In: Mandatory Choice

This has always been baffling:

Even more surprising, nearly 50 percent of the nation’s health-care workers also ignore the reminder [to get a flu shot]. (Chicago Tribune)

As providers weigh the risks of impending H1N1 doom this flu season there are plenty of strategies in place to improve that number…including the dreaded M word: mandatory.  Or, reframed as choice: take the shot(s) or wear a mask.

In: Accountability

I was ready to make a health care comparison using a line from a New York Times article about the failures of higher education,  instead of:

But it won’t solve the system’s biggest problems — the focus on enrollment rather than completion, the fact that colleges are not held to account for their failures.

It could read:

But it won’t solve the system’s biggest problems — the focus on procedures rather than value, the fact that health care is not held to account for their failures.

But then the article did all the work for me:

There is a real parallel here to health care. We pay doctors and hospitals for more care instead of better care, and what do we get? More care, even if in many cases it doesn’t make us healthier.

The era of accountability has just started to shine its light…

In: Staying busy (and making sense)

It’s truly astonishing how so many individuals in health care juggle a gaggle of demanding roles, especially those that do things well.  A description of how Dr. Atul Gawande keeps it all straight in “Harvard Magazine:”

This kind of effortless toggling between tasks helps explain how Gawande can keep so many balls in the air. Certain other habits also contribute. He arrives precisely on time—not late, but not early either. He leaves swiftly when meetings end, as others linger to chat. There is nary an idle moment in his day. He saves his writing for the hours between 7 and 11 a.m. and 4 and 7 p.m. to capitalize on the body’s circadian rhythms. And it helps that he isn’t bothered by a lack of downtime.

The entire article is worth the read.

Extra: Dr. Gawande cemented his position on my list of favorite people with this (via Jay Parkinson) NPR interview and this great quote that has me “harrumphing:”

That’s the disaster of our system, when you have medicine become a business rather than something about what the patient’s needs are.

Oh, and this from an interview with Ezra Klein.  Current reform efforts are focusing on insurance reform which, to borrow from the quality improvement vocabulary, is not the root cause of rising costs.  Here’s what Dr. Gawande says about that:

I had a hard time connecting the dots. My vantage point on the world is the operating room where I see my patients. And trying to think about whether a public option would change anything didn’t connect. I order more than $50,000 worth of health care in a day. Would a public or private option change that?

People say that the most expensive piece of medical equipment is the doctor’s pen. It’s not that we make all the money. It’s that we order all the money. We’re hoping that Medicare versus Aetna will be more effective at making me do my operations differently? I don’t get that. Neither one has been very effective thus far.

In: Simplicity is Difficult

Larry Cheng at Thinking About Thinking:

Over the years, I have come to appreciate that building a product, service or application that is defined by its simplicity is extraordinarily hard.  It takes real talent and ingenuity to create simplicity.  And once you have achieved it – it is as real a barrier to entry as a slew of patents or technical secret sauce.  Simplicity is that valuable.

Simplicity is difficult.  But that’s the beauty.  And the opportunity.

In: The Oracle

Warren Buffett:

To be a successful investor, you don’t need to understand higher math or law. It’s simple, but not easy. You do have to have an emotional stability that will take you through almost anything. If you have 150 IQ, sell 30 points to someone else. You need to be smart, but not a genius. What’s most important is inner peace; you have to be able to think for yourself. It’s not a complicated game.

Seems like a good management thought, too.

In: Apologies

I’m sorry:

For example, with a new policy on apologies, Toro, the lawn mower folks, reduced the average cost of a claim from $115,000 in 1991 to $35,000 in 2008—and the company hasn’t been to trial since 1994. The VA hospital in Lexington, Massachusetts, developed an astonishing approach to apologizing for errors (forthcoming—even when no patient request or claim was made). In 2000, the overall mean VA system malpractice settlement was $413,000. The Lexington VA hospital settlement # was $36,000—and there were far fewer per patient claims to begin with.