jenuesse health

Remember the story about my MD friend's elderly mother , the one who was suffering from falls because she was over-medicated for blood pressure issues? Once the doses were reduced, she did fine: "She has more stamina than ever before. She is happy." Well, here's the next chapter: So Mom is back in her original assisted living place, walking with a walker, to everyone's surprise. However, the medical errors are following her. When she was being discharged, the rehab center sat me down and gave me a discharge summary and medication list, saying they had been faxed to the original nursing home. We went over and discussed every medication. 9 pm the night she went back, my phone rings; it's the nursing office of the original place saying they have her on Tramadol but the pharmacy says there is an allergy. I said, "What?" You see, Tramadol was not on her medication list. They said, "It wasn't on the list YOU gave us but it IS on the lis...

Way back in December 2013 , I introduced my readers to OpenBiome, a start-up formed by a couple of MIT graduate students who had a new concept for Fecal microbiota transplant (FMT), which is now recognized as an effective cure for C. difficile patients. In March of this year, I reported from one of the founders: We've experienced rapid growth and are working with over 230 hospitals in 43 states and have provided treatments for over 2800 recurrent C. difficile patients at this point.  We have also been testing and developing an encapsulated formulation that should reduce procedure related costs and risks for treatment of C. difficile, while enabling long term maintenance therapy for the investigation of chronic conditions where a single dose is unlikely to provide lasting benefit.  Now it looks like that approach is going well. Gabrielle Emanuel at the Commonhealth blog reports : Fecal transplants may have just gotten a lot easier to swallow. OpenBiome , the nation’s f...

Blogger Melissa Clarkson offers a wryly humorous take on a goal established by the CMS Partnership for Patients, to reduce preventable harm by 40% between 2010 and 2014.  She asks: I was not aware that harm comes as a mix of acceptable harm and unacceptable harm and the concern is getting rid of the unacceptable portion. But if hospitals are striving for such a goal, I simply ask that they fully explain this to patients and families. And to help, I would like to provide some ideas for facilitating this communication. Here are some of the graphics she proposes for those hospitals who wish to be fully transparent. For a hospital welcome sign: For a marketing campaign: For the front lobby: More seriously, and perhaps not coincidentally, according to this Modern Healthcare article : The Leapfrog Group has released the second round of its bi-annual hospital safety scores, which show “sluggish” improvement in patient safety among the nation's hospitals.

I have made a serious commitment on this blog to promulgate the best in medical education, with a strong emphasis on programs that focus on clinical quality and safety improvement. It was with a delighted gasp of approval, therefore, that I read this recent bit of feedback posted on the residents' bulletin board of the anaesthesia department at a major academic medical center. This is truly superb pedagogy, well worth emulating in other training programs. In case you are not familiar with Wu-Tang Clan, you can enhance your cultural competence by viewing this video .

Several months ago, through a virtual friendship with her father, I got to know a young lady named Clarissa Schilstra.  She is a lovely and thoughtful person who has been through double doses of cancer in her short life.  She is now a member of the class of 2016 at Duke University. We first met in person (all three of us) in August of 2014.  Clarissa felt that she learned a lot from the passages of her life and wanted to share what she had learned with others, and so she wrote me back in July: "I am really excited to tell you that I have written a book this summer, to help teens and young adults with cancer through the social and emotional challenges of treatment." The book is now out , and it is very, very good.  My review is as follows: Clarissa Schilstra offers knowledge, wisdom, and advice to teenagers and young adults who are facing the travails of a cancer diagnosis. Drawing from her own experience, employing plain talk and empathy, she offers helpful sugg...

My friend and colleague Michael Wheeler, in his excellent book The Art of Negotiation , notes: "Negotiation is never about us alone. What ultimately unfolds is a function of each party's attitudes and decisions, not just our own. Asking ourselves, 'How did I do?' is the wrong question.  It's a one-hand-clapping exercise.  Instead our starting point should be, where did we end up and how did we get there?" I was reminded of this advice by a New York Times article about Justice Ruth Bader Ginsburg by Irin Carmon. Excerpts: “My advice is fight for the things that you care about,” Justice Ginsburg said. Fair enough — banal enough, really. Then she added, “But do it in a way that will lead others to join you.” Justice Ginsburg [has] no patience for confrontation just for the sake of it. “Anger, resentment, envy and self-pity are wasteful reactions,” she has written. “They greatly drain one’s time. They sap energy better devoted to productive endeavors.” A...

A person who has over 3000 friends on Facebook saw no irony in posting the picture above in her status bar.

Above, seen on a table at the back of a conference room during a staff all-day negotiation, team-building, and communication workshop.  It is a great enforcement mechanism to enhance interactions and the learning process, imposed by the conference organizer. I think Sherry Turkle would be pleased. She has said : What I've found is that our little devices, those little devices in our pockets, are so psychologically powerful that they don't only change what we do, they change who we are. Some of the things we do now with our devices are things that, only a few years ago, we would have found odd or disturbing, but they've quickly come to seem familiar, just how we do things. So just to take some quick examples: People text or do email during corporate board meetings. They text and shop and go on Facebook during classes, during presentations, actually during all meetings. People talk to me about the important new skill of making eye contact while you're texting. Why does t...

"In 2009, three medical facilities in the comarca del Garraf, near Barcelona, merged into one organization, the Consorci Sanitari del Garraf. Faced with a 17% budget cut, a result of the financial crisis, the newly created hospital had to find a way to improve its processes and become more efficient." This is a really sweet story from Spain that illustrates how you don't need lots of money and extra resources to apply Lean thinking.  Read the text, but really watch the videos to get a feel for how it happened.

It isn't often that I take someone's comment on a story and use it as the heart of a post, but someone named Greg Lee nailed it and summarized what I've been watching, too.  The context is this latest story about layoffs and buy-outs at the Boston Globe .  Like Mr. Lee, I read the comments of the editor and said, "Nice try."  Here's what Mr. Lee said: I understand the financial realities that drive the recent moves by the Boston Globe. It is now, however, a lesser paper than it was, before this current process.  What was touted to subscribers as redesign and layout changes, has actually been evidence of a slow retreat in journalism, at the Globe. The layout changes feature bigger type sections, more graphics and white space, and much less news coverage and op-ed pieces.  It's depressing, as a life-long subscriber of over 45 years, to see this current decline in the Boston Globe. The new bottom line is less news coverage and less in-depth jour...

It's a big day for transitions in health care here in Massachusetts. Maureen Bisognano has announced that she will step down as head of the Institute for Healthcare Improvement, and Jim Roosevelt announced his retirement as CEO of Tufts Health Plan. Others will surely offer their thoughts on the notable accomplishments of these two folks, and so I prefer to spend a bit of time talking about them as people.  Oddly, I can apply almost the same descriptors and adjectives to the two of them--with one pertinent exception, as you shall see. First, both are driven by a sense of public purpose.  Guided to do what is right for their community or the broader world, they have never left a doubt as to their underlying dedication to make the place work better--safer, higher quality, and with extreme attention to the dignity of individuals. Second, both are unfailingly polite, measured, and respectful in their communications and relationships with people of all persuasions and backgrounds. ...

To understand corporate nimbleness and creativity, read this story and then compare it to my previous one about IBM . As I've noted in the past, there are lots of companies seeking to find one or another Holy Grail in the health care world.  After all, when this sector comprises almost 20% of the US economy, who wouldn't want a piece of it?  But to be successful, you need to offer a product or service that actually enhances the day-to-day lives of clinicians or others in the sector. This brings us to Madaket , founded by my buddy Jim Dougherty and friends .  (Note: I have no financial interest in the venture.) They noticed a very serious hole in the health care marketplace--the enrollment of doctors with the variety of insurance companies with which they must deal--and have developed an elegant solution to fix it.  Short version: The average healthcare provider works with 25 payers. Providers must be enrolled with payers to receive payments. Each payer requires a u...

Cousin Dave hamming it up in the 1960s The joke goes like this: Sherlock Holmes and Dr. Watson decide to go on a camping trip. After dinner and a bottle of wine, they lay down for the night, and go to sleep. Some hours later, Holmes awoke and nudged his faithful friend. "Watson, look up at the sky and tell me what you see." Watson replied, "I see millions of stars." "What does that tell you?" Watson pondered for a minute. "Astronomically, it tells me that there are millions of galaxies and potentially billions of planets." "Astrologically, I observe that Saturn is in Leo." "Horologically, I deduce that the time is approximately a quarter past three." "Theologically, I can see that God is all powerful and that we are small and insignificant." "Meteorologically, I suspect that we will have a beautiful day tomorrow." "What does it tell you, Holmes?" Holmes was silent for a minute, then...

There have been some interesting and important discussions flying across the web in recent days on the issue of protocols in helping to reduce variation and reduce the incidence of harm to patients.  My mistake in the debate was assuming that medical leaders would be reasonable about how protocols should and should not be used. A doctor friend, highly committed to patient safety, notes: My point about the protocols is that I have been chastised for not following them in situations where it was blatantly obvious that they did not apply. ("The protocol is there for a reason.") The chastisement comes not from hospital administrators, but from clinician leaders in the doctor's own department: We just got another email scolding us for not following the "colorectal pathway" sufficiently. One of the provisions of that pathway, for example, is strict limitation of iv fluids, sometimes difficult to "comply" when patients are severely dehydrated from thei...

There are few neurologists I admire more than Martin Samuels, chief of service at Brigham and Women's Hospital in Boston.  So it truly pains me to see him engaging in a convoluted approach to the issue of mistakes.  Read the whole thing and then come back and see what you think about the excerpts I've chosen: The current medical culture is obsessed with perfect replication and avoidance of error. This stemmed from the 1999 alarmist report of the National Academy of Medicine, entitled “To Err is Human,” in which the absurd conclusion was propagated that more patients died from medical errors than from breast cancer, heart disease and stroke combined; now updated by The National Academy of Medicine’s (formerly the IOM) new white paper on the epidemic of diagnostic error. No, the obsession, if there is an obsession, is not about perfect replication and avoidance of error.  The focus is on determining the causes of preventable harm and applying the scientific meth...

Every now and then you hear something so dramatically stupid that you have to wonder. One such example was a couple years back, when someone said: " I only text on the highway. " The latest example comes from a resident who was being "trained" by an attending doctor.  The resident was about to administer a drug using the protocol developed by that hospital's clinical department--one based on evidence produced as a result of systematic clinical evaluations. The attending doctor interrupted the trainee and said, "Don't do it that way. I've been a doing this for over 20 years, and that way is stupid." The resident replied, "But I've been told that this is the protocol." The rejoinder, "Protocols are for nurses. Do it the way I say." Which is worse, the pedagogy that has been employed or the practice of medicine that is being carried out? After several years of participating in resident quality and safety workshops, I can r...

My buddy Sam came home from back-to-school night at Wellesley Middle School inspired by his son's math teacher, Marty Wagner .  He related Marty's message to the parents, that mathematics is about taking risks and making mistakes.  He said, "If your kids aren't frustrated when they come home, I'm not doing my job." In my undergraduate days at MIT, an esteemed mathematician named Gian Carlo Rota taught freshman calculus and put it this way when we were having trouble grasping a new concept: “Learning is overcoming your prejudices.” He understood that people are not really good at getting past their old frameworks of viewing things and in so doing have to work through the discomfort of adopting a new view of a topic. Afterwards, you experience the joy and satisfaction of having learned the new item and find yourself on a new plane. At that point, as noted by Cynthia Copeland Lewis , "As soon as you understand 2 x 4 you can't believe there was a time ...

I'm often asked to read books and post reviews here, and I thus find my bookshelf overly full.  I just can't get to them all.  (Indeed, I just donated a few dozen books--some read and some never opened--to one of our local hospital management degree programs!) I recently received two requests, and frankly, I was hesitant.  For one thing, I am friendly (in the internet virtual kind of way) with the authors, and when friendship is involved little good can come of an honest review. For another, the topics were troublesome and likely to be a bit timeworn--yet another book styled as a guide to personal health and yet another autobiography about the trials and tribulations of being a doctor. Well, what a relief!  They are both very good, and I am pleased to recommend them to you. An Illustrated Guide to Personal Health Tom Emerick and Robert Woods, with some important help from illustrator Madi Schmidt, offer 40 common sense steps to improving your health.  Don't worr...