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Quote of the month
We (the United States) spend more per capita on health care than the Chinese spend, per capita, on everything.
SHANNON BROWNLEE
from the book Overtreated
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NEWS ITEM
Many physicians remain silent on errors and incompetence: study
Nearly half of 1,662 physicians surveyed say they have declined to report incompetent behavior or medical errors by their peers, according to an article in the Annals of Internal Medicine.
The survey of primary-care and specialty physicians found that 45% weren't always reporting impaired or incompetent colleagues in their practices, and 46% of physicians who knew of a serious medical error were not reporting the error "at least once" to authorities. The study was conducted by the Institute on Medicine as a Profession's Survey on Medical Professionalism, and appears this week in the Annals of Internal Medicine.
"This raises serious questions about the ability of the medical profession to regulate itself," said Eric Campbell, one of the lead authors of the study, who attended a news conference to release the survey.
Although nearly half don't report instances of incompetence or medical errors, nearly all of the physicians surveyed said that they believed such instances should be reported to the proper authorities. Some 93% thought physicians should report all significant medical errors to authorities, and 96% thought physicians should report all instances of impaired or incompetent colleagues to authorities.
Modern Healthcare 12/3/07
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MORE QUOTES...
Always bear in mind that your own resolution to succeed is more important than any other.
Abraham Lincoln
The mind, once expanded to the dimensions of larger ideas, never returns to its original size.
Oliver Wendell Holmes, Jr.
Never ascribe to malice that which can adequately be explained by stupidity.
There are no shortcuts to any place worth going.
Beverly Sills
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New Book
In November the National Institute of Health Policy along with the Institute for Clinical Systems Improvement and Minnesota Community Measurement, co-hosted journalist Shannon Brownlee, author of Overtreated: Why too much medicine is making us sicker and poorer.
Shannon Brownlee, based much of her book and recent lecture on the work of Jack Wennberg at Dartmouth and pointed out the upside-down economics of health care, where the supply of medical resources-beds, specialists, intensive care units-determines what care we receive, rather than how sick we are and what we actually need.
Brownlee also offered ideas on how to improve the quality of American health care without the "rationing" Americans fear. Instead of treatment being addressed in terms of "what is good for business", Brownlee suggests better evidentiary standards and comparative research to evaluate care. Her other suggestions include improving the patient-physician relationship, promoting more and better primary care, and finding a way to measure, promote and pay for efficiency. Brownlee suggests using existing models of care integration, such as Kaiser and Mayo, as mentors for others. |
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Management Consulting in Healthcare
is:
A small, focused consulting firm that...
Believes hands on, down in the trenches operational experience combined with consulting expertise is vital in obtaining real, lasting results for clients.
Has experience in acute care, long term care, health systems, CCRCs, medical schools and other healthcare organizations.
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Greetings!
Welcome 2008!
Many of us look to the New Year to renew, to start new things, to change something. A number of years ago, "ready, fire, aim" was a slogan to entice people to act, to do something. That approach might work sometimes but not so much when you're looking at a charging rhino or a raging fire! The beginning of the year is a great time to plan (the end of the year also works great but it's too late now).
You can start out the year with big questions: Who are you and what do you want? That's a question that works on both a personal and organizational level. However, before you answer, think about determining where you are now. What's your starting point? In fact, even if you start with smaller questions like "what are we going to do about all those complaints we get about visitor parking?" or, on a personal level, "should I take the bus to work more often?", it is still good to know your starting point.
Now, taking the ready, aim, fire or assess, plan, implement approach should never be used to put off anything important. Holding yourself or your organization back can be very destructive. The New Year brings new enthusiasm, new views, new options. Take advantage of that and do something. Just be sure to think it through before you act!
Happy New Year!
Ken Bast
KenBast@MgtConsultinginHealthcare.com |
More Tough (Pain Causing) Questions
In November I asked the following:
What questions cause your organization's leadership to become uncomfortable, to squirm, maybe even to feel pain?
Here are some additional samples - how would your organization respond?
Why isn't our board knowledgeable about what's happening in our organization?
People are said to "be what they eat." Organizations are what they direct their spending toword. What does this say about your organization?
Is your organization decision adverse? If so, why?
Why is our board so involved in the day-to-day operation of our organization?
Do your organization's employees use your services or seek out other providers for themselves and their families?
Does your organization monitor leading or predictive measures along with measures of past performance?
Do your front line employees know their roles in carrying out the organization's strategy?
Email any of your organization's pain inducing questions to Ken Bast.
_______________________________
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LTC commission issues warning, few solid plans
A 22-member bipartisan panel headed by former U.S. lawmakers recently warned that the country is not ready to fund, yet alone care for, its growing wave of elderly residents.
In releasing their 94-page report, commission leaders also bemoaned the lack of attention long-term care has received from presidential candidates. In a poll also recently released by the National Commission for Quality Long Term Care, 94% of respondents said long-term care reform is important - yet the majority of them were unclear on what the biggest payer of long-term care is.
Committee leaders former House Speaker Newt Gingrich and former Sen. Bob Kerrey said more emphasis has to be placed on long-term care financing at the national level, but they did not state a clear vision for how it should ultimately be addressed. Gingrich worried about creating more federal bureaucracy but added, "We don't think it can be truly voluntary or purely private."
The commission recommended that the federal government should set quality of care standards; encourage greater workforce retention and incentives; assist in electronic record promotion; and push individuals to provide more financing, while expecting certain limited roles from government and the private sector.
For more on the report or the commission, which will cease to exist at the end of the month, click www.ncqltc.org.
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| Acute Care & Long Term Care
Making Them Work
TOGETHER
At times it seems like there is a no man's land between acute care and long term care (LTC). We help hospitals and health systems navigate the unknown, help align mission, strategy, measures, and quality efforts across the continuum. For example:
Clinical and Management issues can be significantly different in LTC. There is:
Far less physician oversight
Far less management oversight
Far less reimbursement
A heavier reliance on Medicare/Medicaid
A much larger burden on private pay
Far less staff per patient (in general, fewer resources in every area than hospitals)
A greater percentage of for-profit ownership in LTC
While by definition, there are longer length of stays (LOS) in LTC. LOS continues to decline, however, and it can drop quickly, jeopardizing net revenue in operations that typically have slim profit margins. In addition, acute care has an emphasis on technology that is not available in long term care. Often acute care has greater management knowledge and expertise, having learned from corporate America. Finally, there is a much higher turnover rate of caregivers (on average) in LTC making continuity a potential issue.
Let's talk about your issues. |
Quick Link
All Things Considered, December 9, 2007 · Dr. Peter Pronovost saved the state more than $100 million and 1500 lives over an 18-month period by teaching doctors and nurses to use checklists for intensive care unit procedures. Andrea Seabrook talks to Dr. Provonost, as well as Atul Gawande, a surgeon who wrote about the success of the checklist in The New Yorker magazine.
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| Check the Website.
www.MgtConsultinginHealthcare.com
Email Me.
Newsletter Archive Page.
January 2008 Survey Results.
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