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Is Your Organization Too Flat?

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By PAUL LEVY

6a00d8341c909d53ef0120a919772c970b-320wiMy friends and colleagues Jeff Stamps and Jessica Lipnack have made an art and science of studying complex organizations. Their particular focus is on how communication within and across networks of relationships either enhances or degrades a company’s ability to succeed. I recently looked at some draft work they have in progress, based on earlier work they have done. I think it is timely to share it with you (with their permission).

Jeff and Jessica raise provocative and timely questions for those of us implementing the Lean philosophy in complex hospital settings, or even for those who just are trying to manage in these kind of institutions.
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Americans and Their Medical Machines

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By RICHARD L. REECE, MD

Professor Brainstawm

“- The real problem is not whether machines think, but whether men do.”  — B. F. Skinner

“If you are designing a machine, you had better think of everything, because a machine cannot think for itself.”

—  Edgeware: Insights from Complexity Science for Health Care Leaders, 1998

Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity. If the face of our machines sag, we lift its faces up. If our pipes clog, we roto rooter them out or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to remove something in the machine’s interior, we take it out through a laparoscope. If the fuel or metabolic mix is wrong, we alter the mix or correct the metabolic defect with drugs If anything else goes wrong, we diagnose it and rearrange it electronically.

We are reluctant to let nature take its course. We rely on half-way technologies and machines to do the job of keeping us looking young, active, functioning , and alive. This fixation on machines and technologies is the big reason American health care is 50% more costly than that of other nations. With rapid access to machines and our reliance on them, we deliver a different product than other countries – more technologies and more machines, faster and more often. Our belief system is : Give a specialist a machine, and he or she will do the job, and we or the government will pay for it.

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Reflections from “Health 2.0 in the Doctor’s Office”

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By WILLIAM SELLMAN, MD, MBA

Will Sellman has commented on a couple of panels at Health 2.0 and been very prescient. Now he’s spent a bit of time to pen his reflections on what happened in Health 2.0 in the Doctor’s Office, which was held late last month in Florida. Will is at Alameda Family Physicians and is Director of Performance Improvement at Affinity Medical Group

  • Why is there innovation in this sphere?
  • What problems are we really trying to solve, and how?
  • Is there any party missing from the discussion?

These are but three of a series of questions I asked myself during and after the enlightening, and perhaps prescient, Health 2.0 conference that took place last weekend in Jacksonville, Florida. But these particular questions are inextricable from one another when applied to the overarching goal of the movement afoot that Health 2.0 supports. I endeavor here to not only answer these questions, but to communicate their relevance to those striving to maximize a fluid patient experience through technology.

While Health 2.0 is, in my mind, a nexus of technology utilization and process revision with respect to health care, it is also a phenomenon that must be considered within the context of the healthcare industry as a whole if it is to be usefully deployed.

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Nancy Turett on Health Engagement

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By Matthew Holt

One of the more interesting surveys about health care in recent years has been the Edelman Health Engagement Barometer (HEB) first done in 2008 when I was tangentially involved—I wasn’t involved this year). Recently Edelman the global communications giant has redone the survey and it really pushed the boat out this year—doing the survey in 11 countries with a big oversample in the US.

A week or so ago I grabbed a few minutes with Nancy Turett who runs Edelman’s global health practice to get the overview of the new Health Engagement Barometer.

You can also hear more about all of this on Tuesday May 25 at 11 am EST when Nancy and a gang including the ever wonderful Jane Sarasohn-Kahn will be talking more about the HEB. You can get an invite to that by emailing hi***********@*****an.com

Are older patients ready for the personal healthcare revolution?

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By Matthew Holt

Our friend Michael Yuan at Ringful is working with some students in the business honors program at the University of Texas at Austin. They write:

As part of our class project, we are conducting a survey to understand how individuals and corporations are adopting new personal healthcare technologies. We need your help!

If you are managing a wellness or disease management program for an employer or insurer or hospital, we’d love to hear from you. Our goal is to survey members in your wellness / health plan on their perceptions of those potentially disruptive healthcare technologies. After the survey, we will share with you the aggregated results from your own employee/member population.

If you are able to help, please take 5 minutes to fill out a questionnaire. At the end of the questionnaire, we will ask for your email address. We will then get in touch via email and send you the link for your employees/members to fill out the consumer survey. Thank you so much!

 

Truly CA

By Matthew Holt

KQED, local PBS in San Francisco writes to tell me that a new series of Truly CA is beginning Sunday, May 16 at 6pm on KQED Public Television 9. The independent documentary series about life in the Golden State kicks off its sixth season with Firestorm, a timely film about the role firefighters play in the current medical system. The film coincides with the first day of National EMS Week (May 16-22, 2010).

Badness in Baltimore: Can Peer Review Catch Rogue Doctors?

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By BOB WACHTER, MDPicture 7

A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb. A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual blockage was trivial – more like 10 percent.

Disgusting, I thought… if the reports are true, they should lock this guy in jail and throw away the key. After all, the victims now have permanent foreign bodies in their vascular beds, and both the stent and the accompanying blood thinners confer a substantial lifetime risk of morbidity and mortality. As I felt my own blood beginning to boil, the reporter asked a question that threw me back on my heels.

“Why didn’t peer review catch this?” he asked.

Hospital peer review is getting better, partly driven by more aggressive accreditation standards for medical staff privileging. In my role as chief of the medical service at UCSF Medical Center, I’m now expected to monitor a series of signals looking for problem doctors: low procedural volumes, unusual numbers of complications, and frequent patient complaints, unexpected deaths, and malpractice suits. When a flashing red light goes off, my next step is to commission a focused review of the physician’s practice. The process remains far from perfect, but it is an improvement over the traditional system, in which docs tapped a couple of their golfing buddies to vouch for their competence.Continue reading…

Worth It

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By ROB LAMBERTS MD
Rob Lamberts

I saw the note on the patient’s chart before I opened the door: “patient is upset that he had to come in.”

I opened the door and was greeted by a gentleman with his arms crossed tightly across his chest and a stern expression.  I barely recognized him, having only seen him a handful of times over the past few years.  Scrawled on the patient history sheet  in the space for the reason for his visits were the words: “Because I was forced to come in.”

By stomach churned.  I opened his chart and looked at his problem list, which included high blood pressure and high cholesterol – both treated with medications.  He was last in my office in November…of 2008.  I blinked, looked up at his scowling face, and frowned back.  ”You haven’t been in the office for over eighteen months.  It was really time for you to come in,” I said, trying to remain calm as I spoke.

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If I Were as Sexy as Atul Gawande

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By JONATHAN BUSH

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While I don’t much feel sorry for myself these days (I used to, but that was years ago now), I had a recent pang of it reading Atul Gawande’s new book The Checklist Manifesto.

In this bestseller, he points out that much of what ails us in health care is the lack of good checklists.  Not just the lists of course, but the fact that much of health care is now rote stuff that we already know how to do. What we need to do is accept that and stop treating the work like it’s a craft-brewed, once-in-a-lifetime invention. We need to start treating it like a complex set of tasks that needs to be done well, in order, every time and preferably by technicians specially trained to repeat the list.  This Gawande guy is so smart, good-looking and bloody silver-tongued, that he gets to saunter out with what athenahealth has been trying to say and do for the last decade—only he gets published right off! I just know he’s gonna get one of those ooey gooey softball interviews with Terry Gross and even get to meet Obama over it.   I feel like the guy on the FedEx commercial who didn’t get credit for the idea because he didn’t “go like this —” when he offered it.

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