Get that attitude

Dr. Carolyn M. Clancy, the agency’s director, pointed out that projects across the country had shown remarkable success in reducing infection rates by adhering to basic standards for hand hygiene, disinfection of patients, sterile handling of equipment and proper use of antibiotics. But at many hospitals those successes have yet to overcome an entrenched medical culture. (New York Times, emphasis added)

Patient safety is an attitude. Until [] adopts a patient safety attitude, troubling stories like this will persist.

Keep ’em out of the hospital

The Health Blog:

UnitedHealth Group and Walgreens say they’re teaming up with the YMCA on a program that will reimburse pharmacists and lifestyle coaches to help insured patients prevent and control diabetes.

Putting biases aside, isn’t this a great idea? What surprises me, no rubs me wrong, is that today’s healthcare providers (hospitals) can’t/won’t/don’t try programs like this (in more earnest). Maybe it’s a good thing on the disruptive innovation path (just sayin’). Kaiser (and select others) gets it right with their goal of keeping people out of the hospital.

More care (not equal to) better care

An interesting article on the fallacy of more care = better care. Health Beat analyzes:

I believe that pundits are right when they say that Americans have to learn to scale back on medical care. But I don’t think it needs to be achieved in the same way it was during the days of managed health care—when it seemed that many of the treatment denials were made purely to save money, without consideration about quality of care. An increased focus on learning to communicate risk and benefit effectively and by ramping up the patient’s role in decision-making will be far more important in reducing health care costs than learning to “say no.”

Favorites: Get out of healthcare

The complications of delivering healthcare often demand customized solutions.  But that doesn’t mean we need to depend on the ideas inside of our walls for inspiration.  We could do a lot to improve ourselves if we just looked beyond our doors. Memorial Hospital and Health System in South Bend, Indiana has been doing just that for years.  There are plenty of examples of organizations getting out of this industry to improve what’s going on inside.  Here are a few. Memorial has taken an innovation model from industry:

Back in 2000, [CEO Phil] Newbold and Memorial’s Vice President of Marketing, Diane Stover, searched for innovation models within health care and found none. “There was a time, a change would come from Medicare or another funding source and our leadership team would react rather than stick to a plan,” Stover stated. “We launched this initiative to spark positive changes and increase control of our destiny.” Newbold led the charge to engage all 3,800 employees in an understanding of the many challenges facing them and of a commitment to innovative thinking and solution prototyping. The first step was visiting innovators like Whirlpool, 3M, DuPont, W.L. Gore, GE, and Procter & Gamble.

Others have taken checklists from pilots:

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

Some have borrowed barcodes from grocery stores:

The next time you need medication at Medical Center Hosptial don’t be surprised if a nurse asks you to hold out your arm. This month, nurses started using a new bar-code technology to make sure the right medicines get to the right patients. "All that information is right there on the computer so they don’t have to go back out to the nursing unit and gather that information from a paper chart,“ Sharon Nash, the Horizon Admin-Rx project manager, said.

Memorial calls them inno-visits.  You can call them what you want.  The important lesson here is that we realize the extraordinary benefits that come with looking beyond healthcare, the inspiration that comes with a change of scenery.

The problems of healthcare are many, so numerous that one could sit in an office the entire day reading and prophesying about nothing but health care.  Time better spent would be to visit/read/listen/do/join/experience anything outside of this industry.  Your next great idea may come from an experience at a NASCAR track, in the chat of an art historian, from the pages of a great book, or on a visit to Method.  Seriously.

The concept of looking beyond our walls will play a significant role in transforming our healthcare system, indeed it already is.

“If only” (you’d embrace the constraints)

“If only I had one more employee…”

“If only I had a bigger budget…”

“If only I had the newest tool…”

The “if only” plea is often evidence of problems much larger than what the proposed solution would seem to address. Rarely is “if only” an ultimatum between success and failure as some make it out to be.

Near as I can tell there are two options:

  1. Hide behind the excuse that circumstances will only improve “if only” the request is granted, or
  2. Embrace the constraints, get creative, and craft a solution.