Recently, I have discussed networks (Internet and electricity), but I would be remiss if I didn’t spend a few moments on the networks that are most likely to rob us of personal choice and increase costs: Health care networks. Wait, didn’t President Obama promise us that the new health care law would preserve choice for us? Didn’t he promise us lower costs?  Well, in spite of much good ...

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shutterstock_182066816 It’s often said that we learn from our mistakes. Indeed, many a business course in leadership offers that premise as a given. I’ve glibly repeated this often in my classes, speeches, and advisory work. “You don’t learn from your successes,” I point out, “but rather from your errors.” But do we really learn from our mistakes as a matter of course? My friend and colleague ...

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shutterstock_173620244 This is one of those columns that will risk the respect and friendship of some of my closest colleagues in the health care world.  In addition to disagreeing with me, they may argue that I am giving aid and ammunition to "the enemy," where the enemy might be viewed as those forces in the health care world who really don't want ...

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A colleague once said, “Every plan is excellent, until it’s tested. It’s execution that’s the problem.” And so it is. Clay Shirky wrote an excellent article about the gulf between planning and reality. Although the focus was on the misadventures of Healthcare.gov, the US government’s insurance exchange website, the broader lessons that he presents are worthy of consideration in many other settings. Shirky notes: "The management question, when trying anything new, is 'When ...

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Here’s a familiar story in America’s hospitals. An “old fashioned” surgeon decides that the protocols and procedures put in place by the medical executive committee or other governing body don’t apply to him. “I’ve done it this way for 30 years, and it works fine. I’m the busiest surgeon here, and no one is going to tell me how to do my job.” People in the risk management field will advise ...

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Now that I am a "civilian," I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that ...

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The time has come to drive a stake through the heart of an oft-repeated assertion. How often have you heard something like the following when those of us in healthcare who want to stimulate quality and safety improvements draw analogies to the airline industry? "Well, in an airplane, the pilot has an extra incentive to be safe, because he will go down with the ship. In contrast, when a doctor hurts a ...

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An excerpt from How a Blog Held Off the Most Powerful Union in America. The long-term decline in private sector unions in America has been well documented. From almost 25 percent of the workforce in 1973, the rate of unionization has fallen to under 8 percent in 2005. Some unions, though, have been able to buck this trend, most notably the 2.1 ...

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Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness. Now, the health care connection.  As a result of the billions of ...

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Malpractice lawsuits are a necessary evil in our society.  At times, they are frivolous, often resulting from a patient’s or family’s anger at a result that was not what they had hoped.  Some are actually designed just to try to get a financial settlement.  When doctors are sued for malpractice, it is a searing process, isolating and painful.  I have known several excellent doctors who have given up established practices ...

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An excerpt from Goal Play!: Leadership Lessons from the Soccer Field. I recently had lunch with one of my soccer alumnae, now aged 28. Tovah said to me, “Do you remember that play I made in the tournament we went to in Connecticut?  I mean when I mistakenly headed the ball into our own goal and caused us to lose the game.” “Well, I was devastated and was sitting on the ...

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A quality-driven MD colleague writes with frustration about two problems in his academic medical center.  I often hear similar comments from nurses and doctors, and so I present the examples for your consideration. This hospital has a poor record with regard to hand hygiene (in the 30% range), and my colleague suggested at an infection control meeting suggested that the rates be publicly posted in the hospital to provide an impetus for ...

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Back in 2009, Dr. Amy Ship gave a moving acceptance speech when she received the annual Compassionate Caregiver Award from the Schwartz Center. The most memorable tag line from the speech was, "There is no billing code for compassion." This resonated with so many of us -- patients and providers -- in part because it set forth the proposition that compassionate care should be an inherent aspect ...

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One aspect of religious dogma that has entered the medical world is that fee-for-service pricing of medical services is bad and should be replaced by a capitated, or global, arrangement that establishes an annual budget for care for different risk groups of patients. Like other religious beliefs, this is often offered without rigorous analytic support. Some insurance companies are particularly pleased ...

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Proton beam therapy is an effective modality for killing certain types of cancer cells. New England and the Northeast are fortunate to have a proton beam machine at Massachusetts General Hospital, where it has been in use for some time effectively treating patients. This is a valuable resource, serving the entire region and beyond. But what happens when everyone wants one? Well, we see the medical arms race at work again. These ...

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The talk around the country among health insurance companies is that their insurance business is dying. What is happening? First, the consolidations in other industries, resulting in large, multistate corporations, already mean that many companies self insure their employees. Even many local firms have large enough work forces that they can be self-contained risk pools. (One source I found says that in 2008, 89 percent of workers employed in ...

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Is the move towards accountable care organizations (ACOs) and capitated (aka, global) payments likely to reduce health care costs and insurance premiums, or will it do the opposite? Being an economist, my answer will be, "On the one hand ... On the other hand ..." On the one hand, ACOs offer the potential for a better integration of care across the spectrum of primary care, hospitalization, skilled nursing, rehabilitation, and hospice. If ...

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This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think that is just a sign of the times. Hospitals face a similar issue, too. Doctors are certainly next in line. But the Massachusetts insurers have an additional problem. They have been ...

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There are strange things going on in the Massachusetts health care insurance market. For those from out of state, here are some quotes that will give you a sense of the contradictions in the public policy arena. They are, respectively, from two stories that appeared on the same day in the Boston Globe: "Rate cap for insurer overturned" and "Officials give up cutting health perks."

1. An insurance ...

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My suggestion last year that Massachusetts move away from the "free market" approach it uses to set hospital reimbursement rates was not well received by the hospital world. But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, "Well, maybe. What would it look like?" There is a range of options. Let me lay out ...

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