tag:blogger.com,1999:blog-32053362.post1975255806867351550..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: What does it take? (revisited)Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-32053362.post-49538883358987388832010-12-14T12:31:35.756-05:002010-12-14T12:31:35.756-05:00I am a medical resident. To answer your question t...I am a medical resident. To answer your question there is precious little on care delivery and process improvement. We are cheap labor and anytime we are not working clinically requires someone to get paid to do the work.<br />My education in this area is strictly of my own initiative and largely drawn from reading your blog daily.<br /><br />B<br />EMAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-23606814235324056252010-03-21T00:14:41.227-04:002010-03-21T00:14:41.227-04:00Ha! Good old Maggie the pit bull gets hold of this...Ha! Good old Maggie the pit bull gets hold of this:<br /><br />http://www.thehealthcareblog.com/the_health_care_blog/2010/03/a-culture-of-fear-and-intimidation-reforming-medical-education-.html#more<br /><br />Of course she starts with the most sensationalist part, but promises a part 2. The comments should prove interesting....<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-53816958821496881462010-03-17T08:21:37.867-04:002010-03-17T08:21:37.867-04:00I agree with nonlocal. This is all a very reasona...I agree with nonlocal. This is all a very reasonable discussion.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-39894226420334991842010-03-17T08:16:24.214-04:002010-03-17T08:16:24.214-04:0076 degrees:
I saw no venomous comments above. I ...76 degrees:<br /><br /> I saw no venomous comments above. I repeat, READ the report. It addresses your issue also. The people who wrote it are not laymen, after all.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-47913159391812508742010-03-16T22:25:47.629-04:002010-03-16T22:25:47.629-04:00Wow, some people are venomous! Many of these comm...Wow, some people are venomous! Many of these comments demonstrate a lack of understanding of a medical school curriculum. When you add a new segment to a curriculum, you have to take something out. Each person involved in medical education deeply believes that their area is essential. So, curriculum committees are faced with the very difficult task of ranking and reranking priorities for the student's education. It is also paramount that the teachers provide a concise, understandable, and useable aliquot of information. Students of all types quickly "turn off" to poor teaching. They are "under the gun" with their performance measured at each step over and over. It is the responsibility of the proposed teacher to present a proposal to the Curriculum Committee for evaluation, ranking, and possible incorporation into the overall teaching. As far as I know, the earth rotates on a 24 hour basis; sleep is necessary; as are other things. So, submit it in writing!76 Degrees in San Diegohttps://www.blogger.com/profile/14358630186174729315noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78267267986698058172010-03-16T10:28:13.398-04:002010-03-16T10:28:13.398-04:00Did others read the story in the Times this week a...Did others read the story in the Times this week about the soldier who got a Silver Star AND a career-ending letter of reprimand, for the same incident?<br /><br />I think the paranoia about repercussions stemming from investigation naturally keeps professionals from wanting to spend too much time on what went wrong.NYC Patientnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-12017789079048052832010-03-16T08:49:32.874-04:002010-03-16T08:49:32.874-04:00Amendment: you know, I think it really IS the cul...Amendment: you know, I think it really IS the culture, first. What's the use of process improvement knowledge if you're too scared to use it? See:<br /><br />http://www.nytimes.com/2010/03/11/health/11chen.html<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-91796607393223035472010-03-16T08:27:30.396-04:002010-03-16T08:27:30.396-04:00Paul;
The report addresses both the culture and p...Paul;<br /><br />The report addresses both the culture and process improvement issues, as well as virtually every other issue surrounding this problem. As I said, it is a very detailed blueprint, if the right people would just READ it. (36 pages is getting so it exceeds peoples' attention spans these days.....)<br />....I think the med schools can just pull in certain engineering profs from their associated universities and pretty much solve the problem you address, inhouse.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-85593850253245206902010-03-16T08:14:46.912-04:002010-03-16T08:14:46.912-04:00It is not only culture. It is substantive knowled...It is not only culture. It is substantive knowledge of process improvement, which for the most part will have to come from other industries. Brent James can't be everywhere. This takes a new cadre of teachers, with different methods.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-12872102477645693822010-03-16T07:47:05.130-04:002010-03-16T07:47:05.130-04:00Eva raises two points also addressed in the report...Eva raises two points also addressed in the report:<br /><br />1. current faculty are ill-equipped to teach the new culture since they come from the old one;<br /><br />2. Medical students are often subjected to the hierarchical and demeaning behavior patterns of the old culture, thus learning to repeat them - just as abused children become parental abusers.<br /><br />This morning I remembered the old saw about medical research taking 17 years to reach medical practice. When was the IOM report issued? We are closing in on the deadline....<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-44073470162397421442010-03-15T22:27:39.391-04:002010-03-15T22:27:39.391-04:00Thank you blogging about the LLI report. I really ...Thank you blogging about the LLI report. I really do hope medical school faculty are following your blog! The demand for patient safety and quality improvement skills from students is high- just look at the number of students registered with the IHI Open School and the number of Chapters around the world just one year into its existence. What we need is more time and space for patient safety and quality improvement to be formally addressed in the curriculum. Here at the University of Michigan, we are taking creative baby steps to make this happen through brief moments of exposure. In addition to more training during the basic science years, we need solid modeling from faculty when we hit the wards in our third year. I've made some additional comments on the IHI Open School Blog: <a href="http://ihiopenschool.blogspot.com/2010/03/what-do-i-need-to-know-for-my.html" rel="nofollow">http://ihiopenschool.blogspot.com/2010/03/what-do-i-need-to-know-for-my.html.</a> <br /><br /><i>1st Year Medical Student<br />University of Michigan Medical School</i>Eva Luohttps://www.blogger.com/profile/03422162956290956079noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78123663408053332472010-03-15T22:16:57.952-04:002010-03-15T22:16:57.952-04:00Dave;
You're what I need, a fellow rabble-rou...Dave;<br /><br />You're what I need, a fellow rabble-rouser. Did you read the interview with Pronovost in the NYT where he tells the story of the surgeon who refused to change his gloves when Pronovost suspected intra-operative anaphylaxis due to latex allergy?<br />Now THERE'S professional egocentricity.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-65938742001181252942010-03-15T20:40:22.038-04:002010-03-15T20:40:22.038-04:00Wow, go get 'em, nonlocal.
I'm trying to...Wow, go get 'em, nonlocal. <br /><br />I'm trying to recall whether I heard things like this two years ago when I started paying attention to health systems. If I did, I couldn't believe my ears, because only now is it starting to sink in. <br /><br />I'm about to go twitter my fingers off about "professional egocentricity inhibits team building across disciplines." If I believed shaming was useful, I'd say Shame to that one. How unscientific! When lives are at stake!<br /><br />Methinks the reason we need is a patient-in-chief is to slap down people whose egos are more important to them than lives.e-Patient Davehttps://www.blogger.com/profile/10346452642450264511noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-71512005069963685492010-03-15T18:39:07.289-04:002010-03-15T18:39:07.289-04:00Pam, what's your role? (Patient, clinician, ot...Pam, what's your role? (Patient, clinician, other?)<br /><br />I didn't experience it as a course as much as a workshop. (I could easily have read the books in less time than the week took, especially considering the daily commute from New Hampshire!) All the facts I learned in the week was in books we were assigned as pre-reading - I'm reading Lean For Dummies (very good start) and Lean Hospitals, and I hope to soon finish Chasing The Rabbit. <br /><br />Beyond that, we got coaching on our specific challenge project - reducing readmission rates after people are discharged from the hospital.<br /><br />Some suggestions for sharpening one's lean:<br /><br />----I knew some basics about Lean from reading this blog and <a href="http://tedeytan.com" rel="nofollow">Ted Eytan</a>'s excellent healthcare blog. (He's a Kaiser guru in DC, though he'd disagree with guru.)<br /><br />----Mark Graban, author of Lean Hospitals, writes on the <a href="http://leanblog.org" rel="nofollow">Lean Blog</a> and is @LeanBlog on Twitter. <br /><br />----Steven Spear blogs also at <a href="http://chasingtherabbitbook.mhprofessional.com/apps/ab/" rel="nofollow">Chasing The Rabbit</a>.<br /><br />Hope this helps -e-Patient Davehttps://www.blogger.com/profile/10346452642450264511noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-66173803369514862722010-03-15T17:55:54.005-04:002010-03-15T17:55:54.005-04:00Part 2: what should we do about this?
I sent the r...Part 2: what should we do about this?<br />I sent the report link with a cover letter to all 3 institutions of which I am an alumnus, urging them to consider its implementation. The only reply I received so far was from the Iphone of one dean who shall remain anonymous since at least he had the courtesy to reply: “I think you will find we are a leader in this.. Google ___ ____. Med ed includes.”<br />(Hint: __ __ is a patient safety expert whose initials are PP). Now, do you think this dean will read the report? Interestingly, his institution was NOT included on the list of 23 medical schools on p. 30 of the report who are beginning to implement its recommendations. Neither, ahem, is Harvard Medical School.<br /><br />The expert roundtable who compiled the report recommended that all medical schools should be evaluated annually on this issue and school specific results be made public.<br />To paraphrase Warren Buffett’s comment( regarding company CEO’s), “there’ve been plenty of carrots; it’s time for more sticks.”<br /><br />Docs who are believers, please send this report to your institutions. It’s time.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-10946009006406295932010-03-15T17:49:12.120-04:002010-03-15T17:49:12.120-04:00I will break my long comment into two parts:
I hi...I will break my long comment into two parts:<br /><br />I highly recommend that medical professionals take the time to read the entire report (in pdf, available from the site Paul cites),which gives a detailed blueprint for curriculum modification. It was compiled by a roundtable of medical experts including representatives from the Assoc. of Medical Colleges, medical schools, several accrediting boards, patients, and 2 physicians from BIDMC. Allow me to quote from the report:<br />“Experts agree that patient safety is predominantly about the proper design of health care systems and patient care processes. This thesis was the main thrust of the IOM’s To Err Is Human report and is now widely accepted in the health care community.In the engineering community, this has never been news at all. Unfortunately, system design failures continue to translate into preventable patient deaths every day. Thus, one would expect that teaching the prevention of iatrogenic patient deaths would be among the highest priorities in medical schools,but sadly it is not. Missing in part, or totally, from the typical medical school curriculum is substantive attention to safety science, systems thinking, the science of improvement, human factors, and…..teamwork.”<br /><br />And another, “professional egocentricity inhibits team building across disciplines.”<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-83606549587006195502010-03-15T15:38:36.279-04:002010-03-15T15:38:36.279-04:00Dave, how lucky to have been a part of that retrea...Dave, how lucky to have been a part of that retreat. I wish I could have taken part in it.<br />This is a difficult course to find and when you do, it's cost prohibitive.Pamnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-70386922077148080492010-03-15T09:12:58.275-04:002010-03-15T09:12:58.275-04:00Maureen, I had no idea IHI's resources were fr...Maureen, I had no idea IHI's resources were free. Thanks! That makes this even starker: why would a healthcare manager not use free resources to save lives?? Why wouldn't s/he DEMAND it? <br /><br />The most significant phrase in the Leape quote is <b>"most solvable."</b> That's Lean, that's continuous improvement thinking. Pick something achievable, do that, get started.<br /><br />Along those lines, last week I got to be a "voice of the customer" (patient)in a Beth Israel Deaconess Lean / quality improvement retreat. (See <a href="http://patientdave.blogspot.com/search/label/lean" rel="nofollow">my diary</a>.) It was inspiring to work with a bunch of residents, plus attendings and RNs and other staff. All those young sharp well-trained minds, being taught "It doesn't have to be this way" from the start! <br /><br />Please look back 14 months at <a href="http://runningahospital.blogspot.com/2009/01/what-does-it-take.html" rel="nofollow">Paul's original post</a> - and the 50 comments, including IHI's Jim Conway, Atul Gawande, BIDMC's chief of medicine (Mark Zeidel) and VP of Quality (Ken Sands) and Ethics Program Director (Lachlan Forrow) - some heavy hitters.<br /><br />During my treatment I had four central line insertions. Because of this blog I knew about the work being done to standardize and improve safety, and I'm <i>really</i> glad the infection rate dropped from 4.14 to 0.52 per thousand. (More data in <a href="http://runningahospital.blogspot.com/2010/01/progress-in-icus.html" rel="nofollow">this update</a>.) It matters when it gets personal - and to the patient & family it's always personal.<br /><br />In last week's quality retreat one resident reflected on realizing that much useful wisdom exists in disciplines outside healthcare: "If we don't use it, that's not scientific." Well said.e-Patient Davehttps://www.blogger.com/profile/10346452642450264511noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-48754031513049669062010-03-15T07:10:27.382-04:002010-03-15T07:10:27.382-04:00I agree that IHI's Open School is a fantastic ...I agree that IHI's Open School is a fantastic resource. Thanks for mentioning it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-75289129582779210502010-03-15T06:59:45.007-04:002010-03-15T06:59:45.007-04:00Thanks for raising this issue,Paul. It will intere...Thanks for raising this issue,Paul. It will interesting to see what the students tell us. You can refer them to IHI's Open School (ihi.org/openschool) if they want to learn improvement methods for health care settings. All free. <br />Maureen BisognanoMaureenhttps://www.blogger.com/profile/11649648364924910937noreply@blogger.com