Quality Improvement (QI)

Letter From London

I’ve just returned from a few days in London, scoping things out for a planned sabbatical next fall. In what may be a pale echo of the late Alistair Cooke’s always fascinating “Letters From America,” here are a few of my initial observations:The dominant issue, of course, is the Cameron government’s new austerity program, with its planned deep cuts to government services and benefits. While the program (or programme, I guess I should say) has created some upheaval – witness the recent semi-violent demonstrations by university students, whose tuitions may treble – it has not torn apart the society, the way belt tightening of this magnitude undoubtedly would in America. My sense is that the relative acceptance (yes, I know Charles and Camilla had a frightfully awful limo ride to the West End the other night, but this was, er, theater rather than a defining moment) can be explained the…

Could It Be That Patients Aren’t Any Safer?

On the occasion of last year’s tenth anniversary of the IOM Report on medical mistakes, I was asked one question far more than any other: after all this effort, are patients any safer today than they were a decade ago?Basing my answer more on gestalt than hard data, I gave our patient safety efforts a grade of B-, up a smidge from C+ five years earlier. Some commentators found that far too generous, blasting the safety field for the absence of measurable progress, their arguments bolstered by “data” demonstrating static or even increasing numbers of adverse events. I largely swatted that one away, noting that metrics such as self-reported incidents or patient safety indicators drawn from billing data were deeply flawed. Just look at all the new safety-oriented activity in the average U.S. hospital, I asked. How could we not be making patients safer? I may have been overly charitable. Today, in…

Three Short Stories That Illustrate Key Healthcare Lessons

In my travels, I frequently hear short stories that help illuminate my work and world. Here are three recent examples; think of them as little health policy tapas.I recently spoke in a session with Peter Pronovost, the Johns Hopkins intensivist who is the world’s top researcher in safety and quality. We were talking about why engaging physicians in this work – so called “adaptive change” – is sometimes so difficult. Peter recalled a story about his son, who at age 6 came home and told his parents that he was terrified to enter the school bathroom. “There are monsters in there,” he said. His parents reassured him that there weren’t, but the next day he returned, wide-eyed and still panicked. Peter called the school to see if they had any explanation for his son’s sudden bathroom phobia. “Oh, we put in automatic flush toilets last week, and I guess we…

Torture!

Well, it’s over. A ragtag group of has-beens, oddballs, castaways, newbies, and misfits combined grit, teamwork, flawless decision-making and jaw dropping pitching to bring the World Series crown to the Bay, the first time ever. Just last week, we wondered why Renteria hadn’t been cut; tonight, he’s the toast of the town and there’s dancing in the streets. Amazing.The Giants' motto this year was “torture,” and, although the games all year were certainly ulcerogenic, there was nothing more tortured than my son’s trek to San Francisco to see Games 1 and 2. While Doug describes it on his blog, I thought I’d offer a dad’s-eye view of an amazing day of, well, metaphorical water boarding.1991-2010: My oldest son Doug becomes a SF Giants maniac. He leaves for college in Ann Arbor in 2009; his life’s goal is to become the Giants' general manager.August, 2010: With the Giants in the pennant…

Atul Gawande and the Art of Medical Writing

Don’t read this. That is, if you have a limited amount of time for reading today, I’d rather you read Atul Gawande’s essay on end-of-life care in this month’s New Yorker than this blog.But if you can spare a little time, I’ll be focusing on some of the techniques Gawande uses to make his writing so lyrical and memorable. Whether you write yourself or limit your storytelling to cocktail parties and presenting H&P’s on morning rounds, lessons abound. Here are a few, gleaned from this month's piece, "Letting Go: What Should Medicine Do When It Can’t Save Your Life?": Make the First Sentence CountI lecture frequently and think a lot about what makes for a good talk. One lesson is that the first few minutes are crucial: the speaker begins his or her talk knowing and caring more about the topic than the audience does. He or she has exactly…
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