Comments on: The Importance of Outcomes

By: JimJinNJ

JimJinNJ — Wed, 16 Sep 2009 02:41:32 +0000

Hospitals are organizations (how’s that for insight). Meaning they are amenable to the same improvement regimens that the Dr. Jim Long Kim mentions using Southwest as an example. Goldratt’s The Goal and his theory of constraints seems esp appropriate. but organizations change on their own terms and the so-called cultural/behavioral variables are the toughest to change. that’s why “computers” is anther dumb Moyers comment. Many doctors get their jollies by subverting new IT systems. They might however adpot them if they play a role in designing the system. some enlightened facilities actually manage change well–treating organizations as human/technical systems. A lot of modern medicine uses essentially a Taylorian management system–break things into small tasks, specialize every worker, pass things along the assembly line.
That can work in very simple tasks but in the complexity of some medicine that is a bad joke.

Let’s hope Dr. Jim Kim can have an impact. He seems to understand the issues more deeply than most.

By: Silke

Silke — Tue, 15 Sep 2009 09:56:36 +0000

“Or do the bad guys and the good guys in medicine just operate in parallel, non-intersecting worlds?”

if you happen to have met a bad guy before you have found out that he is one you quite often form the opinion that he is more than usual likeable and decent – it takes quite an effort to “harmonize” these two pictures of the same person – the facts and the gut reaction you once had

maybe this probably quite common experience is a great help to those wanting to seem honest crooks

By: Uncle Billy Cunctator

Uncle Billy Cunctator — Tue, 15 Sep 2009 06:28:16 +0000

Not just the insurance companies. A whole new class of doctors that hire nurse practitioners and “expert billing companies” and go hog wild. Bill the local governments for full time hospital employment and open up a few clinics elsewhere. Hey, who’s checking? We had an entire monster hospital company (Columbia/HCA) which took billing to an almost religious level. Wish I had numbers, but just based on personal experience and reading the news, the fraud must amount to many billions of dollars.

*Not* a slam at the profession. The professionals surely have a feel for how bad it is. Why don’t they blow the whistle? Or do the bad guys and the good guys in medicine just operate in parallel, non-intersecting worlds?

By: Hal Horvath

Hal Horvath — Tue, 15 Sep 2009 04:45:23 +0000

How to deliver high-quality, low-cost health care:

This is where the decades of reading economics combined with the years of dealing with health insurance to help me produce some very specific market and market-like mechanisms designed to pay for outcomes over time, and handle various complexities:

http://findingourdream.blogspot.com/2009/06/new-way-to-hold-down-health-care-costs.html

By: Ted K

Ted K — Tue, 15 Sep 2009 03:59:48 +0000

“Transfer of information” (when I was a little kid we called it “communication”) is a problem in health care, but a very very small part in the ballooning costs of health care. Let’s pick our battles. After we stop the parasitical insurance corporations from bilking us, then we can fine tune how people communicate in E.R.

By: Fred H Schlegel

Fred H Schlegel — Tue, 15 Sep 2009 00:14:00 +0000

When my father was ill we made it a point to be available during nursing changes to make sure that information buried deep within a 2 inch thick file made it to the top and assumptions weren’t made by simply looking at the person in the bed. We discovered the need for this after the first exchange out of critical care. The nurse assumed by age and appearance that this was an end of life case instead of a sudden onset and recoverable event, naturally making it appear that attention would be better spent on other patients. Not an indictment, simply a natural human tendency – current orders are all there is time for usually and so much information is lost every shift.

By: CBS from the West

CBS from the West — Mon, 14 Sep 2009 22:35:31 +0000

Suppose you are traveling somewhere in the Bible belt, and you fall and break your arm. You go to the ER to have it assessed and get the fracture set. Do you really want everybody in that ER to know that you are gay, or that you once had an abortion, or something like that? And it’s tricky, because I can’t see any obvious way to restrict the information made available to just “what’s needed for current treatment,” because that is often an extremely vague qualifier.

My opinion is that on balance we’re better off with fully available medical records, but I can certainly understand why people have qualms about it.

By: Andrew

Andrew — Mon, 14 Sep 2009 22:17:00 +0000

Remove the noun “healthcare” or “hospitals” from this discussion and replace it with any large-scale organization. It all still holds true.

The comment about sometimes celebrating poor execution at an institutional level is dead-on. It’s one of the ways that large organizations (corporations, universities, etc.) maintain themselves.

By: Speed

Speed — Mon, 14 Sep 2009 22:12:04 +0000

This is a big topic, so big it deserves a whole book. Wait! Someone wrote a book about it …

The Innovator’s Prescription by Clayton M. Christensen (The Innovator’s Dilemma), Jerome H. Grossman MD and Jason Hwang MD.

It includes pretty much what was said in this post (in greater detail) plus lots more.

By: pebird

pebird — Mon, 14 Sep 2009 21:20:14 +0000

First of all – if a doctor has to see an inordinate amount of patients – and hands them off to someone else – it doesn’t matter how good the information transfer is – you still are churning more than processing information.

There may be some incremental benefit – but this looks like silver bullet syndrome.

The problem is that the information hand off has to happen in the first place – if you have an assembly line operation – which is great for insurance companies to have lots of check points (why there are so many tests, for example) and data, but terrible for doctors to understand the context of a patient’s condition, then efficient information hand off is a band aid solution to a much bigger problem.

By: Yakkis

Yakkis — Mon, 14 Sep 2009 20:08:05 +0000

Americans really need to get out more, and see how the rest of the world is leaving them in the dust while they debate whether something is “socialist” or not.

By: mk

mk — Mon, 14 Sep 2009 20:00:54 +0000

If that is your desire, then I must say you mostly accomplish the task.

By: The Raven

The Raven — Mon, 14 Sep 2009 19:58:34 +0000

Take a look at Sara Robinson's account of an ER visit in Canada. My impression is that most of this is, in fact, already in progress in countries with modern health care system.

By: jake chase

jake chase — Mon, 14 Sep 2009 19:35:30 +0000

Why do we expect that hospitals will run better than your average Burger King? Both have the same perverse incentives.

By: Silke

Silke — Mon, 14 Sep 2009 19:32:00 +0000

Yakkis
that data are completely safe and private is always promised but as I am from a country that traditionally has registered peoples’ place of residence and made “good” use of those data from 1933 on I can’t help being afraid of any data collections, especially electronic ones because they have the big “advantage” over all previous ones that you may connect data from different sources on your screen quite easily serving beneficial as well as sinister purposes.

My favourite example is: how are you ever going to hide a second person in your apartment when a computer is quietly and effortlessly monitoring your electricity and water and sounding the alarm if you use more assuming there is a leakage.

As to health: with the old system I can easily figure out sending somebody to a doctor for treatment having her pose as me. How am I going to pull that off with a central recording and my card all of a sudden showing a disease I plainly do not have? Resistance to government is not only possessing guns it is also preserving the ability to fly under the radar. And yes I am aware that the smart cards have the potential of preventing quite some misery. But I personally living in this country and coming from a bureaucratic profession vote for preserving the misery. But I know it’s no use and I have already sent in my photograph as demanded as demanded by the insurer …