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Explore the challenges of communication, medical errors, and overtreatment in healthcare, and their impact on patient safety and outcomes.
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LONGTom Peters’ EXCELLENCE. ALWAYS.McKesson 2008 Executive Leadership SummitThe Broadmoor/Colorado Springs/23 July 2008
DVM/Lyme/2005-2008**Multiple diagnoses (>5)**Specialist self-certainty**Health deterioration failed to produce urgency- communication**Virtually no communications between specialists**Follow-up very spotty unless bugged incessantly**Lost major test results, mis-placed 3 or 4 occasions**Near fatal drug mistake (one nurse takes charge)**Effectively, disinterest in chronic-care**Lack of curiosity
“[Dartmouth Professor Elliott] Fisher and his colleagues discovered that patients who went to hospitals that spent the most— and did the most procedures—were 2 to 6 percent more likely to die than patients that went to hospitals that spent the least.” Source:Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee
“The more doctors and specialists around, the more tests and procedures performed. And the results of all these tests and procedures? Lots more medical bills, exposure to medical errors, and a loss of life expectancy. “It was this last conclusion that was truly shocking, but it became unavoidable when [Dartmouth’s Dr. Jack] Wennberg and others broadened their studies.They found it’s not just that renowned hospitals and their specialists tend to engage in massive overtreatment. They also tend to be poorat providing criticalbutroutine care.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“If we sent 30 percent of the doctors in this country to Africa, we might raise the level of health on both continents.” —Dr Elliott Fisher, Center of Evaluative Clinical Sciences, Dartmouth Medical School(“Overdose,” Atlantic, Shannon Brownlee.)
CDC 1998:98,000killed and 2,000,000injuredfrom hospital-caused drug errors & infections
HealthGrades/Denver:195,000hospital deaths per year in the U.S., 2000-2002 = equivalent of 390 full jumbos/747s in the drink per year—more than one-a-day.Comments: There is little evidence that patient safety has improved in the last five years.”—Dr. Samantha CollierSource: Boston Globe/2005
1,000,000“serious medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug interactions and allergies.”Source: Wall Street Journal /Institute of Medicine
“Hospital infections kill an estimated 103,000 people in the United States a year, as many as AIDS, breast cancer and auto accidents combined.… Today, experts estimate that more than 60 percent of staph infections are M.R.S.A. [up from 2 percent in 1974]. Hospitals in Denmark, Finland and the Netherlands once faced similar rates, but brought them down to below 1 percent. How? Through the rigorous enforcement of rules on hand washing, the meticulous cleaning of equipment and hospital rooms, the use of gowns and disposable aprons to prevent doctors and nurses from spreading germs on clothing and the testing of incoming patients to identify and isolate those carrying the germ. … Many hospital administrators say they can’t afford to take the necessary precautions.”—Betsy McCaughey, founder of the Committee to Reduce Infection Deaths (New York Times/06.06.2005)
“Experts estimate that more than a hundred thousand Americans die each year not from illness but from their prescription drugs.Those deaths, occurring quietly, almost without notice in hospitals, emergency rooms, and homes, make medicines one of the leading causes of death in the United States. On a daily basis, prescription pills are estimated to kill more than 270 Americans. … Prescription medicines, taken according to doctors’ instructions, kill more Americans than either diabetes or Alzheimer’s disease.”Source: Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs —Melody Petersen
140,000,000 illegible prescriptions per year—John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow
**1,500,000,000,000 claims per year**30% errors**15% lost**25% paper-basedSource: John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow
”I can receive a BlackBerry message from a colleague climbing a mountain, yet I still show up at a doctor’s office [and after a 45-minite wait] learn that my hospital test results have not arrived weeks after they should have.” —John Hammergren (& Phil Harkins), Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow
“stunning lack of scientific knowledge about which treatments and procedures actually work.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
Up To 500,000 Lives:“The medical system has been unable to turn proven remedies into everyday care.* Half the people who need to be treated to prevent heart attacks are not treated and half who are treated are treated inadequately. Patients go home with the wrong drugs or the wrong doses or misimpressions about the importance of taking their medications.”*More: 55% chance of “receiving the best recommended care—which means getting scientifically appropriate, evidence-based medical treatment”—The New York Times, from John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow
“The results are deadly. In addition to the 98,000 killed by medical errors in hospitals and the 90,000 deaths caused by hospital infections, another 126,000 die from their doctor’s failure to observe evidence-based protocols for justfour common conditions: hypertension, heart attack, pneumonia, and colorectal cancer.” [TP: total 314,000] Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“Bottom line” :1900-1960, life expectancy grew 0.64 % per year; 1960-2002, 0.24% per year, half from airbags, gun locks, service employment … Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“Plus God alone knows how many casualties in doctors’ offices, Tom”—Thom Mayer
“ … 25 to 30 percent of our $2.2 trillion goes to wasted care in the form of preventable errors, incorrect diagnoses, redundant treatment, unnecessary infections, and extra time spent in the hospital. Team-based medicine, bar-code prescription scanning, evidence-based medicine—all of these are systems and innovations that are being put into place to eliminate waste so that we can re-apply the money.”—John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow
“Clinical microsystem,” linked microsystems, patient-centric “care teams” —Paul Batalden/DHMCSource: “What System?” Dartmouth Medicine, Summer 2006 (Quality By Design: A Clinical Microsystems Approach, by Eugene C. Nelson, Paul B. Batalden, and Marjorie M. Godfrey)
“If I could have chosen not to tackle the IBM culture head-on, I probably wouldn’t have. My bias coming in was toward strategy, analysis and measurement. In comparison, changing the attitude and behaviors of hundreds of thousands of people is very, very hard.[Yet] I came to see in my time at IBM that culture isn’t just one aspect of the game —it is the game.”—Lou Gerstner, Who Says Elephants Can’t Dance
Ken Kizer/VA 1997: “culture of cover-up that pervades healthcare” “Patient Safety Event Registry” … “looking for systemic solutions, not seeking to fix blame on individuals except in the most egregious cases. The good news was athirty-fold increasein the number of medical mistakes and adverse events that got reported.” “National Center for Patient Safety Ann Arbor”
Thank you Ike , Charlie, Ben & Norm, George, Nelson, and Ben …
“Allied commands depend on mutual confidence [and this confidence] is gained, above all through the development of friendships.” —General D.D. Eisenhower, Armchair General * (05.08)*“Perhaps his most outstanding ability [at West Point] was the ease with which he made friends and earned the trust of fellow cadets who came from widely varied backgrounds; it was a quality that would pay great dividends during his future coalition command.”
George Crile (Charlie Wilson’s War) on Charlie Wilson:“The way things normally work, if you’re not Jewish you don’t get into the Jewish caucus, but Charlie did. And if you’re not black you don’t get into the black caucus. But Charlie plays poker with the black caucus; they had a game, and he’s the only white guy in it. The House, like any human institution, is moved by friendships, and no matter what people might think about Wilson’s antics, they tend to like him and enjoy his company.”
“In the same bitter winter of 1776 that Gen. George Washington led his beleaguered troops across the Delaware River to safety, Benjamin Franklin sailed across the Atlantic to Paris to engage in an equally crucial campaign, this one diplomatic. A lot depended on the bespectacled and decidedly unfashionable 70-year-old as he entered the world’s fashion capitol sporting a simple brown suit and a fur cap. … Franklin’s miracle was that armed only with his canny personal charm and reputation as a scientist and philosopher, he was able to cajole a wary French government into lending the fledgling American nation an enormous fortune. … The enduring image of Franklin in Paris tends to be that of a flirtatious old man, too busy visiting the city’s fashionable salons to pursue affairs of state as rigorously as John Adams. When Adams joined Franklin in Paris in 1779, he was scandalized by the late hours and French lifestyle his colleague had adopted, says [Stacy Schiff, in A Great Improvisation] Adams was clueless that it was through the dropped hints and seemingly offhand remarks at these salons that so much of French diplomacy was conducted. … Like the Beatles arriving in America, Franklin aroused a fervor—his face appeared on prints, teacups and chamber pots. The extraordinary popularity served Franklin’s diplomatic purposes splendidly. Not even King Louis XVI could ignore the enthusiasm that had won over both the nobility and the bourgeoisie. …”Source: “In Paris, Taking the Salons By Storm: How the Canny Ben Franklin Talked the French into Forming a Crucial Alliance,” U.S. News & World Report, 0707.08
The 95% Factor: “What I learned from my years as a hostage negotiator is that we do not have to feel powerless—and that bonding is the antidote to the hostage situation.”—George Kohlrieser, Hostage at the Table
Hard Is Soft (Plans, #s)Soft Is Hard (people, customers, values, relationships))
Relationships(of all varieties):THERE ONCE WAS A TIME WHEN A THREE-MINUTEPHONECALL WOULD HAVE AVOIDED SETTING OFF THE DOWNWARD SPIRAL THAT RESULTED IN A COMPLETE RUPTURE.
“Courtesies of a small and trivial character are the ones which strike deepest in the grateful and appreciating heart.”—Henry Clay
THE PROBLEM IS RARELY/NEVER THE PROBLEM.THE RESPONSE TO THE PROBLEM INVARIABLY ENDS UP BEING THE REAL PROBLEM.
**Stanford/Hagadorn**Conoco/geologists-geophysicists**Schlumberger IPM-IBM Global Services- UPS Logistics (“bet the company”)**GSK/CEDD**Chiat/Day**Batalden/DHMC/“clinical microsystems”**9-11 Commission**Etc**Etc
