy we employ around timely data, transparency, etc. won’t work until the leadership is properly motivated and focused on quality.  And while that happens in pockets, it’s not happening across the entire healthcare system.  And this is where we will pick up in my next blog: how to get the rest of the organizations to make quality a real priority.

 

Read the entire article here

 

[New Scientist Article] Data trackers monitor your life so they can nudge you

From the 7 November 2013 New Scientist article by Hal Hodson

Once you know everything about a person, you can influence their behaviour. A thousand students with tattletale phones are going to find out how easy that is

THERE’S something strange about this year’s undergraduate class at the Technical University of Denmark – they all have exactly the same kind of phone.

The phones are tracking everywhere the students go, who they meet and when, and every text they send. Around 1000 students are volunteers in the largest-ever experiment of its kind, one that could change our understanding of how we interact in groups.

Sune Lehmann and Arek Stopczynski of DTU are using the data to build a model of the social network the students live in – who talks to who, where groups gather. They plan to test whether the results can be used for purposes like boosting student achievement, or even improving mental health. “We hope to be able to figure out how to make this work in terms of academic performance,” says Lehmann.

This is sociology on a different scale, gathering detailed data about an entire group and then using that information to “nudge” them into changing their behaviour. Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous.

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Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous.

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Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous. a 2010 study, participants were encouraged to boost their activity levels either through personal rewards, or rewards given to a buddy who was supposed to keep tabs on them. Being motivated by an incentivised buddy resulted in twice the activity increase of the direct reward.

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..nudges related to public health could be as simple as allowing doctors to ring up their patients when their activity levels start to follow patterns that correlate with, say, diabetes or depression, and asking them if they are feeling OK.

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But we shouldn’t lose sight of the potential dark side, says Evan Selinger, a technology ethicist at the Rochester Institute of Technology in New York. “There is extraordinary power in the access to data at a personal level – even predicting future behaviour,” he says. “There’s a lot to be gained, but there’s a lot of problems that scare the living ******** out of me.”

 

 

Related articles

• It’s time to close the Government’s sinister ‘Nudge Unit’ and let the free market take over (blogs.telegraph.co.uk)
• Doctors Track Your Physical Activity Through Smartphones (biospace.com)

 

Community health centers compare well with private practices, Stanford researcher finds

Community Health Center of Burlington (Photo credit: origamidon)

From the 10 July 2012 article at EurekAlert

STANFORD, Calif. — Government-funded community health centers, which serve low-income and uninsured patients, provide better care than do private practices, a researcher at the Stanford University School of Medicine has found.

Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California, San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.

Their study is to be published online July 10 in the American Journal of Preventive Medicine. Stafford is the senior author.

The results of the study are particularly encouraging given that the Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.

“If community health centers are going to be taking up some of the new demand, we can be confident that they’re giving relatively good care,” Stafford said.

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Related articles

• What is it like for a nurse in a Community Health Center? (giveacareindy.org)
• Florida health centers receive ‘Obamacare’ funding (tampabay.com)
• Mass. community health centers awarded $600K (bostonherald.com)
• West Hawaii Community Health Center Kealakekua Expands Care to Serve All Ages (damontucker.com)
• Stanford researchers move fetal genome testing ahead (sfgate.com)
• Affordable Care Act Helps Improve Access to High Quality, Coordinated Care (whitehouse.gov)
• Three community clinics receive $2.2 million in federal grants (jsonline.com)
• Health care dilemma (photos.mercurynews.com)

Protecting patients from medical apology programs

Protecting patients from medical apology programs

by GABRIEL H. TENINBAUM in the 20 November edition of KevidMD.com

To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.” The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why.  It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation.  These programs are promoted as humanitarian, and, at least in terms of providing an emotional outlet for patients, they are.

 

The evidence also suggests that they are about something else: money.  Every aspect of how they operate – from who risk managers involve, to what those involved are told to say – suggests a key goal is to dissuade patients from seeking compensation by creating an emotional connection with them. …

Related articles

• We’re Only Human, Even Our Doctors and Nurses (hcfama.org)
• Patient Safety Must Be Improved (medicalnewstoday.com)
• In Touch With Patients (1 Letter) (nytimes.com)
• Medical Error Prompts Doctor to Push for Safety Measures (prweb.com)
• Health IT May Be Cause Of Patient Errors (baravaida.wordpress.com)
• How much physician guidance do patients want with medical decisions? (kevinmd.com)