jenuesse health

One of my "thinker in residence" sponsors here in Australia is VMIA, the Victoria state government insurance agency.  I had just finished having a lovely cup of coffee and conversation with one of the agency's executives, where our topic had been risk assessment and mitigation. As I started to leave the coffee shop (not a state agency facility!), I stumbled and looked back to see a drop in the floor levels between two parts of the restaurant.  While I can be clumsy (just ask my soccer buddies!), usually I'm pretty adept at walking out of restaurants without suffering harm.  So, I looked back to reconstruct the situation. Here's the broad scene.  The waiter above has just stepped down into the lower portion of the shop.  And indeed, there is a large sign up and to the right warning patrons of the drop in floor height. The problem is a that there is a very eye-catching sign to the left, designed to draw your attention as you pass through this area. So, I didn't ...

How should we think about medical malpractice claims against doctors?  Are they indicative of something about those doctors who've been sued? Are they a symptom of underlying quality and safety issues in a hospital, a kind of canary in the coal mine that suggests there might be deeper problems?  These are long-standing questions. Perhaps part of the answer is provided in a new article in the New England Journal of Medicine, "Prevalence and Characteristics of Physicians Prone to Malpractice Claims," by David Studdert and colleagues.  (The article has a theme that is somewhat consistent to one I discussed a few days ago , which reported that a small group of doctors in Australia accounted for many patient complaints.) The authors conducted an extensive review of US National Practitioner Data Bank information, analyzing 66,426 claims paid against 54,099 physicians from 2005 through 2014. They found that, over this 10-year period, "a small number of physicians with dist...

Apparently, my recent blog post about preventable medical errors at a Victoria community hospital was widely circulated among the local health care community.  Maybe it's helpful to have an outside observer say things about such a circumstance, but there are also local observers who fully understand the underlying issues and have been working on them for some time. One is Cathy Balding, who wrote this article on the same situation back in November.  Here are some excerpts that go to the heart of the matter, not just in Djerriwarrh, but more generally through the state of Victoria: Creating and maintaining consistently safe, high quality care requires an understanding of complexity, and the mix of interconnected organisational factors required: great people supported by great systems, led from the top, based on a relentless pursuit of excellence. But--we haven't yet achieved universal acceptance that this is what it takes. The belief that point of care is ...

Upon seeing this photo from the town of Koo Wee Rup, Victoria, that I posted on Facebook, our friend Geoffrey Irvin posited that it appeared to be a clear case of nominative determinism, which Wikipedia defines as " the hypothesis that a person's name can have a significant role in determining key aspects of job, profession or even character."  The article notes: The term nominative determinism had its origin in the 'Feedback' column of the British popular science magazine New Scientist in 1994: "We recently came across a new book, Pole Positions — The Polar Regions and the Future of the Planet, by Daniel Snowman. Then, a couple of weeks later, we received a copy of London Under London — A Subterranean Guide, one of the authors of which is Richard Trench. So it was interesting to see Jen Hunt of the University of Manchester stating in the October issue of The Psychologist:  "Authors gravitate to the area of research which fits their surname." ...

What a relief! According to Jessica Gardner in the Sydney Morning Herald , a recent report suggesting that the growth in utilization of the Australia private health care system might slow down is off base. Two rival private hospital leaders, Healthscope's Robert Cooke and Ramsay Health Care's Chris Rex, say a research report from Macquarie that warned of a hit to the companies' growth is premature and ignores important trends. Macquarie's health analyst published a note on Monday warning that a federal government review of the Medicare Benefits Schedule would hit 'utilisation' of services, which is the largest driver of revenue growth for the companies. Investors were unnerved by the analysis. On Monday Healthscope shares fell 4.8 per cent to $2.36, while Ramsay shares lost 3.2 per cent to $60.65. In a strident statement Ramsay's Mr Rex said the report failed to consider further utilisation growth linked to the ageing population. "Macquarie...

In my previous post , I addressed the issue of bullying in Australian hospitals.  In an article published three years ago in BMJ Quality and Safety , Marie Bismark, David Studdert and colleagues addressed a topic that might be correlated in some way with that problem--or might just have importance in it own right. The authors' objective was: 1) To determine the distribution of formal patient complaints across Australia's medical workforce and (2) to identify characteristics of doctors at high risk of incurring recurrent complaints. What they found was: A small group of doctors accounts for half of all patient complaints lodged with Australian Commissions.  The distribution of complaints among doctors was highly skewed: 3% of Australia’s medical workforce accounted for 49% of complaints and 1% accounted for a quarter of complaints. Short-term risks of recurrence varied significantly among doctors: there was a strong dose-response relationship with number of previous complaints...

Notwithstanding Bill Bryson's characterization of this " sunburned country " as a place in which there are dozens of ways to be killed by local fauna*, the chance of actually dying from a spider bite, snake bite, or in other such manner is quite small.  For example, the huntsman above looks pretty ferocious, especially given his 4" (10 cm) span, but he won't kill you. In contrast, though, Australia shares the unenviable status of other developed countries (US, UK, and the like) in the fact that being a patient in a hospital is a significant risk.  I discussed the situation in one Victoria hospital in a previous blog post .  There, a number of babies died of a result of preventable medical errors. In the short time I've been in the country, I've heard several people set forth one aspect of the problem, the existence of inappropriate levels of bullying and intimidation by senior members of the medical staff.  Such behavior can directly influence the safety...

Every language or region has its colloquial response to "Thank you!"  In Spanish, we say, "De nada."  "It's nothing." In the United States, we often say, "No problem." Here in Australia, it's "No worries." This is fine in casual settings, as among friends.  But, in health care settings, it's the wrong answer. I addressed this about five years ago in a blog post , noting: One of the things I learned in my hospital days was how to accept gratitude. A hospital can be an uncomfortable place for patients and family members. It is a strange physical environment, where people are anxious because of feared or actual medical conditions or forthcoming procedures or tests. In that situation, when you do something kind for someone, the person is truly grateful. It can be as simple as offering directions, or picking up a fallen object, or something much more serious. When I started working in the hospital, when someone would ...

One of the pleasures in my appointment as "Thinker in Residence" at Deakin University is the chance to hold workshops for local folks on topics that might be new and interesting to them.  This week's session was an introduction to strategic negotiation for people from Deakin, GMHBA (the region's largest mutual health insurance company), the Western Victoria Primary Health Network , and Barwon Health .  Beyond learning some new approaches to this field, many folks in attendance also had a chance to meet each other for the first time. Here are pictures of some of the attendees, responding to other parties or deep in thought as they considered their approach to negotiating some difficult roles in simulations we carried out.

None of us who use Facebook are so naive as to think that it is a free service.  The "cost" of playing is that they use all of the data you post to direct advertisements your way.  It is simply how these applications on the Internet are monetized. But many friends and I have noticed a dramatic upswing in the number of sponsored items on our news feeds, often showing up with the message that one or another of friends has "liked" the link.  In the past, there would have been a few of these, but now they come in a ratio of 1:10 or 1:20 among the feeds on your page.  Here are three examples of what they look like.  (I've omitted the accompanying pictures.) I searched the web to see if this upswing in such ads is a new deal, but found nothing.  But I did find this "helpful" suggestion on the Facebook "Help Community" from a few months ago : Alison asked: How do I stop the bombardment of advertising posts on my newsfeed - almost all totally irrele...

Jerry Groopman is such an admirable person and has so much good to say that when he is off track, it hurts to see it.  In a recent article in the New England Journal of Medicine , he and Pamela Hartzband conflate two issues.  One the one hand, there are their legitimate complaints about the depersonalization and attacks on professional judgment that derive from so much that is wrong with the health care system today.  On the other hand, there is a complete misrepresentation of the tenets and application of Lean (or Toyota Production System) in clinical settings. I'll not go through all the details.  Mark Graban does that in excellent fashion here . No, what hurts more is the fact that our clinical staff at BIDMC, where the authors reside, were overwhelmingly engaged in the the philosophy and practice of Lean--at least during the time I was there.  What's more, they enjoyed it and found that it made their lives better.  Indeed, Mark Zeidel, our Chief of Med...

In my travels around the world, I've come to realize that the normal state of hospital quality and safety is pretty consistent.  As Captain Sullenberger put it: "Islands of excellence in a sea of systemic failures." That's no reason to give up hope that things will improve, but this description does offer a metric of sorts and acts to prompt a number of us in the field to continue to push for better care and offer training and assistance to health care professionals. But Sully's summary is inadequate in one respect in that it doesn't reflect those institutions that are remarkably worse than even the substandard norm.  There are examples everywhere. In the US, it was exemplified by Parkland Memorial Hospital in Texas. In the UK, it was Mid Staffordshire . Here in the state of Victoria, it is Djerriwarrh . I'd heard about this story of the Bacchus Marsh hospital unit of Djerriwarrh Health Services well before arriving in Australia.  Preventable deaths of b...

Al Lewis and Vik Khanna have been at the forefront of debunking useless, intrusive, demeaning, and coercive wellness programs that have been codified into law by the Affordable Care Act and that have become the favorite of corporate human resources folks who have to justify higher insurance premiums to their employees and of insurance companies looking for new profit lines.  In this article , for example, they noted: Now, more than four years into the ACA, we conclude that these programs increase, rather than decrease employer spending on health care with no net health benefit. The programs also cause overutilization of screening and check-ups in generally healthy working age adult populations, put undue stress on employees, and incentivize unhealthy forms of weight-loss. Not content to merely throw stones, the pair and some friends have started a venture called Quizzify , an on-line service for employers that "teaches your employees to make smarter, better healthcare decisio...

Not many cities have books written about their transit system and its impact on the urban environment.  But Boston does.  In the book Street Car Suburbs, The Process of Growth in Boston , Sam Bass Warner explained how the city of Boston grew and prospered between 1870 and 1900 from the interaction between growth of the transit system, creation of new neighborhoods, and expansion of the city. So, you'd think that the elected leaders of Massachusetts would have a sense of the importance of a properly running--and constantly growing--transist system and their hopes and desires for Boston to remain a world class city.  But that realization seems sorely lacking, and the region often devolves into arguments over routes and fares, "reform," and the like. Riders of the system suffer from what might be termed "a readiness to be injured." I don't mean physically injured.  I mean a depressed, resentful expectation that service quality will be inconsistent at best and s...

This article by Lisa Zyga summarizes a forthcoming Lachlan J. Gunn, et al article in Proceedings of The Royal Society A, "Too good to be true: when overwhelming evidence fails to convince." It offers some interesting thoughts.  This is a useful discussion, especially for those in leadership positions.  See, especially, #5 below. Excerpts from the article: Under ancient Jewish law, if a suspect on trial was unanimously found guilty by all judges, then the suspect was acquitted. This reasoning sounds counterintuitive, but the legislators of the time had noticed that unanimous agreement often indicates the presence of systemic error in the judicial process, even if the exact nature of the error is yet to be discovered. They intuitively reasoned that when something seems too good to be true, most likely a mistake was made.  The researchers demonstrated the paradox in the case of a modern-day police line-up, in which witnesses try to identify the suspect out of a line...

PCA ( patient-controlled analgesia ) pumps are very useful devices, enabling patients to push a button to control the amount of intravenous pain-killer they want to use depending on how they are feeling.  Of course, the pumps have a limit to how much can be drawn--so the patient doesn't get an overdose. The pumps can also be set to deliver a "basal rate," a constant infusion of narcotic pain medication, in addition to the dose the patient gets when he or she pushes the button. No matter how sleepy the patient is, the pump will continue infusing narcotics. Normally, without a basal rate, patients using a PCA can only receive medication when they are awake enough to push the button, which serves as a safeguard against receiving an overdose. As I have noted , PCA pumps need to be carefully employed and can be dangerous without appropriate monitoring: The Happy Hospitalist explains : Why is PCA morphine dangerous?  Too much medication can cause patient...

Every part of the world, it seems, has its meteorological hazards with the potential for death and destruction.  There are monsoons, typhoons, hurricanes, tornadoes, and blizzards.  But I'm guessing that one of the most frightening is a fast-moving bushfire in southern Australia. Standing like sentinels over the Steavenson River in Marysville, Victoria, are these towering burnt out trees.  They are some of the remains of Black Saturday, 7 February 2009, when bushfires spread--well, like wildfire--throughout this region just northeast of Melbourne.  After extensive drought and daytime temperatures of close to 50 degrees Celsius, several blazes began.  The fronts of the fires traveled at 100 kilometers per hour, and cinders and branches were pushed ahead of the firestorm for extensive distances.  Fire tornadoes were witnessed. Beyond the property damage, leaving over 7000 people homeless, 173 lives were lost.  The small historic town of Marysville was on...

Queensland Health was an organization under a great deal of pressure several years ago because of safety and quality issues.  In fact, in 2005, the Queensland Government announced an independent review of QH’s administrative, workforce and performance management systems, with focus on issues of bullying and intimidatory behavior in the workplace.  Among other things, what developed was an interesting approach to leadership training employed during the remediation of those issues. I had not heard about this method and was curious to learn more.  What I discovered is that the approach is qualitatively equivalent to the kind of simulation used to teach clinicians how to deal with unexpected situations.  Here, though, the vehicle is a drama-based interactive case study, a "prophetical."  Here are some excerpts from the article (sorry, payment required): The prophetical is a form of applied theatre which draws inspiration from two words. In the prophetical, the pla...

Longstaff: Arrival of Burke, Wills, and King at the deserted camp at Cooper's Creek Burke and Wills are Australia's equivalent of the United States' Lewis and Clarke, men who walked the south to north length of the continent--from Melbourne 1,500 miles to the Gulf of Carpentaria--exploring its deepest reaches. Unfortunately, the result was fatal to both men and several others. When they returned exhausted and weakened after several months to the base camp at Cooper's Creek, those waiting had left earlier that very same day, leaving Burke and Wills to die in the wilderness several weeks later. A rescue party found their companion King on the site shortly after, emaciated and confused, but alive because of help from native people.  He lived to tell the story from his point of view, and the buried diaries kept by the protagonists were also recovered. Alan Moorehead wrote an strikingly evocative version of the story.  Here's an excerpt about the northward trek: It was ...