Over a decade ago, I consulted on a project for the U.S. Air Force involving very large-scale simulations. These "war games" involved more than 1,500 participants around the world — some in simulators and some using real equipment in training mode. In a warehouse-sized building, a wall of gigantic screens captured the mock battle, as a(...)
A Clear-Eyed Approach to Reducing Costly Health Care Regulations
Posted by | Measurement of Safety and QualityJohns Hopkins ophthalmologist Oliver Schein has found a simple way to save a half a billion dollars a year from our country's health-care bill, with no negative effect on patient health. The only thing standing in the way is a stubborn government requirement. Seventeen years ago, Dr. Schein and colleagues published a study finding that(...)
Breaking Down the Barriers to a Second Opinion
Posted by | Patient-Centered CareWhen patients receive life-altering diagnoses, face aggressive treatments, or have misgivings about a provider’s conclusions, they may wonder if they should seek a second opinion. A recent study by Mayo Clinic researchers suggests that patients who do get second opinions frequently end up with different diagnoses. Of 286 cases referred by primary care practices to(...)
Hospitals Helping Hospitals Improve Patient Safety
Posted by | Organizational and Cultural Change, Preventing Patient HarmThe moment that an accreditation team shows up unannounced can spike the pulse of even the most seasoned hospital executive. The next several days will amount to one big exam for the safety and quality of care, as surveyors meet with executives, managers and care teams, and watch first-hand as care is delivered. Make the(...)
Why Surgical Volumes Should Be Public
Posted by | Measurement of Safety and QualityHer voice cracked with strain. I could imagine the woman at the other end of the line shaking, overcome with remorse about the hospital where her husband had had esophageal surgery. Might he still be alive, she asked me, if they had chosen a different hospital? The couple had initially planned to have the procedure(...)
How We Can Engineer a Less Costly Health Care System
Posted by | Designing Safer Systems, Patient-Centered Care, Preventing Patient HarmIf we want to rein in the costs of the U.S. health-care system — now equal to nearly 18 percent of the nation's gross domestic product — we cannot ignore the fragmented technologies used to help heal and save lives. At first glance, the devices, monitors, electronic health records and machines found in today's hospitals(...)
More Science, Less Sausage-Making Needed for Hospital Quality Measures
Posted by | Measurement of Safety and QualityIf you understand statistics and possess the intestinal fortitude to examine a ranking methodology, you will recognize that it involves ingredients that have to be recombined, repackaged and renamed. It's messy, like sausage-making. This is not to say that the end product — hospital rankings — are distasteful. Patients deserve valid, transparent and timely information(...)
Common Symptoms, Uncommon Causes: Reducing Misdiagnosis on the Front Lines
Posted by | Preventing Patient HarmIn 2013, a 52-year-old man went to an emergency department complaining of dizziness. Physicians evaluated him, decided that it was a benign condition — as it usually is — and sent him home. Days later, it became apparent that this was no harmless event. He suffered a significant stroke, with permanent disability as the result.(...)
Reinventing the Physical Exam
Posted by | Designing Safer Systems, Patient-Centered CareIn the technology-thick landscape of modern health care, the physical exam remains in a backwoods. Sure, there have been advances — blood-pressure cuffs, for example, now inflate themselves — but on the whole the exam has barely changed in the past century. Patients still open up and say "ah," take deep breaths and gaze at(...)
Thinking Outside the Hospital: A Call to Action for Outpatient Safety
Posted by | Patient-Centered Care, Preventing Patient HarmHealth care has been thinking about medical errors for nearly 20 years, starting with the Institute of Medicine’s 1999 report “To Err is Human.” This and other work across the country have correctly shed light upon such medical errors as amputation of the wrong limb, inpatient adverse drug events and hospital-acquired infections, and we have(...)