You Can Unleash This Horsepower!

Paul Levy

Posted 5/6/12 on Not Running a Hospital

Among the great hospital leaders in America, Jeffrey Thompson, CEO of the Gundersen Lutheran Health System in Wisconsin, stands out for going beyond achieving marvelous results in patient quality and safety.  Jeff’s commitment that his system will not accept mediocrity shows up in other arenas as well.  He and his board have adopted a corporate strategic plan that sets a goal of being “the best regionally and nationally on environmental stewardship and accountability.”

This is outlined in a recent keynote speech he gave at CleanMed 2012 in Denver.  Jeff pointed that hospitals have a large impact on the environment and on public health because of their use of electricity.  Noting that his system alone produces 500,000 pounds annually of airborne particulates tied to its electricity consumption, he concluded that reducing that impact can and should be tied into the culture of a health care institution.  He asserted, “We are going to be responsible to members of the community.  We are going to be transparent, and we are going to act to fix things.”

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The Great Experiment

Paul Levy

If you read only one book about state and federal health care policy, it should be The Great Experiment: The States, the Feds and Your Healthcare.  Published by the Boston-based Pioneer Institute, it is the most articulate and rigorous presentation of issues that I have seen, a stark contrast from many papers, articles, and speeches that slide by as “informed debate” in Massachusetts and across the country.  I learned more about health care policy from this book than from anything else I have read in the last decade.

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How To Get Better At Harming People Less

Paul Levy

Posted 4/09/12 on Not Running a Hospital

Every day, a 727 jetliner crashes and kills all the people on board.  Not really.  But every day in America, the same number of people in American hospitals lose their lives because of preventable errors.  They don’t die from their disease.  They are killed because of hospital acquired infections, medication errors, procedural errors, or other problems that reflect the poor design of how work is done and care is delivered.

Imagine what we as a society would do if three 727s crashed three days in a row.  We would shut down the airports and totally revamp our way of delivering passengers.   But, the 100,000 people a year killed in hospitals are essentially ignored, and hospitals remain one of the major public health hazards in our country.

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Free Our Data and Improve Public Health!

Paul F. Levy and W. David Stephenson

Published in the current issue of the Boston Business Journal

Massachusetts has a stunning opportunity to break open many of the mysteries surrounding delivery of health care. Doing so will help resolve important public policy issues. It will help contain rising health care expenses. And, it will even help save lives and improve the public health.

Doing this requires no new state law. The law is already on the books. It requires no addition to the state budget. The costs have already been incurred.
What could cause so dramatic an impact? Liberating data that is already in the hands of the state government.

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Pay Some Doctors More to Save Money

Paul Levy

Posted 3/26/12 on Not Running a Hospital

One of the strange things about health care in America is the manner in which decisions are made about how different kinds of doctors should get paid for their services.  It turns out that the system is controlled in a way most consumers would find unbelievable. As noted by the Wall Street Journal:

 

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

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Our Aim Is At 100%. Other Than That, We Are At Zero

Paul Levy

Posted 3/21/12 on Not Running a Hospital

The power of transparency, as I have noted, is that it provides creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.

MIT’s Peter Senge explains this more fully in his book The Fifth Discipline:

[T]he gap between vision and current reality is . . . a source of energy. If there was no gap, there would be no need for any action to move toward the vision. Indeed, the gap is the source of creative energy. We call this gap creative tension.

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Stop Smiling. It’s Not Good Enough

Paul Levy

Posted 3/13/12 on Not Running A Hospital

Ok, call me a sourpuss, or call me a contrarian, but I am put off by the self-satisfaction evident in this graphic in the Boston Globe. To be fair to the newspaper, its coverage reflects how the story about a reduction in the rate of central line infections was reported by the state Department of Public Health’s Bureau of Health Care Quality and Safety. That report presents data for the period July 1, 2009 through June 30, 2011.

The good news is that the rate of such infections dropped by 24% during that period. The bad news is inherent in this description:

Central Line Associated Blood Stream Infections (CLABSIs): A central venous catheter (CVC), sometimes known as a central line, is a special type of flexible tube that is placed through the skin into a large vein in a patient’s chest, arm, neck or groin and ends in or close to the heart or one of the major blood vessels. . . . While central venous catheters are considered an essential part of providing critical care, their use also places patients at increased risk for infection. Central line associated blood stream infections (CLABSIs) are serious, costly, and most can be prevented by following accepted practices for inserting and caring for central lines (my emphasis).

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