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The Crash of Air France 447: Lessons for Patient Safety

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By Bob Wachter, MD

From the start of the patient safety movement, the field of commercial aviation has been our true north, and rightly so. God willing, 2011 will go down tomorrow as yet another year in which none of the 10 million trips flown by US commercial airlines ended in a fatal crash. In the galaxy of so-called “high reliability organizations,” none shines as brightly as aviation.

How do the airlines achieve this miraculous record? The answer: a mix of dazzling technology, highly trained personnel, widespread standardization, rigorous use of checklists, strict work-hours regulations, and well functioning systems designed to help the cockpit crew and the industry learn from errors and near misses.

In healthcare, we’ve made some progress in replicating these practices. Thousands of caregivers have been schooled in aviation-style crew resource management, learning to communicate more clearly in crises and tamp down overly steep hierarchies. Many have also gone through simulation training. The use of checklists is increasingly popular. Some hospitals have standardized their ORs and hospital rooms, and new technologies are beginning to catch some errors before they happen. While no one would claim that healthcare is even close to aviation in its approach to (or results in) safety, an optimist can envision a day when it might be.

The tragic story of Air France flight 447 teaches us that that even ultra-safe industries are still capable of breathtaking errors, and that the work of learning from mistakes and near misses is never done.

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Which Health Incubator Should You Apply To?

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By Thuc Huynh, MD


Health startups are emerging in high numbers this year and it’s no surprise.  The health tech space is booming with new advances in HTML5, mobile health, and social media.  But with the economic downturn, it’s hard to go out on your own without funding or guidance.  But there’s help.  Over the past year, four startup incubators have surfaced offering a mentoring program specific to health technology entrepreneurs.  But, which one should you apply to? Here’s a breakdown of each accelerator and their offerings:

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A Look Back at 2011

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By John Halamka, MD

2011 was a year of change and tumult. For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian.

It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.

What about the world of healthcare IT?

Federal

In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country. Every aspect of the industry was stressed along the way

  • Vendors were challenged to add the features necessary for certification resulting in some “haste makes waste” lack of usability and workflow integration. GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
  • IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets. Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
  • Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.

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Acne Cured by Self-Experimentation

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By Seth Roberts

In November, at Quantified Self Europe, Martha Rotter, who lives in Ireland, gave a talk about how she cured her acne by self-experimentation. She summarizes her talk like this (slides here):

When I moved to Ire­land in 2007, I began to have skin prob­lems. It began gradu­ally and I attrib­uted it to the move, to stress, to late nights drink­ing with developers and cli­ents, to travel, to whatever excuses I could think of. The stress was mul­ti­plied by the anxi­ety of being embar­rassed about how my face looked, but also because my new job in Ire­land involved me being on stage in front of large audi­ences con­stantly, often sev­eral times a week. A year later my skin was per­petu­ally inflamed, red, full of sores and very pain­ful. When one spot would go away, two more would spring up in its place. It was a tough time. I cried a lot.

Frus­trated, I went to see my homet­own der­ma­to­lo­gist while I was home for hol­i­days. He told me that a) this was com­pletely nor­mal and b) there was noth­ing I could do but go on anti­bi­ot­ics for a year (in addi­tion to spend­ing a for­tune on creams and pills). I didn’t believe either of those things.

I was not inter­ested in being on an anti­bi­otic for a year, nor was I inter­ested in Accu­tane (my best friend has had it mul­tiple times and it hasn’t had long term res­ults, plus it can be risky). What I was inter­ested in was fig­ur­ing out why this was hap­pen­ing and chan­ging my life to make it stop. I refused to accept my dermatologist’s insist­ence that what you put in your body has no effect on how you look and feel.

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2011’s Last Viral Lie About Health Reform

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By Linda Bergthold

When so many good things have happened as the result of health care reform, I hate to end this year with a rebuttal to a viral lie about the Affordable Care Act. However, this one seems to come from a credible source but is so wrong that I can’t resist.

This is how the email reads:

“MUST LISTEN This needs to go viral. A brain surgeon called into the Mark Levin show. If you are over 70 years of age and you go to the ER and you are on government supported care, you will get comfort care instead of surgery. A government panel (a group of people that know absolutely nothing about medicine) will decide if you can have surgery and it has been decided that it will be denied if you are over 70. Patients will also be called “units” instead of “patients”. Sarah Palin was correct–DEATH PANELS!”

http://www.youtube.com/watch?v=0wsnHGI5K-E&feature=player_embedded

The video shows the radio host, Mark Levin, listening to this so-called brain surgeon call into his show. The surgeon claims that he has just been to a meeting of the American Association of Neurological Surgeons in Washington, D.C., where he learned something shocking! Obamacare will require only “comfort care” for people over 70. If you read the comments below the YouTube video, you are directed to the AANS site itself, where the Society blasts this person and his claim as a complete hoax. This disclaimer is on the AANS site under the “AANS news” subtitle:

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FAA’s Pilot Fatigue Prevention Rule Could Translate to Other Occupations

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By Celeste Monforton

Ms. Madeline Loftus, 24, was just one of the 50 individuals who lost their lives on February 12, 2009 when Continental Flight 3407 crashed in a neighborhood near Buffalo, NY. The NTSB investigation and a frightening PBS Frontline investigation called “Flying Cheap” identified airline industry practices that compromise pilots’ fitness for duty, including severe fatigue, as contributors to the disaster.

The Feb 2009 Pinnacle/Colgan/Continental airline disaster was not the first one in which fatigue was identified as a contributing factor in pilots’ errors and poor performance. Following an October 19, 2004 crash at the Kirksville, Missouri Regional Airport that killed 15, the NTSB noted that the pilots had inadequate overnight rest periods, early report for duty times, and too many consecutive flight legs. In response, the NTSB recommended in 2006 that FAA amend its regulations related to crew hours-of-service, and require the airlines to develop fatigue management programs. FAA responded in September 2010 to the NTSB recommendation by proposing comprehensive improvements and responding to thousands of comments on them. The final result is what was announced this week by the FAA.Continue reading…

Physicians Venture out of Practice, Seeking Capital

By Richard Reece, MD

I am contemplating writing a book on physicians seeking venture capital to escape the fetters of practice and to launch innovative ideas.

If I decide to go ahead, I will author the book my colleague, Dr. Luis Pareras. Dr. Pereras is a venture capitalist. He lives in Barcelona. In Europe, aging populations, plummeting birth rates, and soaring costs make it hard to sustain overly generous social welfare states. I live in the U.S, where, to a lesser degree, a similar situation is emerging.

Here Medicare is approaching bankruptcy. Medicare is the single biggest contributor to our growing budget deficit. In Europe, centralized bureaucracies often smother innovation. This may soon be the case in the U.S. Europe and the U.S. are inextricably interlocked sectors of the global economy – economically. clinically, but not always culturally.

Nevertheless, both physicians in Europe and the U.S. are unhappy because government is cutting their pay and ramping up regulations to make national ends meet. Some physicians in Europe and the U.S are turning to venture capitalists to get the money required to launch start-up health –related enterprises. Others rely on their own finances or angel investors.

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What Is Sustainable Health Spending?

By Charles Roehrig, Ph.D.

There is broad agreement that historical rates of increase in health spending are “unsustainable”, and we must therefore find ways to bend the health care cost curve. However, there is surprisingly little consensus – and not even much being written – about what growth rate would be “sustainable”?  Defining sustainable growth and establishing a credible target is one of the top research priorities of our Center. We have put a lot of energy into providing more timely estimates of health spending and having a target for comparison is a key next step.

In this blog, the first in a planned series, I lay the groundwork needed to estimate sustainable health spending growth rates.  I begin with a definition of sustainable health spending that I hope you will find intuitively appealing, even if it does not match your own perspective. I then identify key stakeholders affected by health spending increases and who, in the absence of the Affordable Care Act (ACA), would have their own particular sustainability thresholds. Next, I argue that under ACA, the federal government blunts the impact of health spending growth on most other stakeholders and, in so doing, focuses the sustainability question more fully on its ability to raise the tax dollars required to meet its ACA commitments.

Defining “sustainable” health spending

I consider the nation to have achieved sustainable health spending when the projected growth path of spending is within what the nation is willing and able to pay. Note that this definition introduces elements of choice into the determination of sustainability. If there is an absence of willingness to pay, the spending will be unsustainable even if there is ability to pay.

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What the Healthcare Industry Can Learn From Technology Start-Ups

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By David Shaywitz

A few months ago, I heard a young design entrepreneur named Aza Raskin talk about his idea for a consumer health company, MassiveHealth, built around the concept of providing rapid feedback. For example, if you had a skin dye that faded a certain amount each time you took a dose of your antibiotic, you would be more likely to complete the full course.

Skip ahead not very far. Recently, MassiveHealth launched its first, free app (dubbed an experiment), called the Eatery. The idea is that you take a picture of your meal and rate its healthiness, which is then shared with other users. You benefit, as I understand it, by thinking more about your food and by getting input on your food from other users. What the company itself gets is not yet clear. They’ve shared some pretty maps of San Francisco and New York City showing where people are eating more vs. less healthy foods, and they’ve drawn some fairly general conclusions about how the supposed healthiness of our food changes during the day (good at breakfast, bad during the day, partial recovery at dinner).

At least as important, I’d imagine, they have an engaged group of users who seem (at least at this early stage) to be interested in interacting with the platform, and thus contributing to the development of the emerging data set; after only a week, more than one million food ratings were reportedly received.

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San Francisco’s Universal Health Plan Reaches Tens of Thousands, but Rests on Unstable Funding

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By Barbara Grady

Four years ago, San Francisco launched a grand experiment, becoming the first city in the nation to offer comprehensive health care to its growing ranks of uninsured.

Stitching together two-dozen neighborhood health clinics and an array of hospitals, the city bet that two reforms — emphasis on primary care and a common electronic enrollment system — could improve outcomes and buffer the city against soaring health care costs.Continue reading…