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Tag: IHI

A Time for Boundless Energy and Optimism

2012 has been a challenging year for me.

On the personal side, my wife had cancer. Together we moved two households, relocated her studio, and closed her gallery. This week my mother broke her hip in Los Angeles and I’m writing from her hospital room as we finalize her discharge and home care plan before I fly back to Boston.

On the business side, the IT community around me has worked hard on Meaningful Use Stage 2, the Massachusetts State Health Information Exchange, improvements in data security, groundbreaking new applications, and complex projects like ICD10 with enormous scope.

We did all this with boundless energy and optimism, knowing that every day we’re creating a foundation that will improve the future for our country, communities, and families.

My personal life has never been better – Kathy’s cancer is in remission, our farm is thriving, and our daughter is maturing into a fine young woman at Tufts University.

My business life has never been better – Meaningful Use Stage 2 provides new rigorous standards for content/vocabulary/transport at a time when EHR use has doubled since 2008, the State HIE goes live in one week, and BIDMC was voted the number #1 IT organization the country.

It’s clear that many have discounted the amazing accomplishments that we’ve all made, overcoming technology and political barriers with questions such as “how can we?” and “why not?” rather than “why is it taking so long?” They would rather pursue their own goals – be they election year politics, academic recognition, or readership traffic on a website.

As many have seen, this letter from the Ways and Means Committee makes comments about standards that clearly have no other purpose than election year politics. These House members are very smart people and I have great respect for their staff. I’m happy to walk them through the Standards and Certification Regulations (MU stage 1 and stage 2) so they understand that the majority of their letter is simply not true – it ignores the work of hundreds of people over thousands of hours to close the standards gaps via open, transparent, and bipartisan harmonization in both the Bush and Obama administrations.

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The Science and Religion of Patient Safety

Earlier today, Secretary of Health and Human Services Kathleen Sebelius and Medicare chief Don Berwick announced the “Partnership for Patients,” a far-reaching federal initiative designed to take a big bite out of adverse events in American hospitals. The program – which aims to decrease preventable harm in U.S. hospitals by 40 percent and preventable readmissions by 20 percent by 2013 – marks a watershed moment in the patient safety movement. Here’s the scoop, along with a bit of back story (which includes a gratifying bit part for yours truly).

Last July, I attended the American Board of Internal Medicine’s Summer Forum in Vancouver. This confab has turned into medicine’s version of Davos, drawing a who’s who in healthcare policy. One of the attendees was an old friend, Peter Lee, a San Francisco lawyer and healthcare consumer advocate who had just been asked to lead a new Office of Delivery System Reform within the U.S. Department of Health and Human Services. Peter’s charge was to figure out how to transform the delivery of healthcare in America, challenging under any circumstances but Sisyphean given that he’d be pushing the rock up a mountain chock full of landmines comprised of endless legal and political threats to the recently-passed Affordable Care Act.

Fueled by the enthusiasm of being a new guy with a crucial task, Peter took advantage of some conference downtime to convene a small group – about 20 of us – to advise him on what he should focus on in his new role. After soliciting ideas from many of the participants around the table, he turned to me. I decided not to be shy.

I suggested that the topic of patient safety remained compelling and scary, and that it might be at a tipping point – with new success stories in reducing infections and improving surgical safety, more hospitals possessing the infrastructure to improve safety, and increasing penetration of IT systems due to federal support through the meaningful use standards. I also knew that Don Berwick, Peter’s new boss, would not be content to move around some bureaucratic chess pieces, or even a few hundred million dollars. Instead, he’d be looking to do Something Big – an initiative aimed at capturing hearts and minds, a federal version of his IHI 100,000 Lives and 5 Million Lives campaigns. What better target than patient safety?Continue reading…

Life Saving Errors

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On March 28, 1979 the Three-Mile Island Unit-2 nuclear power plant experienced a feed system failure which prevented the steam generators from removing heat from the plant. The reactor automatically shutdown but, without the feed system to cool the primary, the pressure in the primary system (the nuclear portion of the plant) began to increase. In order to prevent that pressure from becoming excessive, a relief valve opened. The valve should have re-closed once the pressure dropped by a small amount, but it didn’t. The only indication available in the control room showed the valve in the closed position, but that indication was erroneous, representing only that the signal to close the valve (pressure below a set value) had been sent to the valve. Nothing in the system verified the actual valve position. This stuck-open valve caused the pressure to continue to decrease in the system (and ultimately provided a path for spewing thousands of curies of radioactive material into the atmosphere), but the false shut indication prevented the operators from taking actions to mitigate their severe loss of coolant accident.

The primary relief valve design had a history of sticking. That same valve had been involved in at least nine other minor incidents prior to the TMI incident. Most notably, eighteen months before TMI, a similar incident had occurred in another nuclear plant involving a loss of feed and rising temperatures shutting down the plant. In that incident, the plant was just starting up after a maintenance shutdown, so the power level and temperature of the system were not as dangerously high as at Three-Mile Island.

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Why Berwick Matters

Two cover stories in this week’s Time magazine debate a provocative question: Is America in decline?

Both the yes and no arguments are made persuasively, and I found myself on the fence after reading them, perhaps leaning ever-so-slightly toward the “no” side (optimist that I am). Sure, times are tough, but we’ve got the Right Stuff and we’ve bounced up from the mat before.

Then I considered the political fracas over Don Berwick’s appointment as director of the Centers for Medicare & Medicaid Services (CMS), and decided to change my vote, sadly. Yes, America is in decline, and this pitiful circus is Exhibit A.

Berwick, as you know, is a brilliant Harvard professor and founding head of the Institute for Healthcare Improvement. He is also the brains and vision behind most of the important healthcare initiatives of the past generation, from the IOM reports on quality and safety, to “bundles” of evidence-based practices to reduce harm, to the idea of a campaign to promote patient safety.

President Obama’s selection of Berwick to lead CMS last year was inspired. In the face of unassailable evidence of spotty quality and safety, unjustifiable variations in care, and impending insolvency, Medicare has no choice but to transform itself from a “dumb payer” into an organization that promotes excellence in quality, safety and efficiency. There is simply no other person with the deep knowledge of the system and the trust of so many key stakeholders as Don Berwick.

But Berwick’s nomination ran into the buzz saw of Red and Blue politics, with Republicans holding his nomination hostage to their larger concerns about the Affordable Care Act. In the ludicrous debate that ultimately culminated in Obama’s recess appointment of Berwick, the central argument against his nomination was that he had once – gasp – praised the UK’s National Health Service. Interestingly, without mentioning Berwick by name, Fareed Zakaria pointed to this very issue to bolster his “decline” argument in Time:

A crucial aspect of beginning to turn things around would be for the U.S. to make an honest accounting of where it stands and what it can learn from other countries. [But] any politician who dares suggest that the U.S. can learn from – let alone copy – other countries is likely to be denounced instantly. If someone points out that Europe gets better health care at half the cost, that’s dangerously socialist thinking.Continue reading…

The Non-Scalability of Charisma

Early on, many social movements depend on a charismatic leader to focus attention, build a burning platform, and inspire people to action. You know when the movement has made it when it no longer needs such a leader for fuel.

The safety and quality movements have picked up tremendous steam over the past decade, but they haven’t yet hit that self-sustaining tipping point. Last week, there were two things that reminded me of this: the announcement of a new leader of the Institute for Healthcare Improvement (IHI), and a doleful JAMA essay by Peter Pronovost.

During the circus that was Don Berwick’s recess appointment to lead the Centers for Medicare & Medicaid Services (CMS), all eyes were trained Inside the Beltway. But 440 miles north, in Cambridge, MA, arguably the most important organization in the quality and safety galaxy needed to get on with its business. On July 8th, IHI announced its choice of Maureen Bisognano to become its new CEO. Maureen is a nurse and former hospital exec who has spent the last 15 years at IHI as Don’s consigliere. She is a terrific person, with boundless energy and great organizational skills – insiders will tell you that she was the reason that IHI’s trains ran on time for the past decade, as Don is the quintessential big picture guy.Continue reading…

Joint Commission Apes Newt, Takes on IHI

Not content with handing out demerits for bad behavior, the Joint Commission has launched an effort to help those who misbehave change their ways.

As detailed in the Wall Street Journal’s Health Blog, the mission of the Joint Commission’s new Center for Transforming Healthcare will be, in the Journal’s words, “to work on new collaborative programs with leading hospitals and health care systems to find a cause of the most deadly breakdowns in patient care, and put a stop to them.”If the name of the new group sounds familiar, you could be confusing it with Newt Gingrich’s Center for Health Transformation. That center was launched by the former House Speaker to tout the benefits of health information technology and a changed reimbursement system and then show how those benefits could work in practice through demonstration projects. Of course, with the advent of the Obama administration, the for-profit center has changed its mission just a tad from Newt-the-Wonk’s, “Paper Kills” to Newt-the-Republican-Attack-Dog’s “Democrats kill.”  Visitors to the Center’s site can now find helpful op-eds with titles like “Healthcare Rationing” and “Listen to Barney Frank or listen to America?”

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