Program Performance Measurement

The New Joint Commission: Much Improved, With Room for More

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly. Hospitals were given a couple of years' notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the medications, and the floors were slippery as hell). After arriving, the inspectors spent most of their time sealed in a conference room, pouring through policy manuals (we dusted them off before the visit) and meeting with administrators, exposed to whatever reality the hospital wanted them to see. It was an ineffectual kabuki dance.Last week, the Joint Commission visited UCSF Medical Center. Luckily, our director of regulatory affairs, Jolene Carnagey, is tasked with checking the TJC website every Monday at…

Is Don Berwick The One?

The Blogosphere Rumor Factory is heating up with reports that Don Berwick, the world’s most prominent advocate for healthcare quality and safety, will be the next administrator of the Centers for Medicare & Medicaid Services (CMS). (Take this with a grain of salt, because the same Rumor Factory blew it last time on Glenn Steele.) Although I’ve sparred a bit with Don over the years on matters of philosophy, I think he would be a superb choice.Don’s story is well known – a Harvard pediatrician and policy expert who became passionate about improving healthcare well before it was fashionable, he ultimately left his full-time academic perch to pursue his calling. In 1991, he founded the Institute for Healthcare Improvement, which ran on a shoestring for its first decade, fueled largely by the considerable power of Don’s vision and personality.Then came the IOM reports on safety and quality (reports that Don…

Help Us Help You – RIGHT NOW!

Troy Ahlstrom writes... The SHM Productivity Survey Closes in a Mere Month. The MGMA-SHM Hospitalist Productivity and Compensation Survey is ongoing NOW, and data submission closes March 12th.  As you know, SHM has provided the most comprehensive data set and incisive analysis regarding Hospitalist practice for 10 years now.  We are not the only source of such information, but we have provided the most detailed, comprehensive analysis of Hospitalist practice in the past. This year, in 2010, with all of the tumult and unrest over budgets, the economy, and healthcare reform, we will all need (more…)

How UCSF’s Root Cause Analysis Process Became Our Most Useful Patient Safety Activity

Hospitals face so many urgent tasks in safety – computerize, promote teamwork, implement evidence-based safety practices, discover unsafe conditions – that it’s hard to know where to start. If you’re struggling, I recommend that you put your Root Cause Analysis enterprise on steroids. This is what we did at UCSF Medical Center, and it was the most important change we’ve made in our safety journey. Here’s the story, a case of function following form:RCA, like many of our approaches to patient safety, is familiar to other industries (such as engineering and aviation) but, until recently, alien to medicine. It involves the dissection of an error or a near-miss with an eye toward getting at “root causes” – the underlying system flaws (“latent conditions”) that set up the individual caregivers to cause harm. It doesn’t deny the possibility of human error, but recognizes that while a knee-jerk response that focuses on…

NY Times Magazine on Brent James’ Quest to Transform Healthcare Quality

Just a quick heads up on an article in next weekend’s New York Times Sunday Magazine by my friend David Leonhardt. David profiles Intermountain Healthcare’s Brent James, capturing Brent’s (and Intermountain’s) unique and increasingly influential philosophy of using performance data to catalyze physician practice change. ??The piece, which deftly highlights the tension between “cookbook medicine” and clinical intuition, is destined to become another classic in the growing lay-oriented literature that describes how quality and safety can be promoted in medicine. Like my two other favorites in this genre (both New Yorker pieces by Atul Gawande, focused on the work of Don Berwick and Peter Pronovost), it profiles an iconoclastic optimist  – which just shows that this work is so hard, the payment incentives so perverse, and the cultural forces so daunting that you really need a Kevlar-wearing, bullheaded, saintly genius to get it done. Enjoy.
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