tag:blogger.com,1999:blog-32053362.post7966210752625378445..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: The value of standard workPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-32053362.post-62742705717854875652010-12-21T14:14:38.097-05:002010-12-21T14:14:38.097-05:00Resident education is based on the progressive ass...Resident education is based on the progressive assumption of responsibility in medical decision-making, based on an individual's progress and under the supervision of a member of the medical staff. When something "goes wrong", the "captain of the ship" is the attending physician. "Practicing on patients" does not adequately describe this complex process.<br />Most all residencies begin with a set-aside time to teach incoming residents the many processes of the hospital.<br />w/r/t to data entry by less trained personnel, sure, but..."GIGO"! GIGO* is rapidly diseminated now in our EHRs. (*garbage in, garbage out)76 Degrees in San Diegohttps://www.blogger.com/profile/14358630186174729315noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-34139779718834464772010-12-16T12:50:36.017-05:002010-12-16T12:50:36.017-05:00I believe that Inter Mountain may be one of the le...I believe that Inter Mountain may be one of the leaders in this standardization. What is BIDMC going to be doing in the ED to improve outcomes?Peterhttps://www.blogger.com/profile/16908166054365239679noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-61456797467459045892010-12-15T09:57:01.176-05:002010-12-15T09:57:01.176-05:00As a patient who has received care at Mayo Clinic,...As a patient who has received care at Mayo Clinic, I can attest to the quality of care being vastly different than any other institution. It is truly AMAZING!! I do not believe that the providers are necessarily brighter or better but they way in which they are allowed and directed to provide care is vastly different. <br /><br />A friend of mine that has worked as a physician in Boston is now working at Mayo Clinic. When I asked why the quality of care is different, she informed me of several reasons. What I found most striking is the difference in which they oversee their interns, residents and fellows. Everyone employed at Mayo Clinic, no matter their function or status is held to a very strict standard and any deviation has consequences. <br /><br />Mr. Levy, if there is a way for you to spend time at their institution learning what they do and how they do it, it will serve your institution well. I do believe you have the best of intentions at BIDMC and have made wonderful strides in infection control, safety and the like but if you want to truly stand out from your neighbors, emulate Mayo Clinic. I have every confidence BIDMC can provide the same quality of care as Mayo Clinic; which in turn will cut costs and boost patient and employee satisfaction.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80007397684538669832010-12-15T08:30:44.866-05:002010-12-15T08:30:44.866-05:00I could be wrong on this but my understanding is t...I could be wrong on this but my understanding is that some of the factors that differentiate Mayo from other AMC’s include the following: (1) The doctors are all employees of the institution. (2) Physician salaries fall in a tight range across departments. (3) Mayo only hires people who are comfortable working in a team oriented, collaborative and collegial culture. There are no cowboys or lone rangers. (4) The doctor is usually unaware of the patient’s insurance status – Medicare, Medicaid, commercially insured, uninsured.<br /><br />I think #1 and #3 are particularly important in achieving a standardized approach to care and improving processes from there.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-64306335083753187542010-12-15T06:11:58.152-05:002010-12-15T06:11:58.152-05:00It is heartening to see such a post from the CEO o...It is heartening to see such a post from the CEO of an AMC, because AMC's are often the worst offenders of the non-standard approach, with independent departmental fiefdoms both perpetuating the inter-specialty 'tribalism' cited in your previous post; and contributing to the startling fact that an AMC may offer cutting edge care in one department and be perfectly awful in another.<br /><br />I am curious however, without sarcasm, about this sentence:<br /><br /> "When improvements are discovered, there is rapid diffusion of learning."<br /><br />Many physicians fear that such standardization will kill the ability to discover such improvements, because it is the variation in practice which can lead to improvement. How is this potential obstacle overcome at Mayo, I wonder?<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-90746203704270193492010-12-15T00:04:32.021-05:002010-12-15T00:04:32.021-05:00A very large part of what is now primary care coul...A very large part of what is now primary care could be standardized and done by a computer-driven operation where most of the contact was done by technicians and others trained to take histories, draw blood for tests, record blood pressure and other vital signs and spit out reports BEFORE the client sees the physician.<br /><br />Imagine a clinic where the computer schedules well-baby visits, mammograms, screening tests, and regular tests for those on maintenance drugs for diabetes, hypertension, and lipids; and whatever else applies. All of those results would be in the computer record and available BEFORE the physician sees the client rather than after as is now the case. <br /><br />Turn a lot of the decision and treatment decisions over to the patient. I had a tick bite of unknown type. Since Lyme disease is prevalent in my area, I was concerned. A quick search told me that 500 mg of doxycycline is an effective preventive for Lyme, but it took an hour of my time and 20 min of physician time to go through a long conversation until I said to him; what would you do? He said. "I'd take the doxycycline," and finally prescribed it. Bill to Medicare over $100. Cost of doxycycline about 50 cents if I could have picked it up at my local pharmacy.<br /><br />We won't get costs under control until we standardize and get the health care equivalent of WalMart and Home Depot in the business.Engineer on Medicarenoreply@blogger.com