There’s been a lot of talk for quite some time in health care quality improvement circles about why health care can’t be as safe as airline travel. Some of the reasons behind asking this question are very valid, as there are many things health care can learn from the aviation industry. Others, however, are complete fallacy; because on so many levels, it’s like comparing apples to oranges. Over recent weeks, I’ve ...

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This year marks 33 years of administrative positions in academic medicine.  When I first started, I suspect I made many major mistakes.  I learned through the time-tested school of hard knocks.  As I reflect on my own career, and those whom I have observed, I have come to believe the famous saying, "Culture eats strategy for breakfast." Look at ward attending physicians.  The same attendings have “good teams” every ...

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Over the last several years since I graduated from residency, I’ve worked in many different hospitals up and down the east coast. These have ranged from large urban medical centers to rural community outposts. In all of these places I’ve felt the inevitable conflict that exists between physicians and administrators -- to varying degrees. It almost seems like a rite of passage that the world of clinical medicine and administration are ...

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A nudge is a form of social engineering to make better choices. In the world of patient safety and medical decisions, it shares some of the concepts of  human factors engineering. Richard Thaler and Cass Sustein may be the world’s authority on the nudge concept, and have a great book by the same name. Nudges help people to choose their own best decisions by making the easiest, laziest choices -- the defaults -- ...

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The observation versus inpatient distinction is rightly getting more media and public attention with each passing month. In a nutshell, for anyone reading who is not familiar with what this is all about, it’s essentially a way of categorizing people when they get admitted to hospital. You are either deemed an inpatient (basically a more complex case) or an observation (a less serious case). The individual reasons and checkboxes that have ...

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On September 14, 2006, I was in the midst of a 218-consecutive-day hospitalization. What began as a scheduled C-section that April, resulted in a massive infection that nearly killed me. By Autumn, I was receiving physical therapy in the large hospital gym when I was raced back up to my room for my trach to be suctioned. This was not an uncommon occurrence. I was used to the process, and ...

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The first time I cried as a doctor was in residency. I was taking care of a patient who had terminal lung cancer. The first time I met him, his wife was at his bedside. The couple displayed such a positive outlook on life and seemed to have accepted the poor prognosis. He was one of the first cancer patients I took care of. Being a cancer survivor myself, I felt a ...

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Selecting the right hospital to receive care can save your life, lower your risks of getting a complication, or even reduce your financial hardship. The problem is that it's extremely hard for patients to make that judgment. Sometimes, the data they need to select the best hospital for their care doesn't exist. In other cases, it's hard or impossible for the public to find. For instance, if you're getting an esophagus resection ...

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I was working in a hospital recently and saw a note from a CEO on the computer. Notes and memos are ubiquitous these days. Bathroom walls, break-rooms, computer screens. Everywhere there is another reminder to check this, do that, mark those, record metrics, hurry up, don’t make mistakes, sign orders, complete charts, be nice and all the rest. But this note stood out. In it, the administrator was reminding the medical ...

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Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The motivation behind HRRP is simple:  the readmission rate, the proportion of discharged patients who return to ...

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