tag:blogger.com,1999:blog-32053362.post391000763957850728..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Hold the presses: Clinicians jointly decide and act!Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-32053362.post-82546236805875856892013-03-07T01:49:09.489-05:002013-03-07T01:49:09.489-05:00The graph reminds me that when we have rare events...The graph reminds me that when we have rare events, it is sometimes better to plot the time between events rather than the number of events themselves.Mikenoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-67033100235947984352013-03-01T13:23:52.826-05:002013-03-01T13:23:52.826-05:00Thanks for highlighting how this one hospital in N...Thanks for highlighting how this one hospital in NorCal addressed this issue. In response to Barry Carol, I would note that there has been a statewide effort by many stakeholders to bring this to hospitals' attention. CMQCC and CPDH as toolkit author/funders were involved, as was the March of Dimes, which licensed and rebranded the Toolkit and took it statewide and nationally, in concert with ACOG. Anthem/Blue Cross funded a "Patient Safety First" initiative that was administered through three Hospital Associations in CA. Certainly the Kaiser influence was a factor, but also other major systems, like Sutter which implemented this guideline before the Toolkit release. Barry's comment raises another really critical question for me and my colleagues at CMQCC, which is, how to identify and analyze the relative influence of a variety of structural and contextual factors in determining the impact/influence of QI implementation efforts at any one facility? Would LOVE to have some discussion and/or pointers to good literature on that.Christine Mortonhttp://www.cmqcc.orgnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-44241509835424785422013-02-28T14:06:23.840-05:002013-02-28T14:06:23.840-05:00Eureka! It had been so long ago that I'd forg...Eureka! It had been so long ago that I'd forgotten! As Oncology Medical Director I held "Discussion Rounds" 6 days/week. All staff attended, although folks were in and out except when their cases were being discussed. All members of the treatment team were given the power to contramand ANY order in the chart, if they were able to defend it adequately.<br /><br />If all were in agreement, I'd call the patient's physician and present our case.<br /><br />This was not just transparency. This was collective commitment. We did it at no extra cost to the hospital or the patients. Our motives included excellence of care, continuity, commitment and pride as coequals, each with his own perspective.<br /><br />Thanks for bringing that back to me. In the final analysis, I think we were better than just "transparent". Our buy in was that we all bought in.<br /><br />Most of all, it was a kick! A way to combat our individual sorrow and burn-out.<br /><br />Peter Kennedy, M.S., M.D.Unknownhttps://www.blogger.com/profile/14664659815327078025noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-9501034665249153102013-02-28T12:44:50.688-05:002013-02-28T12:44:50.688-05:00Congratulations to everyone at Contra Costa Region...Congratulations to everyone at Contra Costa Regional Medical Center. Keep up the good work. When I think about the potential to replicate this general approach elsewhere, I wonder about three things. First, what was the role of the hospital’s senior management in providing leadership and encouragement? Second, how were doctors brought on board? Are they culturally more collegial and team oriented in the SF metro area than elsewhere? Finally, to what extent did the presence of Kaiser and its dominant healthcare market position in the region influence the effort and ultimate result at this hospital?<br /><br />Kaiser is very successful in Northern CA but it has failed to gain traction in some other geographies. HMO’s are very unpopular in some markets. However, physician practice patterns are more culturally conservative in the upper Midwest than in the Northeast and the Sunbelt. Physician buy-in is critical to the success of all process improvement efforts and I just think it’s an easier sell in some places than others mainly due to differences in culture. <br /><br />This is why I think we need to continue to enhance efforts to structure financial incentives so the most cost-effective doctors and hospitals are rewarded with more patients. Patients, for their part, need to be rewarded with higher wages and/or enhanced other fringe benefits if they make cost-effective healthcare and health insurance choices that save employers money and they need access to good cost and provider quality information to help them do that.<br /><br /><br />Barry Carolnoreply@blogger.com