jenuesse health

A danger of being " Thinker in Residence " for several months here in the state of Victoria, Australia, is the danger of diagnostic anchoring--too quickly reaching conclusions about the state of the health care system--followed by confirmation bias--valuing only those observations that support the conclusion you've reached, while ignoring other data.  With cognitive errors of this sort, the best defense in avoiding them is to be aware of their existence.  So, I've tried assiduously to be careful during my visit here.  But the time has come to offer my considered view on several matters. In a recent blog post , I noted that the extensive program of traffic safety run by the Transport Accident Commission is an example of the strong sense of communitarianism that pervades this society.  I suggested that a future column would explore whether this communitarian view within Victorian society carries over into health care--whether there is a comparable commitment "towa...

It isn't often that I can report that I was honored to see a play, but such was the case recently when I was invited to view the showing of a short four-person drama at West Gippsland Hospital in Warragul and especially because I was permitted to attend the staff discussion that followed the performance.  Here's the background: The Australian Institute for Patient and Family Centred Care was established a few years ago by Catherine Crock and colleagues to promote just what its name implies.  As noted: We aim to to transform people’s experience of healthcare through a three-fold approach: Develop partnerships between patients, their families and health professionals Create a culture that is both supportive and effective Improve healthcare environments through high-quality integrated art, architecture and design. One medium used by the AIPFCC is to commission short plays on key themes in health care delivery and present them, upon invitation, to hospitals throughout the count...

In America, drivers don't try to kill other drivers. In Australia, drivers try not to kill other drivers. After almost three months here, I've decided that this difference in attitudes is the biggest thing that separates these two cultures. America was built on a culture of individualism, sometimes called "rugged individualism."  In Australia, society is characterized by a much greater degree of communitarianism. The place of traffic fatalities in the two countries provides a nice example. There are about 32,000 traffic-related fatalities in the US per year, about 10 per 100,000 population .  I think if you were to ask most American drivers about this figure, they would probably answer, "These things happen."  There is virtually no concern in the general population about these deaths, and there is certainly little or no evidence that road dangers influence the manner in which people drive. In Australia, there are about 1200 deaths per year, or about 5 per 10...

When I was growing up, ultimate (originally known as ultimate frisbee) had not yet been invented .  While we played with frisbees, it was mainly just a lot of tossing them around.  Since then, the sport has developed and highly skilled players and teams compete worldwide. I've had a forced sabbatical from playing soccer here in Melbourne (no one plays during the summer apparently), but have been lucky to be invited to join a local co-ed division three ultimate team.  It's been great fun to play a sport which in which the rules are self-enforced, i.e., without referees, and where the "spirit of the game" is the dominant culture. Nonethless, there remains a role for a team leader, often a player-coach, and in this case we are blessed to have Michelle Phillips, a world class player, as ours.  Off the field, she and I have traded stories about leadership, and I've also had a chance to watch her skills in that regard during games and her post-game advisories to the tea...

Today's story is about how to implement a cultural change among a large group of people.  Stick with me, as this will take a moment. Back in 2001 the Victoria Transport Accident Commission wanted people to slow down just a bit while driving.  They understood that "Speeding just 5km/hr over the speed limit can mean the difference between a close call and a serious accident."  The question was how to get people to do it, and do it consistently.  Of course, you could have police and traffic cameras trying to enforce the speed limit, but that is resource intensive and can never be pervasive enough to hold thousands of drivers accountable to this standard. It would be better if people would internalize the message and hold themselves accountable. What resulted was the Wipe off 5 campaign .  TAC employed a simple statement of principle and combined it with an easily understood and remembered action that every driver could take. The fact statement was pretty strai...

I was recently directed to a lovely example of how an observation of correlation can be misinterpreted with regard to cause and effect.*  It comes from Mind of the Raven by Bernd Heinrich.  Here's the excerpt: At dusk on September 7, 1997, a cougar crept up on Ginny Hannum as she was working at the back of her cabin at the head of Boulder Canyon in Colorado.  The cougar crouched low among the rocks, facing her from about twenty feet, and it was ready to pounce.   Although Mrs. Hannum was unaware of the cougar's presence, she had become "somewhat annoyed" by a raven "putting on a fuss like crazy.  The noisy raven kept coming closer, having started its commotion twenty minutes earlier from about three hundred yards away.  Was this raven trying to say something?  She started to listen more closely. The cougar was ready to make its kill, but the raven was close, and it made pass over the woman, calling raucously, then flying up above her to some rock...

A friend here in Melbourne visiting a doctor in the community took this picture from the bulletin board in the doctor's waiting room.  I posted it on Facebook with the comment: "I know some doctors feel frustrated about this issue, but even if they do, is the waiting room a really good place to put up a sign like this?" Within hours, I received a slew of comments, and I repeat a few of them here. Condescending, much? Gotta fight snark with snark! My search engine spends more than 2 minutes with me, doesn't disregard my input, and is available for follow up...so it'd be hard to confuse with a real doc.  It is offensive to put that in a waiting room. Period. I would turn right around and walk out. I'd turn around and walk right out too, if I could. Great example of an ego-based practice! Yikes, not at all appropriate for posting in a waiting room.   Don't confuse your medical degree with human empathy. We have had some great doctors lately so have res...

It isn't often that I am surprised in a negative way by something relating to an Ohio pediatric hospital.  Indeed, the hospitals in that state have been at the forefront of working together to enhance quality and safety for their patients. But this recent story in the Columbus Dispatch caught my eye. An excerpt: Non-compete agreements built into contracts help ensure that doctors can’t join a hospital’s crosstown rival or enter private practice across the street — at least for a while. The choice to relocate elsewhere to practice medicine is especially limited for pediatric specialists employed by Nationwide Children’s Hospital. The Dispatch reviewed a non-compete agreement that shows that Nationwide Children’s pediatric specialists risk being sued if they take a job within 100 miles of the hospital within two years of leaving it. It turns out that other Ohio hospitals have similar, if slightly less restrictive clauses.  The rationale: Recruiting and hiring require a signifi...

In the end, The Boston Courant did not shut down because of the oft-discussed pressures on the print media.  No, it was because of legal fees and a judgment made against the newspaper from a former employee's lawsuit. David Jacobs and Gen Tracy and their loyal crew worked hard to provide neighborhoods of Boston with relevant, current news--well written and clearly presented.  Advertisers rewarded the paper with their business because it was widely and consistently read. The owners and staff deserve to feel proud about their contribution to the City, which will be diminished by the absence of their newpaper.

I don’t know if the following observations are profound or trite or somewhere in between. They are prompted by a recent visit to the Cascades Female Factory in Hobart, Tasmania. Every country, it seems, has something to be ashamed of in its history. Certainly, among other things, the US bears blame for its treatment of native Americans, slaves imported from Africa, and forced detention of Japanese descendants during World War II. And yet, those same countries have often made contributions to political systems that are truly noteworthy in the advancement of human society.  Think of the principles espoused in the Mayflower Compact, the Declaration of Independence, the Constitution, and in the practice of civil disobedience against injustice, a philosophy that stemmed from the writings of Thoreau and others.  These contradictions between eras of cruelty and shame and periods of enlightenment may be irreconcilable. Or perhaps there is some underlying theory of the advancement of ...

Given the stakes to society and the persistent growth in health care delivery costs throughout the developed nations, there is an understandable desire to achieve the “breakthrough” technological solutions that will result in a substantial disruption in diagnostic and treatment practices and patterns that have evolved over the decades.   Well intentioned and intelligent people with thoughtful ideas are focused on ways to achieve these solutions.   Investors, seeing the large (and growing) percentage of each nation’s GDP that is devoted to health care, likewise hunger for the opportunity to grab even a small portion of that wealth. As I noted in a blog post last year , an area that consumes tremendous energy is the search for the Holy Grail of decision support products that would mine health care “big data.” People are looking for the algorithms that could help doctors—in real time—analyze the condition of patients and put in place more efficient and efficacious diagnostic regi...

I am borrowing a line from Dr. Amy Ship, the 2009 recipient of the Campassionate Caregiver Award from the Schwartz Center, to remind folks that nominations are now open for this coming year's award. The award recognizes health care professionals who display extraordinary devotion and compassion in caring for patients and families.  It is open to health care professionals who work in any U.S. health care setting. The nomination deadline is March 31, 2016. Here's the link . There's no better way to express your appreciation to a friend, colleague, or caregiver than to nominate them for this honor.

I mean no disrespect to my Australian hosts when I say that I've seen this all before.  The details differ, but the same underlying themes emerge. And when stories are placed side by side, it can be confusing to the public. In Australia, the government strongly encourages private health insurance coverage for a portion of the population, a policy that was designed to reduce overcrowding in the public hospitals.  There are a whole series of regulations that influence both corporate and individual behavior in this arena.  These rules have essentially created the private health insurance market in the country. As noted just a few days ago , the private hospitals in the country want to assure their investors that the demand for health care services will not diminish over the next several years.  They cite underlying demographic factors: In a strident statement Ramsay's Mr Rex said the report failed to consider further utilisation growth linked to the ageing popula...