Implementing lean: A hospital case studyImplementing lean: A hospital case study An excerpt from Beyond Heroes: A Lean Management System for Healthcare. Lean was a serious initiative from the beginning. It was energetically championed by our CEO at that time, John Toussaint, MD, who began his own lean investigations in 2002. By this time, I was a vice president with operational responsibilities ...

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Patient noncompliance. I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time. We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often ...

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The Institute of Medicine in 2010 famously recommended that nurses should be encouraged to practice “to the full extent of their education and training.” Often, you’ll hear people advocate that every health care worker should “practice at the top of their license.” What this concept is supposed to mean, I think, is that anyone with clinical skills should use them effectively and not spend time on tasks that can be ...

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Health care reform is a reality.  The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today.  The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans.  Certainly these are noble and lofty goals: But have we completely missed the mark? Today, many remain uninsured and the majority that have signed up for the exchanges are simply ...

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Health technology must improve patient safetyThis was the dream: We would use technology to create a seamless health care system, one where people, computers and machines would work together to improve patient care in many different ways. Health care would be more efficient, it would be safer, it would be less expensive, we would be able to transfer health-related information quickly and accurately. After ...

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Improving health care: Are physicians knights or pawns? How do we motivate physicians and other health professionals to work at their best? How do we create systems of high performance? Is it by a series of top-down highly specific mandates or by setting up general guidelines and providing tools? I believe it comes down to one’s vision of physicians. Are physicians knights to be empowered in their service of patients ...

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Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like ...

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I wouldn’t say I’ve had a lot of revelations in my professional life, but there is one that still affects me emotionally to this day, and it’s about nurses. I had been a PICU doctor for a number of years, and I was rounding on all the patients in the PICU with the rest of the team. The background sounds consisted of the usual beeps, alarms, and humming from the patient’s ...

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Why the VA scandal is a red flag for single payer advocates "I will not stand for it.” That’s what President Obama said about the deepening VA health care crisis.  It’s also a lightening rod for how partisans want to frame the ongoing health debate. Some are eager to link the VA scandal to Obamacare, and more broadly, government-run health care. Others extol the virtues of the VA, holding it as ...

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Who watches the watchers?  It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well.  It means, "How do I know that the people guarding me are worthy?"  It has also been translated, "Who guards the guards?" But it seems to me that it applies to medicine quite appropriately.  Who watches those watching physicians?  We ...

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