Author Archives

John Irvine

A Few Thoughts on “Culture” in Healthcare

Jun 3, 2015• 9

By MARC-DAVID MUNK, MD

The big news in Boston healthcare last month was the announcement that Tufts and Boston University Medical Centers were calling off their proposed merger. The Boston Globe wrote:

“Although they did not specify why the deal fell apart, the hospitals were apparently unable to overcome differences in culture, mission, and strategies for the future, analysts said. “Culture always trumps strategy,”said Ellen Lutch Bender, president of the consulting firm Bender Strategies LLC.

I don’t know any of the details about the proposed merger, and certainly can’t tell you if the deal made sense. But it also wouldn’t be the first partnership that failed due to perceived incompatibilities in organizational culture. In fact, one of the great healthcare case studies in business school is about the ultimately failed merger of Stanford and UCLA health systems– a marriage that came apart after two years. The cause, according to the Stanford Alumni Magazine?

The venture’s biggest downfall may have been that it never managed to bind the two institutions together with a common culture.

I’ve been thinking a lot about the concept of culture in healthcare. You hear the term used frequently– generally to describe either some sort of social incompatibility between one group and another. Besides mergers, the other time you hear the term used is to explain poor operational performance at healthcare organizations. People in healthcare often finger “culture” as the explanation for a litany of disappointing outcomes, failed initiatives and poor performance.

Congrats. You’ve Just Been Named CTO of HHS. What’s Next? Yup. SELFIES!!!!!!

Jun 3, 2015• 1

THCBist

Screen Shot 2015-06-02 at 12.46.24 PM

What you were expecting serious policy statements? ; ) Newly inaugurated HHS CTO Susannah Fox captures the joy of federal service in one dramatic selfie at this week’s DataPalooza.

Building Healthy Communities 2.0

Jun 3, 2015

By SUSAN DENTZER

With its elegant homes, pleasant park and bustling stores, the Woodlawn section of Birmingham, Alabama was described in a 1950 news article as “a really great section of Birmingham…typical of the fine things in life.” Then came the racial unrest of the 1960s, disruption from urban renewal gone awry and white flight to Birmingham’s suburbs. Joblessness and poverty took root; the housing stock decayed. Today, median income in Woodlawn is just $21,000, less than half the level for Birmingham as a whole.But now Woodlawn is in the midst of a turnaround, aiming to become not just a neighborhood that prospers economically, but also one where people live healthier lives.

Why Large Scale Government IT Projects Fail and What To Do About It

Jun 2, 2015• 1

By KEVIN DE SOUZA and KENDRA SMITH

The volume of failed large-scale information technology (IT) projects in the public sector is troubling. These projects are failing at an alarming rate. The long history of public sector IT failures has seen billions of dollars lost, embarrassment, redundancy, waste, and a loss in public trust. In 2004, the U.S. Air Force (USAF) began work on the Expeditionary Combat Support System, a project designed to streamline and automate the USAF’s operations by consolidating over 200 legacy systems. The USAF contracted with Oracle and then Computer Sciences Corporation and by 2012, the project had spent $1.1 billion taxpayer dollars and was ultimately terminated. U.S. Senators Carl Levin and John McCain stated that this project was “one of the most egregious examples of mismanagement in recent memory.” The National Programme for IT in Great Britain has failed miserably after £12.7 billion was spent to create an online portal that would allow citizens access to their personal health information; the project will arrive four years late in 2015. In Victoria, Australia, a smartcard ticketing system for public transportation was started in 2005 and was flawed from conception. Eventually, the project was implemented years late, marred by various missteps, and went $500 million over budget.

Even though leaders are familiar with past failures, many in the public sector have failed to learn from these mistakes. Bent Flyvberg and his colleagues dubbed this phenomena the “megafailures paradox” where there is continued investment in IT projects while failing to understand the causes of failures.

Data Shows Large Rise In List Prices at Hospitals

Jun 2, 2015

By TWITTER BOT

Data Shows Large Rise in List Prices at Hospitals http://t.co/y89oxoN2ou #hdpalooza pic.twitter.com/wrybYb873g

— Brian Ahier (@ahier) June 2, 2015

Interoperability via Direct Exchange: A Brief Update Mid-2015

Jun 1, 2015• 4

By DAVID C. KIBBE, MD

Over the past three years it has been my good fortune to work with talented individuals and organizations dedicated to making sharing of health information ubiquitous, secure, inexpensive, and easy to use. Quietly and without much fanfare, they have built both technical and trust infrastructures that reach almost 40,000 health care organizations, interoperably connecting users of over 200 EHRs and PHRs from different vendors. What follows is a brief update of the current status of interoperability in health IT via Direct exchange.

Health Data – It’s a “Thing!”

Jun 1, 2015

By STEVEN FINDLAY

This year’s Datapalooza conference, June 1-3, in Washington, D.C. takes place as health data edges close to becoming “a thing” in the cultural landscape. Consumers may not know it yet, but all that fitbiting, medical social networking, and test result accessing through patient portals could soon swell into a full-fledged consumer movement.

You can almost hear it now: “Hey man, did you upload your stats after your knee surgery—you know, how much you’re walking, your pain levels, and all that?”

Or, to a newly diagnosed cancer patient: “Be sure to track your treatment experience online. It’s kind of cool to do and helps researchers figure out what works and doesn’t.”

Or: “Check this app out—you can enroll in a clinical trial in, like, 5 minutes.”

This is, of course, what many health data heads have forecast for years. It’s also now crystal clear that the use of big data to improve health care is no longer a research backwater. To be sure, there’s hype around the potential to dramatically alter physician and consumer behavior via big data analytics. We are still dealing with human beings, folks. As well, concern about privacy continues to vex health data entrepreneurs, researchers, and consumers.

If You Can Read My Note, The Patient Was Sick

Jun 1, 2015• 2

By STEVEN ROTHMAN, MD

When my junior year in medical school started in September of 1971, my classmates and I entered daily notes in patients’ hospital charts, loose leaf notebooks that documented their medical progress – or not – over the course of their hospitalizations. The notes were official, legal – and largely useless. About half of what was entered by faculty and consultants on any single day was so illegible that the medical alphabet more resembled cuneiform than English. The possibility of a note being misread was not lost on one of our senior professors, who mumbled: “If you can read my note, you know the patient was sick,” as he slowly wrote a note on a patient who qualified as “sick”.

Physician Burnout Presents Differently in Male and Female Doctors

Jun 1, 2015• 3

By DIKE DRUMMOND, MD

Burnout is a chronic epidemic in physicians and a major threat to patient satisfaction and quality care. Recent research is showing that women and men experience burnout differently.

Numerous studies have shown that an average of 1 in 3 practicing physicians are suffering from symptomatic burnout on any given office day … worldwide, regardless of specialty. There is good evidence to believe the physician burnout rate is higher in the USA than in other world markets simply because of the uncertain political and payment environment and the massive merger and acquisition activities across the country. As evidence, the 2015 Medscape Physician’s Lifestyle Survey showed a 46% burnout rate, 16% higher than the same survey in 2013.

The three classic signs and symptoms of burnout are measured by a standardized evaluation; the Maslach Burnout Inventory (MBI) developed by Christina Maslach and her team at the University of San Francisco in the 1970’s.

Here is Maslach’s description of the experience of burnout: “… an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.” The three symptoms of the MBI are.

Did Dr. Virginia Apgar worry about work-life balance?

Jun 1, 2015• 1

By KAREN SIBERT, MD

Dr. Margaret Wood, who chairs the Department of Anesthesiology at Columbia University Medical Center, has published a wonderful article titled “Women in Medicine: Then and Now“, in the journal Anesthesia and Analgesia.

I think I speak for many of us in admitting that Anesthesia and Analgesia doesn’t occupy a prominent place on my bedside table. Many readers may have missed Dr. Wood’s article. That’s a shame, because it isn’t just about anesthesiology, and speaks to issues in medicine independent of specialty or gender. Here are some of my favorite passages about lessons she learned over the course of her long and successful career:

“1. It is important to have a passion for what you do if you strive for excellence. If you have that passion, then the efforts do not feel like a sacrifice and “burnout” is not an issue. I cannot imagine that Virginia Apgar spent a single moment talking, thinking, or worrying about burnout.

2. The current fashion to complain about “life balance” can be self-destructive; however, pacing oneself is critical. You can have it all, just not all at once. The Chairman of Anatomy gave the inaugural lecture to my incoming class of medical students. His thesis was that as a physician/medical student you could have (i) an active time-consuming social life, (ii) a family, and (iii) a career, but to be successful you should have no more than two of these at the same time. I believe this to be true and have followed this advice since.