ROCHESTER, Minn. — Major medical errors self-reported by American surgeons are strongly related to both burnout and depression. Those findings appear today in the online edition of Annals of Surgery. The Mayo Clinic-led study included collaborators from Johns Hopkins and the American College of Surgeons.
Interesting study... It is not open for review, so it is hard to say how the authors controlled for all the variables involved... but the results are a bit troubling.
By making simple decisions to buy or not buy, consumers have changed entire industries — banking, travel, cell phones. A little pressure from consumers typically produces a lot of innovation that shifts products, competition, prices, quality, choices, and ultimately value. The problem with healthcare is that it has been built around providers, insurers, the government, employers — and not around consumers. We've ended up with spiraling costs and few consumer choices, primarily because many of the regulations and mindsets governing health care have inhibited the kind of broad-scale consumer innovation that's happened in other industries.
Now, while the U.S. government is undertaking one of the biggest reform efforts in our history, the debate seems to be overlooking the essential element of consumers.
Healthcare is not going to be reformed by simply revising the current system, which is centered on providers. Instead, we need to concentrate on re-engineering healthcare around the consumer, building innovative approaches that can help consumers take more control of their ongoing care. After all, the ultimate success of healthcare reform will depend on consumers changing their behaviors and interactions with the healthcare system as much as it will on the legislation under consideration in Washington, DC.
But, alas (sigh), it is in the hands of politicians, who are guided by special interests, and not their constituents BEST interests.
We're continuing a tradition at THCB started last year. Asking you to take a moment this weekend to discuss your desires for how to live the end of your life as meaningfully as possible--If you want to reproduce this post on your blog (or anywhere) you can download a ready-made html version hereMatthew Holt
Last Thanksgiving weekend, many of us bloggers participated in the first documented blog rally to promote Engage With Grace a movement aimed at having all of us understand and communicate our end-of-life wishes. It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations our closest friends and family. Our original mission , to get more and more people talking about their end of life wishes, hasn't changed. But it's been quite a year , so we thought this holiday, we'd try something different.
A bit of levity.
At the heart of Engage With Grace are five questions designed to get the conversation started. We've included them at the end of this post. They're not easy questions, but they are important. To help ease us into these tough questions, and in the spirit of the season, we thought we'd start with five parallel questions that ARE pretty easy to answer:
Silly? Maybe. But it underscores how having a template like this, just five questions in plain, simple language, can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion. So with that, we've included the five questions from Engage With Grace below. Think about them, document them, share them.
Over the past year there's been a lot of discussion around end of life. And we've been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation. One man shared how surprised he was to learn that his wife's preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge. Wishing you and yours a holiday that's fulfilling in all the right ways.
(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )
Many people buy a car (probably their single biggest discretionary purchase) based on slamming a door, kicking a tire and judging the handshake of a salesperson.
We choose a surgeon based on the carpeting in his office and a politician by his hair cut.
During the first week of swine flu vaccines in New York, most parents (more than half!) chose to keep their kids out of the program.
Interviewed parents said things like, "I'm not sure it's safe," and "I wanted to see if it affected other kids..."
No mention of longitudinal studies or long-term side effects. No science at all, really, just rumors and hunches and gut instincts.
In his post he distinguishes between scientific evidence which is (hopefully) objective, and the *amateur scientist* who is typically swayed by anecdotes.
Health care decision making is sooooo complex... we all (docs and patients alike) incorporate scientific evidence, anecdote, and our judgment (professional or otherwise) into the decision making process... Complicating it further, our judgment and interpretation of the science is influenced by many variables as well.
Perhaps that's why he concludes --- "that people have added a veneer of scientific rationality to their irrational decision(s)"--- and somehow that rationale *empowers* the masses in their decision making.
Maybe I'm wrong... but clinical decision making is far from a perfect science and we all still have a lot to learn....
My experience in discussing a potential social media outreach strategy with a hospital (my own or one I consult for) typically generates the same concerns John references in his blog article sourced above.
What these institutions and companies don't understand is that the social media community is already vetting their institution or corporation. A simple search of Twitter, Facebook, Tumblr, and Posterous would likely prove to be very revealing to those who are most concerned about their perceived loss of control, potential brand tarnishing, and other unfounded variables they simply can no longer control.
Having a clear social media policy, and engaging the social media community will increase your control and offer you the opportunity to make your brand shine. Hiding your head in the sand will lead you to miss the gathering storm... should one exist.
Does this surprise anyone? Disappointing, of course. Right now EMRs exist as siloed, tethered pockets of data and are being utilized primarily as an expensive, poorly designed, digital cousin of the paper record kept by most physicians.
Cost, quality and improved care will follow when these systems are better designed, OPEN SOURCE, more affordable, inter-operable and connected on a nationwide level. Then the API developer community will see to it that the data can be scrubbed and analyzed in a manner that can benefit everyone.
Massachusetts’ largest hospitals say they have significantly cut the number of patients who acquire painful, costly, and sometimes deadly infections in their operating suites and intensive care units, suggesting that pressure from government regulators and patient groups, as well as a shift in doctors’ attitudes, is starting to make medical care safer.
New policies and procedures ??? In many cases... no. It is simply adhering to the tried and true policies of old such as washing your hands, supplemental oxygen in certain cases (diabetics, blood supply issues), adhering to pre-operative antibiotic prophylaxis recommendations, weaning patients sooner, changing catheters more regularly. You get the picture. The answers are *simple*. We simply need adherence to existing protocols, punishment for non-compliance and continued efforts to push compliance by IHI, World Health, patients, etc--- and hopefully *health-care* can be a safer environment for all.
Now we have to do away with the white coats and neck ties.... known risks for infections. #DNV #JCAHO
Remember the news about an EMR outage at Fletcher Allen Health Care in Burlington, Vt., from August? A new, $57 million installation was rendered useless for hours following a power loss and subsequent failure of battery backups. Fortunately, the health system had a plan in place to revert to paper records during the unscheduled downtime. "This went smoothly because our staff still remembered how to document and write orders on paper, as it hadn't been that long since we'd gone electronic," Chief Nursing Officer Sandra Dalton says in a For The Record feature story on dealing with EMR and EHR downtime.
This problem was figured out nearly a decade ago, but my numbers might be a little off. There are very few reasons to have a local server run your EMR program. Perhaps you should configure your EMR to work locally if the internet slows or is briefly disrupted.... BUT as soon as the connection is restored you return to a cloud based operations/storage solution. This is a no-brainer, and a non-starter for platforms that insist on residing locally... even with redundancy built in.
•80% of physicians use the internet to verify information from a patient
•73% percent of physicians consider the internet to be a standard part of their clinical practice
•83% of physicians rely on the Internet more now than in the past.
•78% of physicians believe the internet has made the practice of medicine easier
•69% of physicians trust online information
Physician Internet usage does not spike at any particular time throughout the day. They use the Internet around the clock, in short bursts.
The data is very telling. Physicians are increasing their reliance on the Internet to make the practice of medicine easier and to vet the information received from their patients.
It is still a little surprising to me that the primary source for clinical information is a search on --- Google.
This points to the fact that traditional sources of information, CME, textbooks, etc are being replaced or at the very least augmented. The more effective and approachable the Internet becomes the more the trends are pronounced.
Something tells me Google is not the end game however. It's a good bridge to a more intelligent network. One in which relevant/contextual knowledge and information is instantly available...whether at the point of care, in our offices or on the go. The transformations we have seen in just the last 10 years are incredible when you stop to think about it. Imagine what the coming 10 years has in store...
If you ran a business where a customer represented an additional $2,000 in profit, how would you staff? How long would you make someone wait? If staff costs $25 an hour, how long would that extra person take to pay off?
Few businesses understand (really understand) just how much a customer is worth. Add to this the additional profit you get from a delighted customer spreading the word--it can easily double or triple the lifetime value.
So, a chiropractor might see a new patient being worth $2,500, easily. And yet... how much is she spending on courting, catering to and seducing that new customer? My guess is that $50 feels like a lot to the doc. Instead of comparing what you invest to the benefit you receive from the first bill, the first visit, the first transaction, it's important to not only recognize but embrace the true lifetime value of one more customer.
So few physicians understand this concept…In some studies, a significant percentage of patients report that they will not return to a physicians office because of the way they were treated by the staff. Others stated they wouldn’t return because of the time they had to wait or the doctor was too succinct in his/her evaluation. Patients have sent physicians a bill for their time after waiting three hours in their office.
Word of mouth referrals are the best drivers for bottom line appreciation in a physician’s office. Every physician should read this and post it on the walls throughout their office.
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