The American healthcare system is broken. Patients are dissatisfied. Providers are unhappy. Costs are too high. Services with no value are far too common. I have pointed to the landmark book from the National Academy of Medicine (NAM) Crossing the Quality Chasm
Hi, Bill. Great entry today. It’s not entirely correct that “we have done nothing” with the QI method. In the early to mid-90s Don Berwick and his colleagues at the IHI ran a number of collaborative QI projects, and these were very successful. One such success significantly lowered the amount of time patients were post-op on with breathing tubes and in the ICU when removal was clinically indicated. There were many other. Characteristically, these efforts involved multiple hospitals and small groups of clinicians working both independently and then comparing data and results. It was very exciting to see how easy it was to accomplish better outcomes when guided by a proven methodology and data. However, as hospital competition heated up and making profit became more and more the goal of health care, it was increasingly difficult to put the QI collaborative methodology to practice. I was personally involved in QI at this time as a trainer, and I remember that some hospital administrators became worried about lengths of stay decreasing for some patients, which decreased reimbursement. It all sort of died away.
That's correct. I agree with everything you say. Still, we have barely begun the deep reengineering the NAM is calling for. Since 2001, little has changed and the potential is better than ever.
Hi, Bill. Great entry today. It’s not entirely correct that “we have done nothing” with the QI method. In the early to mid-90s Don Berwick and his colleagues at the IHI ran a number of collaborative QI projects, and these were very successful. One such success significantly lowered the amount of time patients were post-op on with breathing tubes and in the ICU when removal was clinically indicated. There were many other. Characteristically, these efforts involved multiple hospitals and small groups of clinicians working both independently and then comparing data and results. It was very exciting to see how easy it was to accomplish better outcomes when guided by a proven methodology and data. However, as hospital competition heated up and making profit became more and more the goal of health care, it was increasingly difficult to put the QI collaborative methodology to practice. I was personally involved in QI at this time as a trainer, and I remember that some hospital administrators became worried about lengths of stay decreasing for some patients, which decreased reimbursement. It all sort of died away.
That's correct. I agree with everything you say. Still, we have barely begun the deep reengineering the NAM is calling for. Since 2001, little has changed and the potential is better than ever.
Bill is correct. The system is corrupt. All so-called “innovations” are window dressings, without substance. It was just a show.