October 16th, 2011 by Linda Burke-Galloway, M.D. in True Stories
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The story of Tanya* is compelling. She was 24 weeks pregnant with her third child and the hospital was threatening to send her home. Two years ago, she faced similar circumstances and delivered a baby at 23 weeks. Luckily, the baby is now two years old but the one before that was not so lucky. Tanya presented to a local hospital during her first pregnancy because of complaints of abdominal pain. She was sent home because her contractions “weren’t regular.” Ten hours later, Tanya returned to the hospital because of a “nagging feeling that something was wrong” although her contractions were still not regular. Unfortunately, her cervix was dilated and the contractions could not be stopped. Her son was born alive but died one hour later because the hospital was not equipped to deal with premature newborns. Tanya’s second pregnancy was similar to her first because she developed premature contractions again, at 23 weeks. As with the first pregnancy, her contractions were not strong and regular so she was discharged home from the hospital with a monitor that was supposed to help. It didn’t. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
October 11th, 2011 by Iltifat Husain, M.D. in Opinion
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Doctors love their Apple Products. Just walk into any hospital ward, and see the types of mobile devices we are using. At weekly Grand Rounds conferences, you see plenty of iPads in use. At physician meetings, the laptop of choice is often the Macbook Pro. The data backs these anecdotal examples as well.
Doctors love their Apple Products – and Steve Jobs was obviously an extension of these products, often times cited as the singular force behind these products, and it’s why physicians who love his products mourn his passing.
There are three specific reasons why :
1) Simplicity
In medicine, we deal with enough complexity. Knowing disease pathology and the mechanism of various illnesses and their treatments is a fascinating exercise, but it’s taxing. For every known in medicine, there are at least five unknowns. It’s what makes being a physician exciting, but stressful as well. We’re always on high alert – especially those of us who practice in the critical care arena.
Juxtaposed to this is Read more »
*This blog post was originally published at iMedicalApps*
October 10th, 2011 by Happy Hospitalist in Humor
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The airline industry was a lot like physician practices several years ago. Costs were rising all around them while stagnant revenue caused declining margins. Well, this is America, not North Korea. How did the airline industry survive and thrive (except for American Airlines)?
- Efficiency
- Add on revenue opportunities
Physician offices are just now catching on. What can doctors learn from the airline industry? Here’s picture proof of efficiency in action.
Text from Sister Happy: Here’s how I just checked in at my orthopedists…it’s all by kiosk now. Have to say…they were faster and nicer than many receptionists. Only problem is… Read more »
*This blog post was originally published at The Happy Hospitalist*
October 8th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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Mechanism Design has demonstrated that the most efficient systems are created when everyone’s vested interests are aligned.
“An example is defense contracting. If you agree to pay on a cost plus basis you have created incentive for the contractor to be inefficient.
The defense contractor will build enough extra into a fixed price system to account for cost overruns. The cost overrun would be permitted in the rules if the price was transparent. If there were no cost overruns the contractor’s profit would be increased. It would provide incentive to be efficient.
“If you agree to pay a fixed price, you can come close to an efficient price if you have all the truthful information.”
A reader wrote,
Stanley:
History has proven over and over again that only the market mechanism of willing sellers and willing buyers is the optimal way to allocate economic resources. This presumes an informed buyer, and a willingness of sellers to compete for buyers. Adam Smith was clear on this in the Wealth of Nations.
If incentives are aligned and truthful price information is available an efficient system is created. Most stakeholders think they can do better by not sharing truthful information. If the rules of the game require truthful information the system can become an efficient market driven solution.
The healthcare system must become market driven. At present Read more »
*This blog post was originally published at Repairing the Healthcare System*
October 7th, 2011 by admin in Opinion, Research
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It’s been more than five years since Henry Mintzberg released the enlightening book ‘Managers, not MBAs’, a well-reasoned criticism of prevailing management education that basically revolves around Master in Business Administration (MBA) programs. Financial crisis was not even in sight but Mintzberg, a professor at McGill University in Montreal and one of the most important guiding lights in the questionable field of management, already pointed out that it was a serious danger for modern organizations to rely on professionals that had just finished their MBAs as the prime source for senior managerial positions.
Mintzberg focused his criticism on two essential aspects. First, most programs are aimed at people with no previous experience or knowledge about organizations and how they look like from the inside… and these same people then storm into companies believing that the real world works exactly as business school taught them it does. The second point is that many of these business schools spread a perverted set of values, such as the hunt for short-term profit, the belief that a good aim justifies any means and the urge to translate all human behaviors into accountable figures (the ‘countophrenia’ depicted by Vincent de Gaulejac in his must-read ‘La Société Malade de la Gestion’).
Then the crisis rose, and many CEOs of the biggest organizations had their share of responsibility for it, as they were enjoying multi-million dollar bonuses while taking their companies to the edge of bankrupcy. Most of them came from the most famous business schools in the world. I have outlined in the past the outrageous conflict of interests of many of these institutions, starting with Harvard, as Charles Ferguson perfectly displayed in his brilliant documentary ‘Inside Job’.
‘Social Science and Medicine’ published in its August issue a very interesting work by Amanda Godall, professor at the IZA Institute for the Study of Labor in Bonn, Germany. Godall’s is the first empirical research on the correlation between hospital results and having MDs in their top managerial positions. Read more »
*This blog post was originally published at Diario Medico*
The story of Tanya* is compelling. She was 24 weeks pregnant with her third child and the hospital was threatening to send her home. Two years ago, she faced similar circumstances and delivered a baby at 23 weeks. Luckily, the baby is now two years old but the one before that was not so lucky. Tanya presented to a local hospital during her first pregnancy because of complaints of abdominal pain. She was sent home because her contractions “weren’t regular.” Ten hours later, Tanya returned to the hospital because of a “nagging feeling that something was wrong” although her contractions were still not regular. Unfortunately, her cervix was dilated and the contractions could not be stopped. Her son was born alive but died one hour later because the hospital was not equipped to deal with premature newborns. Tanya’s second pregnancy was similar to her first because she developed premature contractions again, at 23 weeks. As with the first pregnancy, her contractions were not strong and regular so she was discharged home from the hospital with a monitor that was supposed to help. It didn’t. Read more »
