Kristal Gartner, RN at Grant Medical Center sat next to me at lunch in Columbus and talked about morel mushroom hunting with her husband. You see them here in the wild and on the family picnic table.
Friday, April 30, 2010
Ohio mushrooms
Kristal Gartner, RN at Grant Medical Center sat next to me at lunch in Columbus and talked about morel mushroom hunting with her husband. You see them here in the wild and on the family picnic table.
Hello, Columbus
I am currently in Columbus, Ohio, where I was invited to be one of two keynote speakers on quality and safety issues at the Central Ohio Patient Safety Conference. This is an annual conference organized by a number of hospitals in the area who decided years ago that "we compete on everything, but we don't compete on safety."
The other keynote speaker is one of my heroes, Robert Wachter, who is Professor and Associate Chair of the Department of Medicine at the University of California, San Francisco. Bob is a leader in patient safety. In 2004 he received the John M. Eisenberg Award, the nation’s top honor in patient safety, and his 2008 book, Understanding Patient Safety, received stellar reviews and is already in its 2nd printing. He also writes a great blog.
This is a serious conference, with about 500 doctors, nurses, and others focused on ways to reduce harm to patients. And these folks have produced results. The chart above gives just one indication, showing improvement in care to heart failure patients. At one point, the chairman asked half the people in the audience to stand up to demonstrate the number of lives saved in just the last year for this group of hospitals, just with regard to one of the metrics collected.
Here are some of the people who attended. They were wonderful hosts to this interloper from the East Coast!
Healthier Hearts? Not quite.
I recently received this data about trends in heart-related procedures. I'm sorry that I don't know the source, but I believe it to be one of the Massachusetts agencies (perhaps the DPH?)
The short summary is that procedures related to cardio-vascular health problems have dropped dramatically, with the exception of valve repairs. The explanation that I was given is that the use of drug-related therapies has risen, with equal or better efficacy than surgery. Perhaps those in the field would like to comment.
These are MA statewide volume trends between 2004 and 2008.
All open heart surgeries: Down 11% from 8762 to 7801.
Any CABG surgery: Down 21% from 5739 to 4553.
Valve surgery only: Up 15% from 2137 to 2448.
PCI only (stents): Down 24% from 16650 to 12613.
Vascular surgery: Down 10% from 19,834 to 17,823.
I hear also that fewer medical students are choosing to specialize in heart surgery. As noted here:
The educational process to become a Cardiac Surgeon is one of the longest in the medical field; after four years of college and another four years of medical school, aspiring Cardiac Surgeons spend five years in a general surgery residency and two or three more in a specialized cardio or cardiothoracic fellowship.
In the face of declining demand and this kind of personal commitment, and the likelihood of downward pressure on the rates paid for these procedures, it would appears that medical students are making rational decisions. On the other hand, if fewer enter the field and there is a shortage, maybe those who have chosen it will have the market power to drive up their reimbursement rates.
The short summary is that procedures related to cardio-vascular health problems have dropped dramatically, with the exception of valve repairs. The explanation that I was given is that the use of drug-related therapies has risen, with equal or better efficacy than surgery. Perhaps those in the field would like to comment.
These are MA statewide volume trends between 2004 and 2008.
All open heart surgeries: Down 11% from 8762 to 7801.
Any CABG surgery: Down 21% from 5739 to 4553.
Valve surgery only: Up 15% from 2137 to 2448.
PCI only (stents): Down 24% from 16650 to 12613.
Vascular surgery: Down 10% from 19,834 to 17,823.
I hear also that fewer medical students are choosing to specialize in heart surgery. As noted here:
The educational process to become a Cardiac Surgeon is one of the longest in the medical field; after four years of college and another four years of medical school, aspiring Cardiac Surgeons spend five years in a general surgery residency and two or three more in a specialized cardio or cardiothoracic fellowship.
In the face of declining demand and this kind of personal commitment, and the likelihood of downward pressure on the rates paid for these procedures, it would appears that medical students are making rational decisions. On the other hand, if fewer enter the field and there is a shortage, maybe those who have chosen it will have the market power to drive up their reimbursement rates.
Thursday, April 29, 2010
Does market power help patients?
Rob Weisman and Liz Kowalczyk report in today's Boston Globe that the US Justice Department is investigating possible antitrust violations against Partners Healthcare System, the dominant hospital and physician provider group in Massachusetts.
The letter, obtained by the Globe, said the probe sought to determine whether the practices violated the Sherman Antitrust Act, which bars companies from using their market power to limit trade or artificially raise prices.
Since the Attorney General has already reported that rates collected by PHS are clearly higher than most others in the market, I imagine the case will rise or fall on the following proposition: Is the market power of this system necessary to produce an integration of care that brings clinical advantages to the public served by it? You could test this the following way: If you look at the actual data, is the safety and quality of care offered by PHS significantly different (in a positive way) from other academic medical centers, community hospitals, and physician groups in the state?
Note that I include all three components of the provider network. If a Partners GI doctor in the suburbs doing colonoscopies secures higher rates than his non-Partners colleague down the street -- solely because of his affiliation -- can you document that his care is better? If a patient goes to Newton Wellesley Hospital or North Shore Hospital, where the hospital and the doctors are both paid more than other community hospitals, can you document that their care is better? Ditto, of course, for the care given at the academic centers downtown.
Put it another way. Does the absence of such data -- given the paucity of transparency about clinical outcomes -- create a prima facie case that there is no demonstrable clinical benefit from Partners' market power and its resultant higher prices? Perhaps the answer depends on who has the burden of proof in anti-trust cases. Does the government have to prove that there is no demonstrable clinical advantage, or does Partners have prove that there is?
The letter, obtained by the Globe, said the probe sought to determine whether the practices violated the Sherman Antitrust Act, which bars companies from using their market power to limit trade or artificially raise prices.
Since the Attorney General has already reported that rates collected by PHS are clearly higher than most others in the market, I imagine the case will rise or fall on the following proposition: Is the market power of this system necessary to produce an integration of care that brings clinical advantages to the public served by it? You could test this the following way: If you look at the actual data, is the safety and quality of care offered by PHS significantly different (in a positive way) from other academic medical centers, community hospitals, and physician groups in the state?
Note that I include all three components of the provider network. If a Partners GI doctor in the suburbs doing colonoscopies secures higher rates than his non-Partners colleague down the street -- solely because of his affiliation -- can you document that his care is better? If a patient goes to Newton Wellesley Hospital or North Shore Hospital, where the hospital and the doctors are both paid more than other community hospitals, can you document that their care is better? Ditto, of course, for the care given at the academic centers downtown.
Put it another way. Does the absence of such data -- given the paucity of transparency about clinical outcomes -- create a prima facie case that there is no demonstrable clinical benefit from Partners' market power and its resultant higher prices? Perhaps the answer depends on who has the burden of proof in anti-trust cases. Does the government have to prove that there is no demonstrable clinical advantage, or does Partners have prove that there is?
Wednesday, April 28, 2010
ACGIM recognizes Dr. Phillips
Dr. Russell Phillips was recognized this week by the Association of Chiefs of General Internal Medicine as the division chief "who most represents excellence in Division leadership." From my point of view watching Russ at work here at BIDMC, this was a superb choice. Congratulations!
A happy announcement
Ellen Feingold, who has run Jewish Community Housing for the Elderly for 28 years, is passing the reins to Amy Schectman. I can't say enough good about both people!
Amy is currently Associate Director for Public Housing & Rental Assistance for the Massachusetts Department of Housing and Community Development. In that position, she has gotten rave reviews from all parties. I'm sure they will miss her, but I bet she figured out how to ensure that her successor will continue to be successful. (Oh, did I mention that she also has a Master in City Planning from a very reputable school in Cambridge?)
Ellen is a legend in the Boston community, running and building housing and related programs at JCHE over the years. She talks of retirement, but it is hard to believe. For starts, watch her help organize an effort to defeat a referendum on this November's ballot that would kill off much of the potential to expand the state's affordable housing.
Amy is currently Associate Director for Public Housing & Rental Assistance for the Massachusetts Department of Housing and Community Development. In that position, she has gotten rave reviews from all parties. I'm sure they will miss her, but I bet she figured out how to ensure that her successor will continue to be successful. (Oh, did I mention that she also has a Master in City Planning from a very reputable school in Cambridge?)
Ellen is a legend in the Boston community, running and building housing and related programs at JCHE over the years. She talks of retirement, but it is hard to believe. For starts, watch her help organize an effort to defeat a referendum on this November's ballot that would kill off much of the potential to expand the state's affordable housing.
Aligning Forces for Quality
A significant announcement comes from the Greater Boston Quality Coalition, a group of over thirty hospitals, community health centers, physician groups, business groups, and nonprofits. Here are excerpts:
The Greater Boston Quality Coalition (GBQC) announced today that it has been selected by the Robert Wood Johnson Foundation to participate in Aligning Forces for Quality (AF4Q), an unprecedented effort to lift the quality of health care provided in select communities nationwide.... Greater Boston joins 16 other select regions that are coordinating efforts to improve the quality of health care at hospitals and in doctors’ offices, reduce racial and ethnic disparities in care, and provide models for implementing national reform.
The work will be grounded on the core principle that in order to transform the health care system, everyone who gives care, gets care and pays for care must work together. The Greater Boston Quality Coalition’s AF4Q initiative will focus on four key areas:
-- Performance measurement and public reporting: using common standards to measure the quality of care that doctors and hospitals deliver to patients and making that information available to the public.
-- Consumer engagement: encouraging patients to be active managers of their health care, and make informed choices about their doctors and hospitals.
-- Quality improvement: implementing techniques and protocols that doctors, nurses and staff in hospitals and clinics can follow to raise the level of care they deliver to patients.
-- Health Equity: reducing disparities in care for patients of different races and ethnicities.
Specifically, the Coalition’s AF4Q initiative will initially center its work on reducing preventable emergency department visits and associated admissions. This indicator of primary care access, primary care effectiveness, appropriate treatment in community settings, and system integration has been overwhelmingly supported by GBQC stakeholders.
The Greater Boston Quality Coalition (GBQC) announced today that it has been selected by the Robert Wood Johnson Foundation to participate in Aligning Forces for Quality (AF4Q), an unprecedented effort to lift the quality of health care provided in select communities nationwide.... Greater Boston joins 16 other select regions that are coordinating efforts to improve the quality of health care at hospitals and in doctors’ offices, reduce racial and ethnic disparities in care, and provide models for implementing national reform.
The work will be grounded on the core principle that in order to transform the health care system, everyone who gives care, gets care and pays for care must work together. The Greater Boston Quality Coalition’s AF4Q initiative will focus on four key areas:
-- Performance measurement and public reporting: using common standards to measure the quality of care that doctors and hospitals deliver to patients and making that information available to the public.
-- Consumer engagement: encouraging patients to be active managers of their health care, and make informed choices about their doctors and hospitals.
-- Quality improvement: implementing techniques and protocols that doctors, nurses and staff in hospitals and clinics can follow to raise the level of care they deliver to patients.
-- Health Equity: reducing disparities in care for patients of different races and ethnicities.
Specifically, the Coalition’s AF4Q initiative will initially center its work on reducing preventable emergency department visits and associated admissions. This indicator of primary care access, primary care effectiveness, appropriate treatment in community settings, and system integration has been overwhelmingly supported by GBQC stakeholders.
Airspace Rebooted
My pilot friend who had sent along previous no-fly zones sends this fascinating clip on the restoration of air traffic in Europe as ash levels from the Iceland volcano diminish. He notes: "Due to varying ash density across Europe, the first flights can be seen in some areas on the 18th and by the 20th everywhere is open."
If you cannot see the video, click here.
If you cannot see the video, click here.
Airspace Rebooted from ItoWorld on Vimeo.
Tuesday, April 27, 2010
Healthy Work/Healthy Home
BIDMC celebrated its 12th annual Healthy Work/Healthy Home Enivironmental Action day today. Awards were presented to environmental champions in the hospital, and especially people for whom their specific efforts were not part of their job description.Jim Hunt, Mayor's Menino's chief of environmental and energy services, was the guest speaker. He talked about the City of Boston's engagement in sound environmental and energy practices, which has been recognized in the City's 6th place ranking by SustainLane.
Following the breakfast session, people congregated at a set of exhibits and were offered these nice water bottles as a remembrance of the day.
Monday, April 26, 2010
Update on MA Health Reform
Sarah Iselin, President of the MA Blue Cross Blue Shield Foundation, sent along a copy of a new report entitled, "Enrollment and Disenrollment in MassHealth and Commonwealth Care." It was prepared for the Massachusetts Medicaid Policy Institute by Robert Seifert, Garrett Kirk, and Margaret Oakes. Neither an indictment nor a congratulatory document, it is a thoughtful and useful report on a particular aspect of the MA health reform experiment.
Here's the link.
From the Executive summary:
Massachusetts has made great strides in making health insurance attainable for nearly all of its residents, and the state’s main public coverage programs — MassHealth and Commonwealth Care — have been a significant component of this achievement. Beyond getting coverage, though, it is necessary to maintain coverage, because continuity of coverage is an important element of access to care, particularly among those with frequent medical needs.
Evidence from MassHealth and CommCare, and from Medicaid and CHIP programs in other states, suggests that a sizable number of people are unable to maintain their coverage over a period of time, despite remaining eligible for the program. There are a number of reasons for this enrollment volatility, including:
--an enrollee’s income has increased or they have gained access to employer-sponsored insurance;
--an enrollee does not want to or is unable to pay required premium contributions; or
--an enrollee fails to return paperwork or provide other necessary documentation of their eligibility, in some cases because MassHealth does not have a current address for them.
Of those who are disenrolled, some will come back to the program at a future date and requalify for benefits, while others will transition to another public program, private coverage or uninsured status. If an individual returns to the program after a short time, it is often because the initial disenrollment was due to a failure to return paperwork, provide adequate documentation of income or employment status, or some other reason unrelated to conditions of financial eligibility. These administrative closings followed by swift reopenings — sometimes called “churning” — can disrupt people’s access to health care.
Not all movement on and off of programs is churning: some enrollment and disenrollment is a natural and legitimate consequence of a program where eligibility is based on income and employment circumstances that are subject to frequent change.....
Here's the link.
From the Executive summary:
Massachusetts has made great strides in making health insurance attainable for nearly all of its residents, and the state’s main public coverage programs — MassHealth and Commonwealth Care — have been a significant component of this achievement. Beyond getting coverage, though, it is necessary to maintain coverage, because continuity of coverage is an important element of access to care, particularly among those with frequent medical needs.
Evidence from MassHealth and CommCare, and from Medicaid and CHIP programs in other states, suggests that a sizable number of people are unable to maintain their coverage over a period of time, despite remaining eligible for the program. There are a number of reasons for this enrollment volatility, including:
--an enrollee’s income has increased or they have gained access to employer-sponsored insurance;
--an enrollee does not want to or is unable to pay required premium contributions; or
--an enrollee fails to return paperwork or provide other necessary documentation of their eligibility, in some cases because MassHealth does not have a current address for them.
Of those who are disenrolled, some will come back to the program at a future date and requalify for benefits, while others will transition to another public program, private coverage or uninsured status. If an individual returns to the program after a short time, it is often because the initial disenrollment was due to a failure to return paperwork, provide adequate documentation of income or employment status, or some other reason unrelated to conditions of financial eligibility. These administrative closings followed by swift reopenings — sometimes called “churning” — can disrupt people’s access to health care.
Not all movement on and off of programs is churning: some enrollment and disenrollment is a natural and legitimate consequence of a program where eligibility is based on income and employment circumstances that are subject to frequent change.....
Sunday, April 25, 2010
Non-zero sum
Let's face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense does it represent other markets, in which transparency of these elements reigns and which therefore have a better chance of reaching the "efficient market" described by economists.
In such an environment, growth in market share by one participant is usually solely at the expense of another: a zero sum game. But even in the dysfunctional world of hospitals and physician marketplaces, such transactions can add value to society. In that case, the result is a non-zero sum game. But only if the "winners" actually do add value.
The business strategy of our hospital is remarkably straightforward. We hope to be the high quality, low cost provider among academic medical centers in our region. We look for community-based partners -- hospitals and physician practices -- for whom we can respectfully help to deliver coordinated care. You have read numerous examples on this blog about how we are trying to do this.
But this is more than a business strategy. It is a matter of values and mission. You won't find this mission statement written in our formal documents or in any strategic plan. Its strength lies in the fact that it is a deeply held belief.
I never told you this story, but when Gloria Martinez, one of our transporters, won our first caller-outer-of-the-month award, she first graciously accepted the award on behalf of herself and the other transporters. Then, with no coaching or prompting whatsoever, she said that she and her colleagues viewed their job as "trying to provide the kind of care we would want members of our own family to receive."
I know I do not violate confidences when I tell you that this simple statement from Gloria left tears in the eyes of our Board members. That a person who pushes beds and wheelchairs and delivers specimens -- who in another institution might be anonymous and ignored -- could simply and elegantly express the community purpose of our hospital was a very moving moment.
We fully engage clinical transparency because we view openness in such matters as the best way to hold ourselves accountable to the standard of care we -- the Board, the clinical leaders, and the administrative leaders -- have set for ourselves. We do not do this for competitive purposes, but if the health care marketplace recognizes our progress and rewards us with a growing market share, we are happy to contribute to a non-zero sum result for society.
In such an environment, growth in market share by one participant is usually solely at the expense of another: a zero sum game. But even in the dysfunctional world of hospitals and physician marketplaces, such transactions can add value to society. In that case, the result is a non-zero sum game. But only if the "winners" actually do add value.
The business strategy of our hospital is remarkably straightforward. We hope to be the high quality, low cost provider among academic medical centers in our region. We look for community-based partners -- hospitals and physician practices -- for whom we can respectfully help to deliver coordinated care. You have read numerous examples on this blog about how we are trying to do this.
But this is more than a business strategy. It is a matter of values and mission. You won't find this mission statement written in our formal documents or in any strategic plan. Its strength lies in the fact that it is a deeply held belief.
I never told you this story, but when Gloria Martinez, one of our transporters, won our first caller-outer-of-the-month award, she first graciously accepted the award on behalf of herself and the other transporters. Then, with no coaching or prompting whatsoever, she said that she and her colleagues viewed their job as "trying to provide the kind of care we would want members of our own family to receive."
I know I do not violate confidences when I tell you that this simple statement from Gloria left tears in the eyes of our Board members. That a person who pushes beds and wheelchairs and delivers specimens -- who in another institution might be anonymous and ignored -- could simply and elegantly express the community purpose of our hospital was a very moving moment.
We fully engage clinical transparency because we view openness in such matters as the best way to hold ourselves accountable to the standard of care we -- the Board, the clinical leaders, and the administrative leaders -- have set for ourselves. We do not do this for competitive purposes, but if the health care marketplace recognizes our progress and rewards us with a growing market share, we are happy to contribute to a non-zero sum result for society.
Saturday, April 24, 2010
Sunday in Chinatown
While some people wait patiently for a dim sum table on Sunday morning, others play an intense game of Chinese chess. (Taken a couple of weeks ago.)
Friday, April 23, 2010
Geoff delivers for the interpreters
More from our interpreter service group. A really nice note from Stephanie Baumeister, the group's coordinator, about Geoff O'Hara, one of our systems specialists. Translation of some terms: CCC is our electronic medical records and scheduling system. "Non-staff languages" means foreign languages where we rely on per diem help for interpreters because there is not enough demand to have people on payroll. Shari is our head of interpreter services.
Good morning, Paul!
I just wanted to let you know about the great work that Geoff O’Hara did for us. Because non-staff languages do not have their own CCC schedule where appointments for patients who need an interpreter can automatically be booked with their healthcare provider (which is the case for staff language interpreters), we used to have to rely on schedulers to notify me in order for me to arrange for an interpreter to be present. There had to be a better way.
Here is what the emails look like. See how Geoff added location for my benefit? My interpreters appreciate that!
An appointment for a patient requiring interpreter services has been scheduled.
Patient: XXX,XXX (MR # XXXXXXX) Language: *BULGARIAN
10/15/10 | 9:00 AM | GERONTOLOGY LMOB (SB) | GERONTOLOGY,GANGAVATI LM Lowry Bldg (
***
An appointment for a patient requiring interpreter services has been changed.
Patient: XXX,XXX (MR # XXXXXXX) Language: *ARMENIAN
From:
05/25/10 | 5:15 PM | GI WEST OFFICE (SB) | FALCHUK,KENNETH R.
LM
To:
05/21/10 | 2:45 PM | GI WEST OFFICE (SB) | FALCHUK,KENNETH R.
LM
***
An appointment for a patient requiring interpreter services has been cancelled.
Patient: XXX,XXX (MR # XXXXXXX) Language: *ARMENIAN
04/16/10 | 1:45 PM | PHYSICAL THERAPY -SHAPIRO CC2 | HARRIER,DARLENE SC Shapiro Clinical Ctr | 2nd Floor
What vacation?
It is April and school vacation week here, but some students choose to use their vacation time for non-recreational purposes. Here, Brookline High School senior Kate Spencer is spending the day shadowing our Spanish interpreters to get an idea of how they do their jobs. You see her with Teresa Barbosa, the lead for our Spanish group, who is outlining the plan for the day.
Thursday, April 22, 2010
Keep 'em coming , Claire!
I'm always getting ideas from the staff. Sometimes these are in person, sometimes on Facebook. Here's one that came by email from a loyal Red Sox fan:
Hi,
Sorry to bother you but I had a thought, why are our patient's sox blue and green ? They should be red, for the Red Sox. I think this would be a great idea. Imagine all of our patients with red sox on !!!!!!!
Thanks for your time.
Claire
---
Me to Joe, head of purchasing:
Cute question -- answer, Joe?
---
Paul, please see the answer provided by Jeff, one of our managers and the individual who handles this portfolio.
Hope that helps and please let us know if you need any additional information.
Thanks for your note,
Joe
We receive this suggestion every year. Although it would be a very trendy idea, we have sound reasons why we do not.
The most important reason why we do not is for slip and fall prevention of our patients. Our current double tread slipper socks are currently color coded to size: Medium Green, Large Blue, X-Large Beige and Bariatric Gray. With separate coloring, this quick visual helps nursing obtain the correct size they are looking for and that the patient is fitted correctly. A one-size-fits-all slipper in red or any other color does have a tendency to slip, bunch or turn and possibly increase the chance of a fall. If we were to have the same color (Red) in all the sizes, nursing would spend too much time looking for the correct size and improper sizing could occur.
This suggestion has been before the Product Standards Committee several times in the past and has been rejected.
Jeff
---
Claire --
I found out the answer! Sorry...
Paul
---
Thanks for your help, I had my hopes up. I had visions of patients in red sox in my head!!! I have other ideas I would love to share with you. I'll be in touch. I really, really appreciate your attention. Thank you.
Claire
Hi,
Sorry to bother you but I had a thought, why are our patient's sox blue and green ? They should be red, for the Red Sox. I think this would be a great idea. Imagine all of our patients with red sox on !!!!!!!
Thanks for your time.
Claire
---
Me to Joe, head of purchasing:
Cute question -- answer, Joe?
---
Paul, please see the answer provided by Jeff, one of our managers and the individual who handles this portfolio.
Hope that helps and please let us know if you need any additional information.
Thanks for your note,
Joe
We receive this suggestion every year. Although it would be a very trendy idea, we have sound reasons why we do not.
The most important reason why we do not is for slip and fall prevention of our patients. Our current double tread slipper socks are currently color coded to size: Medium Green, Large Blue, X-Large Beige and Bariatric Gray. With separate coloring, this quick visual helps nursing obtain the correct size they are looking for and that the patient is fitted correctly. A one-size-fits-all slipper in red or any other color does have a tendency to slip, bunch or turn and possibly increase the chance of a fall. If we were to have the same color (Red) in all the sizes, nursing would spend too much time looking for the correct size and improper sizing could occur.
This suggestion has been before the Product Standards Committee several times in the past and has been rejected.
Jeff
---
Claire --
I found out the answer! Sorry...
Paul
---
Thanks for your help, I had my hopes up. I had visions of patients in red sox in my head!!! I have other ideas I would love to share with you. I'll be in touch. I really, really appreciate your attention. Thank you.
Claire
El aspecto humano
I received this warm and moving letter of appreciation from the South American friend of a patient here. I present it in the original Spanish to be true to its sentiment. Ana Marin is our patient navigator, part of a joint effort with the American Cancer Society. Annie Banks is one of our social workers and part of our palliative care consult service.
[BIDMC] que fue para él y mÃ, nuestra segunda casa, mientras él recibia tratamiento de un tumor canceroso en el cerebro, ésta lucha duro 1 ano y 1 mes hasta que falleció. Deseo agradecer el mas importante aporte - "El aspecto humano" de todos las personas que intervinieron en su atención. Fue maravilloso, ver su sonrisa, consideración, campasión y profesionalismo.
Cabe mencionar el personal del departamento de Neurologia, las trabajadores sociales y la Navigadora de pacientes con cancer, Ana C. Marin, ACS/BIDMC, quien también me puso en contacto con Annie Banks, LICSW, a quienes profeso enorme gratitud y aprecio.
[BIDMC] que fue para él y mÃ, nuestra segunda casa, mientras él recibia tratamiento de un tumor canceroso en el cerebro, ésta lucha duro 1 ano y 1 mes hasta que falleció. Deseo agradecer el mas importante aporte - "El aspecto humano" de todos las personas que intervinieron en su atención. Fue maravilloso, ver su sonrisa, consideración, campasión y profesionalismo.
Cabe mencionar el personal del departamento de Neurologia, las trabajadores sociales y la Navigadora de pacientes con cancer, Ana C. Marin, ACS/BIDMC, quien también me puso en contacto con Annie Banks, LICSW, a quienes profeso enorme gratitud y aprecio.
Wednesday, April 21, 2010
Hope and Monique visit with Emily
I have written before about this wonderful new book for young women. It has received a nice review from the Washington Post. An excerpt:Gynecologist Hope Ricciotti and health writer Monique Doyle Spencer have produced this guide for women in their late teens, 20s and 30s to steer them away from what they call the "Favorite Four" sources of health (mis)information: best friends, Mom, magazines and the Internet.
Now you get to hear and see the authors discuss it on Emily Rooney's Greater Boston Show on WGBH-TV.
If you can't see the video, click here.
Reputation versus quality: U.S. News Hospital Ranking
Each year, US News and World Report publishes its list of the top 50 hospitals in various specialties (example here). Now, an article has been published suggesting that one aspect of the methodology used by the magazine is flawed.
"The Role of Reputation in U.S. News & World Report’s Rankings of the Top 50 American Hospitals," by Ashwini R. Sehgal, MD is in the current edition of the Annals of Internal Medicine. (You can find an abstract here, and you can obtain a single copy for review from Dr. Sehgal by sending an email to axs81 [at] cwru [dot] edu.)
Dr. Sehgal finds that the portion of the U.S. News ranking based on reputation is problematic because reputation does not correlate with established indicators of quality:
The relative standings of the top 50 hospitals largely reflect the subjective reputations of those hospitals. Moreover, little relationship exists between subjective reputation and objective measures of hospital quality among the top 50 hospitals.
More detail is provided in the article:
The predominant role of reputation is caused by an extremely high variation in reputation score compared with objective quality measures among the 50 top-ranked hospitals in each specialty. As a result, reputation score contributes disproportionately to variation in total U.S. News score and therefore to the relative standings of the top 50 hospitals.
Because reputation score is determined by asking approximately 250 specialists to identify the 5 best hospitals in their specialty, only nationally recognized hospitals are likely to be named frequently. High rankings also may enhance reputation, which in turn sustains or enhances rankings in subsequent years.
Given the importance attributed to the U.S. News ranking, this article is bound to raise concerns. I know that the folks at the magazine have worked hard over the years to make their rankings as objective as possible, and it will be interesting to see their response to Dr. Sehgal's critique.
"The Role of Reputation in U.S. News & World Report’s Rankings of the Top 50 American Hospitals," by Ashwini R. Sehgal, MD is in the current edition of the Annals of Internal Medicine. (You can find an abstract here, and you can obtain a single copy for review from Dr. Sehgal by sending an email to axs81 [at] cwru [dot] edu.)
Dr. Sehgal finds that the portion of the U.S. News ranking based on reputation is problematic because reputation does not correlate with established indicators of quality:
The relative standings of the top 50 hospitals largely reflect the subjective reputations of those hospitals. Moreover, little relationship exists between subjective reputation and objective measures of hospital quality among the top 50 hospitals.
More detail is provided in the article:
The predominant role of reputation is caused by an extremely high variation in reputation score compared with objective quality measures among the 50 top-ranked hospitals in each specialty. As a result, reputation score contributes disproportionately to variation in total U.S. News score and therefore to the relative standings of the top 50 hospitals.
Because reputation score is determined by asking approximately 250 specialists to identify the 5 best hospitals in their specialty, only nationally recognized hospitals are likely to be named frequently. High rankings also may enhance reputation, which in turn sustains or enhances rankings in subsequent years.
Given the importance attributed to the U.S. News ranking, this article is bound to raise concerns. I know that the folks at the magazine have worked hard over the years to make their rankings as objective as possible, and it will be interesting to see their response to Dr. Sehgal's critique.
Tuesday, April 20, 2010
Dr. Yang explains the Lean approach in 7 minutes
Following up on the post below about the use of Lean process improvement in the hospital setting, I am pleased to present this video. It shows Dr. Julius Yang explaining the difference in a traditional workplace setting from one in which Lean principles are in effect.
If you can't see the video, click here.
If you can't see the video, click here.
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