Category: Healthcare Quality

Specialists and Practice Guidelines: On the Cash Cow in the Room

Here’s a personal story about medical overuse and willful ignorance. Stay tuned for the punchline. First, a little background: a couple of weeks ago I came across a great study on medical overuse, specifically adherence to national recommendations published in 2012 regarding the use of the PSA (prostate specific antigen) blood test to screen for prostate cancer.

On Healthcare as a Complex System: Ensuring Context and The Capacity to Adapt

There is a minor brouhaha in the world of healthcare quality and process improvement.  It started with a perspective piece written by Pamela Hartzband and Jerome Groopman published in a January issue of the New England Journal.  In the essay, (and I’m paraphrasing) Groopman and Hartzband argue that process improvement tools like LEAN are “medical Taylorism” that lead to ...

To Reduce Physician Burnout Eliminate Garbage Time

Here’s a new chart from the AMA (reprinted from work done by Dr. Shanafelt and colleagues in Mayo proceedings) that reports the percentage of burnt out physicians sorted by specialty.  It’s a pretty horrifying report.   I’m not at all surprised to see emergency medicine at the top of the list. There are a bunch of theories on the ...

Consolidating Surgery: Another Example of Balancing Population-Level Improvements with Poignant Individual Loss

In healthcare quality circles it’s become a truism that high surgical volume is linked to improved outcomes.  If you want to have the best surgical result, the thought goes, find the surgeon who has done the most cases like yours… Harvard’s Ashish Jha outlines the case in a recent JAMA Forum: We have always known that volume ...

Swiss Flight 188, the Normalization of Deviance and a Better Way to Communicate: Lessons for Healthcare Leaders

I recently came across some captivating footage of a Swiss Airlines flight crew dealing with the unexpected loss of an engine.  Watch this- you won’t be able to take your eyes off this smooth, competent crew.  

A Few Thoughts on “Culture” in Healthcare

The big news in Boston healthcare last week was the announcement that Tufts and Boston University Medical Centers were calling off their proposed merger.  The Boston Globe wrote:  Although they did not specify why the deal fell apart, the hospitals were apparently unable to overcome differences in culture, mission, and strategies for the future, analysts ...

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Segmenting Healthcare into “Luxury” and “Value” Brands… Thoughts On Not Getting Stuck in the Middle.

A few months ago, I wrote about how healthcare is poised to segment according to cost and service levels– and that we will likely begin to see healthcare brands emerge that appeal to price-conscious consumers looking for reliable, basic care. My suspicion was that US healthcare is now facing its “Southwest Airlines” moment, where nimble and lean competitors will soon undercut inefficient legacy ...