tag:blogger.com,1999:blog-32053362.post7591779158477915157..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Carrier pilots do itPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-32053362.post-27762242595417000062008-09-22T13:26:00.000-04:002008-09-22T13:26:00.000-04:00jamie30 hours?? How old are you?jamie<BR/>30 hours?? How old are you?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-71589090873787500472008-09-17T18:05:00.000-04:002008-09-17T18:05:00.000-04:00I've worked on several projects attempting to come...I've worked on several projects attempting to come up with these metrics. For most places, the answer has to do with what their organizational philosophy is, and what their overall goals are. If you just look at something like RVU's, you aren't accurately capturing the physicians who are working on harder cases. Likewise, if you just use HCC's, you may be dealing with a whole other set of statistics, such as who the coder was for that day. <BR/><BR/>It's important that physicians understand that it's not second guessing their medical expertise. It's amazing to me that while my work is measured hour by hour (healthcare IT consultant), that physicians often do not have the same strict controls on their hours. <BR/><BR/>It's vital to get the feedback of physicians, and often especially the disgruntled ones, to understand the atmosphere of your organization, and to see it in the context of overall vision and strategy. Patient care isn't black and white -- every patient is different -- which is one of the reasons that this is so hard.<BR/><BR/>But then again, I've spent well over 30 hours of my life in various organizations just even trying to define what a new patient is!Jayhttps://www.blogger.com/profile/07450919399407519624noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-19705933741710234222008-09-17T00:30:00.000-04:002008-09-17T00:30:00.000-04:00As a senior resident at a top-notch residency prog...As a senior resident at a top-notch residency program, I would love to get a report on how well I am caring for patients. And I think many of my peers would value the same feedback. As it stands currently, our evaluations are pretty bland and fail to illuminate any real deficits in our training. And I suspect that this is the case for most student-resident-attending evaluations. In addition to learning how well I worked with others, I would like to get data on how well my patients are doing. Are my CHF patients discharged with the right medications? What's the average A1C of my outpatient panel? etc...<BR/><BR/>Of note, when giving me face-to-face feedback, I had one CCU attending discuss with me his evaluation scheme--he evaluates residents based on how well the patients do under the care of that resident. So not only did I learn where I did well clinically, but I also learned from where I could have done better. This feedback was extremely valuable and constructive--something we all hope to get and to give with our evaluations.Chasehttps://www.blogger.com/profile/13082522994746633431noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-58243562179222265662008-09-16T15:36:00.000-04:002008-09-16T15:36:00.000-04:00I agree with anon 9:57. Although now retired and n...I agree with anon 9:57. Although now retired and not "up" on the latest JC requirements, it was my distinct impression that physician-specific performance metrics are a required element - at least they were in our hospital. Our group of pathologists monitored such metrics as accuracy of frozen sections, percentage of "critical" (e.g. unexpected and/or life threatening, such as cancer in a uterus removed for benign reasons) results called to the attending physician in a timely manner, etc., etc. Certain types of cases were also reviewed monthly, such as all prostate biopsies. The results were presented by name within the group, but only the aggregated data was presented to the medical executive committee. We did have one consistent outlier who was eventually fired by the group (after too many years, in my opinion).<BR/>So any doctor who looks askance at these metrics is behind the times, in my opinion. They should be part and parcel of every departmental meeting and submitted to the med exec for final review and monitoring.<BR/><BR/>nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-21194173420508069502008-09-16T13:22:00.000-04:002008-09-16T13:22:00.000-04:00Metrics? A joke. If only physician "compliance" ...Metrics? A joke. If only physician "compliance" could be linked to metrics, let alone compliance. However, I applaud your efforts, Mr. Levy.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-77830197761002106712008-09-15T21:57:00.000-04:002008-09-15T21:57:00.000-04:00The concept of peer review for physicians has been...The concept of peer review for physicians has been around for some time now. I believe it is a mandatory requirement by Mass. board of reg. for medicine & as of this year it has been made a requirement by the joint commission. Hopsitals or physician organizations have some leverage in deciding the metrics by which the physician performance gets measured. It is not quite the concept you mentioned with the pilots, but perhaps the existing peer review system can be built on.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-51877400925005275552008-09-15T21:15:00.000-04:002008-09-15T21:15:00.000-04:00I always practice the advice "ask a good doctor to...I always practice the advice "ask a good doctor to find a good doctor." In my experience that has worked out well. But how do doctors form these opinions? There must be some way they do. Sadly, you only get into the "system" of good doctors if you already have a good one.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-18725168541511602842008-09-15T21:03:00.000-04:002008-09-15T21:03:00.000-04:00Many ER doctors are used to seeing our patient sat...Many ER doctors are used to seeing our patient satifaction scores which include a ranking among our peers.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-46720188156765096752008-09-15T18:19:00.000-04:002008-09-15T18:19:00.000-04:00A failed carrier landing as a result of pilot erro...A failed carrier landing as a result of pilot error has the potential of killing the pilot and crew if the aircraft is not a single seater. A failed surgery as a result of the surgeons error will never kill the surgeon or the "crew". <BR/><BR/>Perhaps pilots see the value of such regular (every landing) and rigorous assessment as something that protects them and their crew.<BR/><BR/>There are six elements to the ultimate rating given each landing. Primary to the LSO's rating is safety-not where did the pilot land or catch wire, but rather how the pilot got the plane on deck. All LSO's are rated (pilots) so they have earned the right to offer an opinion on another pilot.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-71232201944129441432008-09-15T15:55:00.000-04:002008-09-15T15:55:00.000-04:00Why is there so much resistance to letting patient...Why is there so much resistance to letting patients see how their doctors stack up against their peers? Is it really better that we have to rely on the nurses for this information?chrxhttps://www.blogger.com/profile/17673032598616257940noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-30721618960919163842008-09-15T15:52:00.000-04:002008-09-15T15:52:00.000-04:00Sorry, I am confused by your question. I don't kn...Sorry, I am confused by your question. I don't know of any place where it has been in effect.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78457915331522277222008-09-15T15:46:00.000-04:002008-09-15T15:46:00.000-04:00Hasn't your proposed "system" been in effect for a...Hasn't your proposed "system" been in effect for a few years now, or are you just catching up?Anonymousnoreply@blogger.com