jenuesse health

With 4646 blog posts dating back to August 2006, it's time to end this adventure. After over 9-1/2 years of almost daily output, I will cease adding new posts to this blog. Why? The main reason is that it is simply time to move on to other pursuits. The time and effort spent conceiving, researching, writing, and editing articles has pushed off other projects that I've had in mind for several years. I'd like to focus on those. I'm deeply appreciative of my loyal and engaged readers.  They commented directly on the blog over 22 thousand times, and many have also sent private emails with their observations.  The readers have been polite, respectful, attentive, and thoughtful, and I cherish the time we've spent together. I'm also grateful to members of the Fourth Estate with whom I have corresponded on many of the topics covered here.  Sometimes we have sourced one another, sometimes we have collaborated, and sometimes we have offered mutual support in the face of h...

Michael Greco and his mates at Patient Opinion have developed a simple and useful way to collect opinions about medical care from patients and provide a lovely forum for interactions back and forth with the hospital and providers.  The purpose is simple: To enable and enhance issue resolution, relationship restoration, and improvement. An easy-to-use website makes it possible. The folks at Eastern Health in Victoria have had PO in place for some time.  Here are some stories from their health system.  As you can see, things go in both directions in a helpful, direct, and friendly fashion.  In fact, this first story is actually an apology from a patient to the staff. An excerpt: I was upset and not in the mood to talk much nor was I paying attention to what was being said, as a result I presented as being rude. When the descending red misty haze had finally settled, remorse set in. I regret deeply if I had offended this person and caused them to perform their du...

With a plethora of books about the value and importance of storytelling, we might wonder if another could offer any value. Well, the answer is yes, emphatically. Shawn Callahan's about-to-be released book Putting Stories to Work: Mastering Business Storytelling , is a must-have for your actual or digital library.  It is available now on pre-order and will be on the "bookshelves" on March 20. Shawn is the founder of Anecdote , the world’s largest business storytelling company.  His book is engaging and wise, and yes, replete with useful stories. His advise is concise and helpful, and--unsurprisingly--he has a way with words!  Let me provide some excerpts.  First, this teaser: Natural as it is for us to tell stories, as soon as we enter a meeting, begin a presentation or start a formal conversation with a colleague, all our stories disappear. We bring forth our most authoritative voice and opine away, saying things like: ‘There are three key points here...’ and ‘I th...

Regular readers will know that I am no fan of hospital rankings and have been quite critical over the years at the ones at US News and World Report .  But let's give credit to where it is due: Check out this news release . Excerpts: Patients and families who've used our rankings tell us they want more from hospitals. What they want is meaningful transparency. U.S. News will implement two closely related methodology changes this spring that could drive broader transparency. Both will affect only our rankings of Best Hospitals in Cardiology & Heart Surgery. In that specialty, we will award credit to hospitals that publicly release their own performance data via one or both of two clinical registries, the Society of Thoracic Surgeons' (STS) Adult Cardiac Surgery Database and the American College of Cardiology's (ACC) National Cardiovascular Data Registry. In the case of the ACC data, two constituent registries will be considered: CathPCI and ICD. ACC and its participat...

It's been some time since I commented on issues of market dominance in Massachusetts, but a recent story by Bruce Mohl at Commonwealth Magazin e caught my interest. He writes about a petition being supported by a health care union, SEIU, and Steward Health Care that would mandate a flattening of rate disparities among the state's hospitals. The Massachusetts Hospital Association opposes the ballot question.  Mohl notes: All but one of the hospital association’s board members head institutions that would benefit financially from the ballot question, but nevertheless they have formed a united front against it. Their reasons vary. Some are wary of government price regulation; others don’t think a ballot question is the best way to set health care policy. Whatever their motivation, the united front benefits Partners HealthCare, the one association member who would take a big hit if the ballot question becomes law. Mohl notes that under the proposed legislation: Lowell Gener...

You have to be willing to acknowlege your problems before you can remedy them.  If I were to characterize the state of public and private hospital care in the state of Victoria, Australia, I'd have to say that this first step is lacking.  Both the public and private hospital systems and the goverment regulators who oversee them are in a state of denial with regard to the level of harm being caused to the public by inadequate attention to quality and safety deficiencies. The health system as a whole, also, is characterized by an uwillingness to engage patients and families in the appraisal and improvement of care. The question is when and if the body politic and hospital governing bodies and clinical and administrative leaders will overcome their denial of the extent of the problem. On the public side of the hospital system, the Victoria Auditor-General is about to issue an important report on patient safety in Victoria hospitals, described as follows : Clinical incidents in he...

In his wonderful book about the All Blacks, Legacy , James Kerr reminds us that a key to the success of this remarkable rugby team is an unbreakable social contract, "No dickheads." I'm beginning to think that the body politic needs a similar approach.  If we view each country as having an implicit social contract, we can see that its tenets have an ebb and flow--from inclusive to exclusive, from sharing to selfish, and so on.  It appears that we are now heading, in several countries, to the end of the spectrum that is dysfunctional. Martin Flanagan sets forth this thought in his book about Australia, In Sunshine or in Shadow . Although written several years ago, I have found his observations to be apt today in many ways.  A country whose philosophy was based on " mateship " has moved.  He writes: I ask my father-in-law--what does it mean to be Australian? He looks out the window and says, "Giving the bloke beneath you a hand up." This ethic is direct...

You can't be here in Australia for very long before hearing about the concept of "mateship."  Here are some explanations: Wikipedia says : "Mateship is an Australian cultural idiom that embodies equality, loyalty and friendship." But it goes further than that.  This government site says: 'Mateship' is a concept that can be traced back to early colonial times. The harsh environment in which convicts and new settlers found themselves meant that men and women closely relied on each other for all sorts of help. In Australia, a 'mate' is more than just a friend. It's a term that implies a sense of shared experience, mutual respect and unconditional assistance. And this article notes: " It is a term that conjures images of young men providing unconditional support for one another amid the toughest of conditions." But what I've found is that the term also often implies demonstrating that loyalty with a panache of machismo, somet...

The most common question I get--worldwide--after I give a talk or seminar on creating a learning organization to improve clinical processes in hospitals is:  "I really like what you are saying, but what can I do if those above me in the organization have not adopted the philosophy you espouse."  I respond by saying, "Start small, and just try to get something fixed in your area, working with other like-minded people. Maybe the ideas will spread organically. Maybe they won't, but at least you will have made things better for some." Well, May Wong from Sydney didn't need my advice.  My buddy Sarah Dalton at the New South Wales Clinical Excellence Commission told me the story: Several years ago in her intern year, the thing that most frightened May was having to participate in a resuscitation.  To alleviate part of her anxiety, she checked the resuscitation trolley ("code cart" in our region) in her ward to be intimately familiar with the location of ...

One of the great pleasures of being ex-CEO of a hospital is to visit other places around the world and see the staff in action.  Whatever you might have heard about the stresses and problems faced by doctors and nurses and others, there remains an underlying sense of purpose and commitment that often shines through. Here's a example, from the theatre in which young patients at Royal Children's Hospital receive lumbar punctures and bone marrow tests to receive chemotherapy and/or to assess their progress with regard to leukemia treatments.  I offer the explanation totally in pictures, which pretty well tell the story.  The only one warranting a bit of explanation is the one showing Steve, the anaesthesia technician, driving a small toy car as the patient enters the room--to distract and engage the child!

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...