jenuesse health

Here's a different take on end-of-life issues from ZDoggMD.  Worth watching and perhaps using in your place to get the conversation started. (Thanks to Dr. Susan Shaw in Saskatoon for the reference.)

My buddy Jeff Thompson is stepping down as CEO of Gundersen Health System in a few months.  I have commented several times here on Jeff's leadership abilities, which are again demonstrated in a note he sent to his staff this week.  In simple, direct terms he reinforces the narrative that is at the heart of his hospital's purpose.  It could be the same purpose of any hospital in the world, but it is not often set forth so well.  An element of leadership is that the narrative is expressed in so eloquent and elegant a fashion--one that permits all recipients to feel ownership of the privilege and obligation they have been given. Dear Colleagues, We are experiencing many changes as an organization. Some are very exciting like Dr. Rathgaber taking over as CEO in September. Others are more of a struggle. There is always going to be change, especially in our business. But it is not the changes that are the most important.  It is how we respond. How we respond to c...

Here's a quiz.  Can you guess who posted the following messages on Twitter? Any idea how many hospital execs' bonuses are tied to their institution's U.S. News rankings? When execs confide this arrangement, they expect me to be impressed or flattered. Are you kidding? I'm deeply disturbed.   In my view it's a symptom the board has abdicated its responsibility to measure, monitor & incentivize quality improvement. You might be surprised to learn that it was Ben Harder, @benharder, chief of health analysis at US News and World Report , the magazine that publishes "data, rankings & tools to help consumers choose hospitals, doctors, health plans & more." Probably more than anyone in the country, Ben understands the inherent limitations in any such rankings. More important, he understands that the rankings are designed to advise patients with complex medical conditions.  They are not an indication about the general level of quality of care or safety...

Here are some excerpts from just a few blog posts written by medical and nursing students after the first day the Napa version of the Telluride Patient Safety Camp (seen here having lunch!)  I encourage you to read others : -- They would act as though nothing is wrong. I wrote this quote down on my pad during the Lewis Blackman video that was shown today because I’ve been guilty of this during rotations myself. Hellen Haskell, Lewis’ mother, was talking about the nurse taking care of her son and the fact that nursing notes ultimately revealed that she was indeed deeply concerned about the patient and his deteriorating clinical condition.   The truth is I don’t quite know how to act (maybe act is the wrong word) or rather what emotions to show around families. No one ever tells you to show a impassive face, to act as if everything is proceeding according to plan even when your team is struggling to figure out what is wrong, yet this is exactly what one learns observi...

The Risk Management Foundation of CRICO recently supported a research program to test the effectiveness of 360 degree reviews in influencing surgeons' communication and behavioral skills.  The results were just published in the Journal of the American College of Surgeons . The context was important: The program was deployed as part of a long-standing, surgical chief-led patient safety and quality collaborative. The collaborative had previously constructed a Code of Excellence (COE), an explicit description of behaviors expected of all surgeons within their departments. The 360 degree evaluation process was designed to assess progress towards these standards. Here's how the study was designed: Three hundred and eighty five surgeons in a variety of specialties [in the Harvard hospitals] underwent 360-degree evaluations with a median of 29 reviewers each. Beginning six months after evaluation, surgeons, department heads, and reviewers completed follow-up surveys evaluating...

When the history of the patient safety movement is told, it will be appropriate that the Association of American Medical Colleges * will be left out.  The recalcitrance of this organization in acknowledging patient safety problems was legendary for the first decade of this century. The AAMC's leadership not only refused to acknowledge the depth of patient harm but also precluded use of the organization's arms in working on the issue. For example, when an AAMC committee was to be established in the mid-2000's on patient quality and safety issues, the leadership insisted that the word "safety" be omitted from the committee's name and charter. For example, when people would submit articles on patient safety to the AAMC's main journal, Academic Medicine , they would be summarily refused, refused even the courtesy of peer review.  The authors were told that patient safety was not an issue of public concern and therefore did not warrant space in the journal. For...

A hearty welcome to the newest participants in the Telluride Patient Safety Summer Camps , taking place this week in Napa, CA.  Here's a sample of the medical students and nursing students who are attending:

Back in 1962, John Steinbeck published Travels with Charley , a series of stories and observations from interactions with people across America.  I happened to pick it up yesterday to re-read it, about 50 years after the first time it was assigned to me in junior high school.  Early in the book Steinbeck relates a discussion he has with a New Hampshire farmer about what was still a major post-World War II concern, the recent development and spread of nuclear power and weapons. The farmer says, "Take my grandfather and his father.  They knew some things they were sure about. They were pretty sure give a little line and then what might happen.  But now--what might happen?" "I don't know," responds the author. "Nobody knows. What good's an opinion if you don't know. My grandfather knew the number of whiskers in the Almighty's beard. I don't even know what happened yesterday, let alone tomorrow. He knew what it was that makes a rock or a table. ...