tag:blogger.com,1999:blog-32053362.post5463842125026489483..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Mr. Ness, everybody knows where the booze is.Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-32053362.post-29610122413105982172011-11-15T12:42:13.797-05:002011-11-15T12:42:13.797-05:00While we wait for Human Nature 2.0, we can see the...While we wait for Human Nature 2.0, we can see these kinds of quality problems fixed if the money flow works the right way. Kaiser, the mother of all ACOs, has made dramatic improvements in quality. Why? Because poor quality, e.g. central line infections and the like, is really expensive. If the org is both the provider and the payor, somehow leadership in the Kaiser health plan, care delivery (nursing mgmt), physicians, unions (nurses et al), and companies/orgs with Kaiser health plans see the light and change comes. Academic medical centers have no such combination of financial incentives. <br /><br />I agree with you that from an ethical standpoint, the failure to act is appalling. I guess it's not appalling enough to academic medical center leadership unless they or their loved ones are lying in the bed when someone comes in to treat them and doesn't wash hands or change gloves...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-18501155875824025452011-11-15T08:02:23.999-05:002011-11-15T08:02:23.999-05:00From Facebook:
How interesting that you (Lee) shou...From Facebook:<br />How interesting that you (Lee) should mention Alinsky; a quote from his 'Rules for Radicals" which seems to apply:<br /><br />"There's another reason for working inside the system. Dostoevski said that taking a new step is what people fear most. Any revolutionary change must be preceded by a passive, affirmative, non-challenging attitude toward change among the mass of our people. They must feel so frustrated, so defeated, so lost, so futureless in the prevailing system that they are willing to let go of the past and change the future. This acceptance is the reformation essential to any revolution.'Beverlynoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-6892397461829806402011-11-14T21:06:22.207-05:002011-11-14T21:06:22.207-05:00Like many medical centers, we are undergoing a mul...Like many medical centers, we are undergoing a multi-million dollar expansion. The market surveys suggest we can fill those beds so it is financially advantageous to build it...and we are building it in a manner that will recreate our current inefficient and unsafe processes - just add beds. If we spent 10% of that to improve existing systems, we would save hundreds of lives. Wonder how it might be received for MDs and RNs to protest at the construction site for improved care for our patients...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-24369804102833817412011-11-14T15:22:47.731-05:002011-11-14T15:22:47.731-05:00I recognize the hospital that your friend practice...I recognize the hospital that your friend practices in - because I and most docs in the country have also practiced there.<br /><br />Anon 12:12 has it dead on as to why this situation perpetuates itself. Occupy Healthcare - now THERE is a real thought........<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80724411305967299182011-11-14T12:12:40.968-05:002011-11-14T12:12:40.968-05:00I'm not surprised that data has not made so gr...I'm not surprised that data has not made so great a difference as it should. There is no accountability for provider reporting, nor street-level connectivity to make the numbers meaningful to the public. <br /><br />It isn't data but ideas and beliefs (self-motivated and self-deceptive, among them) that drive what people do. Take a poll down a street, "If you are very sick, what hospital would you go to? Why? What do you know about safety in the hospitals in your community?" The first two questions will contain some element of safety - but ask the source, and it will be a story, not a number. How many can tell where such data exists? <br /><br />Those who know, know that sparkling lobbies, bustling halls, and engraved lists of donors have no correlation to the complex safety behaviors that happen to a person in bed with lines and machines and layers of medical care. People respond to salient features of the environment that are reassuring - and to the gossip currents in which they live. It is about trust, and disrupting misplaced trust should be as central to patient safety efforts as producing good data itself. <br /><br />What would Occupy Healthcare look like?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-20342704509011270432011-11-14T09:58:39.876-05:002011-11-14T09:58:39.876-05:00Many employer health plan managers have been aware...Many employer health plan managers have been aware of the shortcomings at academic med centers for years. A small but increasing number of employer-sponsored plans are using plan design to "steer" certain types of patients away from academic med centers for those reasons. Watch for this to grow significantly going forward.Tom Emerickhttp://crackinghealthcosts.com/noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-9580994100386986522011-11-14T08:06:01.956-05:002011-11-14T08:06:01.956-05:00The kind of selfishness you describe is endemic to...The kind of selfishness you describe is endemic to human nature. People don't want to admit mistakes or weaknesses and "leaders" who can cover up, do. Penn State is just the latest high profile example. These people are the disease that will kill us and they populate the boardrooms throughout the country. I have two words "the bastards" I find myself using on a pretty regular basis. Health care should be different, but so should education, religious ministry, banking even. I hate to say it, but the older I get the more resigned I become to corruption in character. The bastards!wrinkledmanhttps://www.blogger.com/profile/13277962566188964360noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-83995221433261854142011-11-14T07:45:49.499-05:002011-11-14T07:45:49.499-05:00When you mentioned the small group of facilities t...When you mentioned the small group of facilities that have taken the lead in quality initiatives, I thought instantly of Cleveland Clinic. <br /><br />Then I thought, they just STOPPED their most public reporting of their quality shortcomings. (Of course they didn't call it that, but that's what they did.) Clearly for them something is more important. (They cited costs, but if that's their best current opportunity to control costs, they must be really amazing.)<br /><br />Have you thought of reaching out to Dr. Cosgrove there and asking "What's up???"e-Patient Davehttps://www.blogger.com/profile/16381434866099596466noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-36054713973457818392011-11-14T06:03:51.827-05:002011-11-14T06:03:51.827-05:00Hi Chris,
Lee (above) suggests the former, in ess...Hi Chris,<br /><br />Lee (above) suggests the former, in essence, when he brings up Saul Alinksy, the mentor of all movements.<br /><br />Others, like Clay Christensen in The Innovators Prescription, suggest the latter.<br /><br />Let's see what other commenters think about this.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-13332858457212561992011-11-14T01:23:49.544-05:002011-11-14T01:23:49.544-05:00Paul,
so if the leadership of these organizations...Paul,<br /><br />so if the leadership of these organizations are failing the question is, "what's the next step"? <br /><br />It would seem that leadership needs to be replaced with one that is more patient-centric and owns its problems, not hides behind them. <br /><br />But how does any one person or group make the case against a power block like this? It would seem that while dangerous that building the case in the community would be the best way.<br /><br />Or must the focus be on disrupting them by investing ourselves in new and needed segments?<br /><br />What do you think?Chrishttps://www.blogger.com/profile/09694351567926001402noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-88704977196812487382011-11-13T21:53:09.835-05:002011-11-13T21:53:09.835-05:00From Facebook:
Saul Alinsky had solutions for cir...From Facebook:<br /><br />Saul Alinsky had solutions for circumstances like this.Lee Tilsonnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-32133936720593166112011-11-13T21:52:37.576-05:002011-11-13T21:52:37.576-05:00From Facebook:
Again Paul- you get it. We had to ...From Facebook:<br /><br />Again Paul- you get it. We had to start a new academic medical center from scratch because of our lack of ability to do it within established academic medical centers. The study of disruptive innovation makes it clear that creating new disruptive organizations is what is necessary- it cannot happen within the established industry leader organizations. At least, not at this point in history.Bruce Ramshawnoreply@blogger.com