Monday, December 19, 2011

Really, the most significant?

Medscape Today has an article featuring "The Most Significant Medical Advances and Events in 2011."  The list includes things like some FDA drug warnings; the fact that the Supreme Court will review the health care reform law; some finding about cellular phone use and brain activity; withdrawal of propoxyphene from the market; and new listings of top hospitals.

To which I say, "Bah, humbug!"  Most of the things mentioned have had and will have little or no impact on you, me, our relatives and friends as we seek to get care or avoid care.

What are the most significant advances and events?  They are the ones that have occurred by communities, patients, and clinicians in their home towns or their home regions that demonstrate the potential for real improvement in clinical care.  These are the ones that save lives now.  These are the ones that empower patients to be true partners with their caregivers and vice versa.  These are the ones that have nothing to do whatsoever with government mandates, accreditation actions, and the like.

These are the ones that occur because, by strategy or opportunism, well intentioned and thoughtful people modestly work together to reorganize the work in hospitals and other settings.

Examples from this blog are:

1 -- A patient named Christian who persuaded a nurse to allow him to administer his own dialysis, and who then trained others, transforming care in a Swedish hospital.

2 -- Peter Pronovost and colleagues document that reducing central line infection rates in Michigan also lowered costs.

3 -- Glen Cove hospital achieves 1223 patient days without a central line infection.

4 -- The one million people of Saskatchewan allocate $5 million per year of government funds to establish and maintain a Health Quality Council, an independent agency that measures and reports on quality of care in Saskatchewan, promotes improvement, and engages its partners in building a better health system.

5 -- The University of Michigan Health System demonstrates the power of adopting a Lean process improvement philosophy and generously shares its experience with the world.

6 -- Jeroen Bosch Hospital in the Netherlands celebrates the opening of a new building by enthusiastically endorsing transparency of clinical outcomes.

7 -- Aided by the Vermont Oxford network, thousand of neonatologists create state consortia to to set statewide targets and objectives, compare best practices, and understand the variability in clinical practices across and within institutions. 

8 -- The SCAD ladies band together and influence the direction of medical research.

9 -- The Sepsis Alliance presses for greater awareness of this deathly clinical syndrome.

10 -- The Manukau District Health Board in New Zealand propounds the following philosophy: 
What we need to do if something goes wrong is pull back from the instinct to place blame and instead think more deeply about the contributing factors. We need to think about how the system got us to where we are and where the faults in it lie.


Anonymous said...

This is really excellent. I hope you sent it to the editors of Medscape. It illustrates the paradigm shift in orientation that so far escapes us in the profession.

nonlocal MD

Susan Shaw said...

We are honoured and excited that you put the Saskatchewan Health Quality Council on your list, especially considering the considerable passion, expertise and results demonstrated by the other organizations and people that you highlight.

While we believe we are on the right path, we are only just getting started on all the work that Saskatchewan needs us to do. Keep your eyes on us because you ain't seen nothing yet!

Susan Shaw
Board Chair
Saskatchewan Health Quality Council

HarryBlack said...

I am hopeful that by next year you will be able to add our group of ten surgeons in Daytona Beach, led by Dr. Bruce Ramshaw. We truly believe we are on the virge of transforming care in our community as we form patient-centered teams--transparent and including patients and families to provide horizontal rather than siloed care.

Jim Siegel said...

Paul, thanks for this terrific post. You’re correct that the list of major advances and events is a superficial, typical end-of-year wrap story that misses the real accomplishments and improvements in clinical care that are achieved every day, patient by patient, at the grassroots level. This reminds me of what Don Berwick said in his recent speech at the Institute for Healthcare Improvement Forum in Orlando: “Act locally. The moment has arrived for every state, community, organization, and profession to act. We need mobilization – nothing less.”

One area of clinical care quality improvement that too often gets overlooked are the contributions of the professional board certified chaplain as a member of the hospital clinical team. Board certified professional chaplains have been recognized as the experts in identifying beliefs and values important to the patient and advocating for their inclusion in their medical plan of care. These include spiritual, religious, and cultural issues that impact the patient experience of their illness, injury, and interaction with the health care system. Patients experience less distress when these needs are identified, and clinical processes are improved by the quality improvement practices that are often the result of the recurring issues identified by the professional chaplain.

Anonymous said...

Being included in this list of innovators, whose accomplishments have literally saved lives and improved patient care, is truly an honor for the SCAD Mayo Clinic research initiatives. Thank you, for your belief in the promise of patient-initiated research.

Katherine Leon

Pamela Ressler, MS, RN, HN-BC said...

As always, insightful and spot on, Paul! I was struck by the collaboration and lack of ego in all of your examples. Perhaps this is the beginning of the paradigm shift from cowboys to pit crews that Atul Gawande so eloquently argues for in the Checklist Manifesto.

Best wishes for a wonderful 2012,

e-Patient Dave said...

In general I agree - this Medscape thing appears to be about the business of medicine, not about better care for the people who need it. I'm guessing this was an inside-baseball post, nothing more, nothing less: "Us medicals talking about what interests us."

Which, btw, seems to include zero-zippo about anything *patients* had to say this year. Nor impact on patients. For instance, the MMR-autism fraud item talks only about the inside-baseball aspects - not a peep about the children harmed by the fraud. So it's clear where this publication's priorities are. (I'm trying hard not to get moral about it, but just to observe.)