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April 2014 Archive for High Reliability Healthcare

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Systemic solutions to analyze underlying causes of specific care breakdowns and improve overall quality.

Taking care of my parents


Apr 23, 2014 | Comments (1) | 8876 Views

Ana Pujols McKee, M.D.Ana Pujols McKee, M.D.
Executive Vice President and Chief Medical Officer
The Joint Commission

My father died the day after Christmas. It would have been much earlier had I not stepped in.

His last six months – after being moved to the city in which my sister and I live – saw him under the care of physicians and nurses that understood his goals of care and what mattered to him most. This was in striking contrast to the disjointed care, with seemingly endless tests, his physicians had imposed on him in his home city.

We know the reasons for overuse of medical treatments and tests are multifactorial. We also know that most of the time, the clinician has good intentions. But ordering dangerous tests for frail elderly patients who do not want them demonstrates lack of both knowledge and caring.

With first-hand experience with this dangerous situation, I proposed a call to action in JAMA Internal Medicine.

Taking a stand against costly and complex


Apr 16, 2014 | Comments (0) | 4872 Views

By Daniel J. Castillo, M.D., M.B.A.
Medical Director
The Joint Commission

In 2006, McKinsey Global Institute compared health care spending by country and concluded the U.S. spent nearly $650 billion more than other developed countries on health care. You read that right – $650 billion.

You might think this large discrepancy was caused by our population being sicker, but it’s not. Instead, the factors identified were the growing capacity of outpatient services, the cost of technological innovation, and the increase in patient demand in response to the available services. Approximately $91 billion, or 14 percent of the total, was due to inefficiencies or redundant administrative practices. More recently, former CMS administrator Donald Berwick estimated that waste consumed between $476 to $992 billion, or 18-37 percent of health care spending, in 2011.

No wonder the U.S. health care system has been described by The Institute of Medicine (IOM) as far too complex and costly. And those are not the only alarming statistics. Despite this higher spending, studies have shown that compared with other developed nations, the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity and healthy lives.

It’s this alarming trend that I tackle in an upcoming article in The Journal of Integrated Healthcare Delivery. In the article, I begin to lay out a roadmap to assist the adaptation of organizations’ delivery models from fragmented and costly to integrated and efficient.

Please stay tuned for this upcoming article, and to this blog, as we try to better our health care systems.

Taking care of my parents


Apr 02, 2014 | Comments (0) | 4504 Views

Ana Pujols McKee, M.D.By Ana Pujols McKee, M.D.
Executive Vice President and Chief Medical Officer
The Joint Commission

My father died the day after Christmas. It would have been much earlier had I not stepped in.

His last six months – after being moved to the city in which my sister and I live – saw him under the care of physicians and nurses that understood his goals of care and what mattered to him most. This was in striking contrast to the disjointed care, with seemingly endless tests, his physicians had imposed on him in his home city.

We know the reasons for overuse of medical treatments and tests are multifactorial. We also know that most of the time, the clinician has good intentions. But ordering dangerous tests for frail elderly patients who do not want them demonstrates lack of both knowledge and caring.

With first-hand experience with this dangerous situation, I proposed a call to action in JAMA Internal Medicine.

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