Comments

Brilliant list Tom - I like it and I am delighted you rattling the cage of healthcare so well - please keep it up and make sure you do it over here as well - we have the same problems in the UK :-)

My only observation would be for you to look at it through the patient’s eyes entirely. I wrote a well received article about patient involvement in health.

I called the article 10 Great Myths of Patient Involvement. It is my contention there are myths created by healthcare managers so that patients can be kept ‘at a distance’ in the running of healthcare organisations.

My ten great myths are as follows. I’m happy to send you the full article if you want it.

Myth Number One: “Patients don’t understand”
Myth Number Two: “Patients are not representative”
Myth Number Three: “There are hard to reach groups”
Myth Number Four: “Patients talk about wants we know what they need”
Myth Number Five: “Demands will mean we can’t cope”
Myth Number Six: “The New Way is best”
Myth Number Seven: “It will all cost too much”
Myth Number Eight: “Staff don’t have time to do all this as well”
Myth Number Nine: “All this stuff cannot be measured”
Myth Number Ten: “Patients and the Public are not really interested in all this anyway”

Posted by Trevor Gay at December 21, 2005 4:37 PM

Tom,

Don't just limit things to PA's. Don't forget about Nurse Practitioners. In most states they have to have a BS in Nursing along with nursing experience along with an MSN (Masters of Science in Nursing), so they have a strong background in health care before they can provide a lot of different types of care in a more cost effective way. They also may have the time to address the customer side of the administration of health care.

If you are serious about the health care focus, go talk to some. You will not regret it.

Henry

Posted by Henry at December 21, 2005 4:50 PM

Tom,

Happy to see that you are doing work in this space. The inspiration, motivation (read pressure) to change the system will have to come from outside of it. We need to improve both the effectiveness and the efficiency. So PA's you bet, Nurse Practitioner as well, more/better IT is a no brainer, however the industry is slow to change because of both historical and (status quo) economic reasons. Therefore the work that you do is incredibly IMPORTANT in helping move the conversation.

Thanks!

Posted by Carlos at December 21, 2005 8:19 PM

In the UK our Dept. of Health is using "survial of the fittest" to drive change and efficiencies .. from Jan 06 every patient will be able to CHOOSE which provider they receive their care from .. those with the shortest waiting lists, lowest levels of infection rates, lowest level of fatalities will survive .. the rest will close and cease to exist .. to see how the UK is spending $15bn to make itself fitter check out www.connectingforhealth.nhs.uk

Posted by eHealth at December 22, 2005 6:25 AM

Wouldn't it be great if the HC can of worms was opened!

I'd like to add 'transparency' to your brilliant list. HC information should be dummied so that it can be understood by customers - so that they can make informed decisions.

Also, along with your customer care bullet; what about 'compassionate' care? Compassionate treatment, especially for those in our society that are vulnerable (the elderly, mentally handicapped, etc.)

No better man to bring the issues to light. May 2006 be the year that Health Care gets healthy!

Posted by Tom O'Leary at December 22, 2005 6:45 AM

The state of USA health care is such that I'm freaked out by a colonoscopy procedure coming up next month - the 6' insertion probe is one thing - the IV in the arm is another - infection is the big fear - shouldn't be but we'll be watching them ultra closely.

Posted by Sean at December 22, 2005 9:35 AM

The intersection of clinical practice, evidenced-based medicine (EBM) and information technology is a very fertile area. Itcontains issues such as diffusion and adoption of new findings by practitioners, errors in clinical reasoning, practice on the basis of dogma vs. evidence, the integration of information technology into clinical practice and so on.

http://www.cebm.net/index.asp

Former Intel Chief Says Healthcare Business has Much to Learn from IT
BY JOHN CARROLL
http://host1.bondware.com/~mississippi/news.php?viewStory=298

From the medical literature:

Brody H, Miller FG, Bogdan-Lovis E Evidence-based medicine - watching out for its friends PERSPECTIVES IN BIOLOGY AND MEDICINE 48(4):570-584

Graber ML, Franklin N, Gordon R Diagnostic error in internal medicine ARCHIVES OF INTERNAL MEDICINE 165(13:1493-1499

Garg AX, Adhikari NKJ, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes - A systematic review JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 293(10:1223-1238

Wilczynski NL, Haynes RB Optimal search strategies for detecting clinically sound prognostic studies in EMBASE: An analytic survey JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION 12(4:481-485

Apkon M, Mattera JA, Lin ZQ, et al. A randomized outpatient trial of a decision-support information technology tool ARCHIVES OF INTERNAL MEDICINE 165(20):2388-2394

Mykhalovskiy E, Weir L The problem of evidence-based medicine: directions for social science SOCIAL SCIENCE & MEDICINE 59(5:1059-1069

Posted by JMG at December 22, 2005 3:44 PM

How about increasing the doctor pool - incentivize kids to take up medical profession, incentivize doctors from other countries. Increasing the doctor pool will increase the supply of doctors and make healthcare a lot cheaper.

If you go to a dentist or a doctor they make you wait, look at you for 5 minutes, don't listen to you and charge you or your insurance company hundreds of dollars.

Changing the supply side of equation would straighten this out.

Posted by AA at December 23, 2005 7:53 PM

Hi AA

Great points you make - one snag is that every country is now competing for a limited supply of Doctors and nurses. In UK many nurses are now brought into the country from other parts of the world. That is fine but there will always be a limited pool to call on even worldwide.

I like your idea of giving more incentive to youngsters to go into medicine. We could start that by valuing our current doctors more than we do. I have seen and worked for years with many stressed doctors and any youngster in their right mind wouldn’t want to go into the pressure cooker of the traditional ‘doctor model’ where they are worked too hard with far too many management targets and too much management interference. If we really want to make the job attractive lets start by valuing our current crop of docs properly.

Posted by Trevor Gay at December 24, 2005 5:16 AM

I wonder how long it will take for HC's to understand the value of digital communication and collaboration... and I'm not talking about remote robot surgeries or web based med schools. I'm thinking specifically about the simplest of online collaboration tools -- email.

To me this comes down to an issue of efficiency. It seems that HC's stand to benefit greatly by turning some of their attention to resource efficiency. This doesn't have to involve squeezing overworked employees either. Great gains could be realized by shifting to a PAPERLESS model.

Most practices are capable of sending me a postcard reminder. Why don't they begin the transition to email, and automate the process while they're at it?

Posted by Jeffrey Osborne at December 26, 2005 4:12 PM