Healthcare Reform
Activating Patients - The Achilles Heel of Heathcare Reform?-
Studies show 25% of the population is not involved in their healthcare, but reform efforts assume wider application of evidence-based medicine is the key to better value. Perhaps it is the Achilles' Heel?
Clinical Microsystems
Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform.
CQI - Wave of the Future -
An editorial advocating CQI as a method of clinical accountability.
Medical Evidence -
Medical evidence is a four-source: guidelines, registries, data mining and " in my experience".
Different clinical situations use different types of evidence and have different implications for
provider behavior. These implications are considered in detail.
On Change -
Why do people change? A consideration of the desirable future state.
On Failure -
Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A
consideration of how to tolerate failure.
Opting Out vs. Opting In -
EMR's have changed the way orders are given in ways that have unintended consequences. The
article considers the power of opting out vs. opting in as a means to improving care.
Rationing -
Rationing is a dirty word, but a necessary part of healthcare reform. A consideration of
the implication of this for practicing physicians.
Shared Decision Making -
A consideration about decision making at the person, group and organizational levels.
The Case for Physician Leadership -
Why the successful healthcare organization of the future must find a way to create physician
leadership if it is to achieve the IHI Triple Aim.
The Tragedy of the Commons -
Recognizing the Commons is critical for success in an era of rapid change.
Thoughts on Clinical Realities -
An extended discussion of important clinical analogies that make most schemes for healthcare
reform unlikely to succeed.
West Tennessee Health Care -
A presentation making an argument for integrated healthcare.
What Business Are We In? -
All healthcare organizations have both a clinical and a business function. The proper balance
is crucial for success.
What Do I Owe? -
A discussion of unexamined assumptions about what physicians owe their hospitals.
Institutions
Assumptions -
Doctors and hospitals operate with different cultures and unexamined assumptions may cause
conflict.
Building Resilient Dialysis Units -
An extended presentation showing how CQI and clinical data-driven leadership can create
resilient dialysis units capable of achieving superior clinical and financial results.
Clinical Integration 2008 -
A presentation about clinical integration aimed at physicians.
Clinical Integration for Administrators -
A presentation about clinical integration aimed at administrators.
Clinical Microsystems
Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform.
Culture Matters -
The scandal at the VA shows the importance of choosing performance measures wisely and the
need to consider organizational culture in applying standard management techniques.
How did you know?
How do experts know? The role of formal and tacit knowledge are considered.
Nursing Staff Turnover
If empowered teams of clinicians is the key to effective, efficient care, then staff turnover is Achilles' heel. Nationally, RN turnover exceeds the cap needed to maintain patient safety and quality of care. The problem and approaches to a solution are considered.
On Failure -
Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A
consideration of how to tolerate failure.
On Institutional Failure -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
On Institutional Failure, Part 2 -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
Patient-Centered Care -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Productivity in the Dialysis Unit -
A presentation about the role of the team in producing improved financial results in a constrained reimbursement environment.
Restoring the Commons -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Shared Decision Making -
A consideration about decision making at the person, group and organizational levels.
Teams and Learning Organizations -
A brief introduction to the concept of the learning organization for physicians.
The Case for Physician Leadership -
Why the successful healthcare organization of the future must find a way to create physician
leadership if it is to achieve the IHI Triple Aim.
The Problem of Scale -
Have we lost our moral compass as medical organizations have grown larger?
The Tragedy of the Commons -
Recognizing the Commons is critical for success in an era of rapid change.
What Business Are We In? -
All healthcare organizations have both a clinical and a business function. The proper balance
is crucial for success.
What Do I Owe? -
A discussion of unexamined assumptions about what physicians owe their hospitals.
Leadership
Building Resilient Dialysis Units -
An extended presentation showing how CQI and clinical data-driven leadership can create
resilient dialysis units capable of achieving superior clinical and financial results.
Clinical Microsystems
Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform.
Jaques' "Time Span of Discretion" and Physician Leadership.
Physicians choice of specialty is influenced by their tolerance for time-dependent complexity, which should be considered in choosing leadership projects.
Leadership in Medical Institutions -
A presentation to AMGA about physician leadership - why it is so rare and so difficult.
Leadership Styles -
A short presentation about medical leadership grafted onto a presentation.
Medical Director - Everything You Wanted To Know -
A presentation to DCI nurses as administrators on the effective medical director in removing
barriers that prevent the medical director from being effective.
Nursing Staff Turnover -
If empowered teams of clinicians is the key to effective, efficient care, then staff turnover is Achilles' heel. Nationally, RN turnover exceeds the cap needed to maintain patient safety and quality of care. The problem and approaches to a solution are considered.
On Being a Medical Director -
A presentation for nephrologists on being effective dialysis unit directors.
On Failure -
Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A
consideration of how to tolerate failure.
On Institutional Failure -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
On Institutional Failure Part 2 -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
Restoring the Commons -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Teams and Learning Organizations -
A brief introduction to the concept of the learning organization for physicians.
Teamwork -
Teamwork, like Mom and apple pie, is something everybody says they are for. But do we really
mean it?
The Case for Physician Leadership -
Why the successful healthcare organization of the future must find a way to create physician
leadership if it is to achieve the IHI Triple Aim.
Quality Improvement
Activating Patients - The Achilles Heel of Heathcare Reform?-
Studies show 25% of the population is not involved in their healthcare, but reform efforts assume wider application of evidence-based medicine is the key to better value. Perhaps it is the Achilles' Heel?
Building Resilient Dialysis Units -
An extended presentation showing how CQI and clinical data-driven leadership can create
resilient dialysis units capable of achieving superior clinical and financial results.
CQI 1992 -
A paper describing initial results using CQI to improve patient outcomes in dialysis units.
CQI 1996 -
A paper describing initial results using CQI to improve patient outcomes in dialysis units.
CQI - Wave of the Future -
An editorial advocating CQI as a method of clinical accountability
Culture Matters -
The scandal at the VA shows the importance of choosing performance measures wisely and the
need to consider organizational culture in applying standard management techniques.
EBM in the Dialysis Unit -
A presentation of 15 years experience with CQI in the dialysis unit; advantages and limitations.
How did you know?
How do experts know? The roles of formal and tacit knowledge are considered.
Medical Evidence -
Medical evidence is a four-source: guidelines, registries, data mining and " in my experience".
Different clinical situations use different types of evidence and have different implications for
provider behavior. These implications are considered in detail.
Opting Out vs. Opting In -
EMR's have changed the way orders are given in ways that have unintended consequences. The
article considers the power of opting out vs. opting in as a means to improving care.
Patient-Centered Care -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Productivity in the Dialysis Unit -
A presentation about the role of the team in producing improved financial results in a constrained reimbursement environment.
Activating Patients - The Achilles Heel of Heathcare Reform?-
Studies show 25% of the population is not involved in their healthcare, but reform efforts assume wider application of evidence-based medicine is the key to better value. Perhaps it is the Achilles' Heel?
Clinical Microsystems
Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform.
CQI - Wave of the Future -
An editorial advocating CQI as a method of clinical accountability.
Medical Evidence -
Medical evidence is a four-source: guidelines, registries, data mining and " in my experience".
Different clinical situations use different types of evidence and have different implications for
provider behavior. These implications are considered in detail.
On Change -
Why do people change? A consideration of the desirable future state.
On Failure -
Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A
consideration of how to tolerate failure.
Opting Out vs. Opting In -
EMR's have changed the way orders are given in ways that have unintended consequences. The
article considers the power of opting out vs. opting in as a means to improving care.
Rationing -
Rationing is a dirty word, but a necessary part of healthcare reform. A consideration of
the implication of this for practicing physicians.
Shared Decision Making -
A consideration about decision making at the person, group and organizational levels.
The Case for Physician Leadership -
Why the successful healthcare organization of the future must find a way to create physician
leadership if it is to achieve the IHI Triple Aim.
The Tragedy of the Commons -
Recognizing the Commons is critical for success in an era of rapid change.
Thoughts on Clinical Realities -
An extended discussion of important clinical analogies that make most schemes for healthcare
reform unlikely to succeed.
West Tennessee Health Care -
A presentation making an argument for integrated healthcare.
What Business Are We In? -
All healthcare organizations have both a clinical and a business function. The proper balance
is crucial for success.
What Do I Owe? -
A discussion of unexamined assumptions about what physicians owe their hospitals.
Institutions
Assumptions -
Doctors and hospitals operate with different cultures and unexamined assumptions may cause
conflict.
Building Resilient Dialysis Units -
An extended presentation showing how CQI and clinical data-driven leadership can create
resilient dialysis units capable of achieving superior clinical and financial results.
Clinical Integration 2008 -
A presentation about clinical integration aimed at physicians.
Clinical Integration for Administrators -
A presentation about clinical integration aimed at administrators.
Clinical Microsystems
Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform.
Culture Matters -
The scandal at the VA shows the importance of choosing performance measures wisely and the
need to consider organizational culture in applying standard management techniques.
How did you know?
How do experts know? The role of formal and tacit knowledge are considered.
Nursing Staff Turnover
If empowered teams of clinicians is the key to effective, efficient care, then staff turnover is Achilles' heel. Nationally, RN turnover exceeds the cap needed to maintain patient safety and quality of care. The problem and approaches to a solution are considered.
On Failure -
Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A
consideration of how to tolerate failure.
On Institutional Failure -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
On Institutional Failure, Part 2 -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
Patient-Centered Care -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Productivity in the Dialysis Unit -
A presentation about the role of the team in producing improved financial results in a constrained reimbursement environment.
Restoring the Commons -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Shared Decision Making -
A consideration about decision making at the person, group and organizational levels.
Teams and Learning Organizations -
A brief introduction to the concept of the learning organization for physicians.
The Case for Physician Leadership -
Why the successful healthcare organization of the future must find a way to create physician
leadership if it is to achieve the IHI Triple Aim.
The Problem of Scale -
Have we lost our moral compass as medical organizations have grown larger?
The Tragedy of the Commons -
Recognizing the Commons is critical for success in an era of rapid change.
What Business Are We In? -
All healthcare organizations have both a clinical and a business function. The proper balance
is crucial for success.
What Do I Owe? -
A discussion of unexamined assumptions about what physicians owe their hospitals.
Leadership
Building Resilient Dialysis Units -
An extended presentation showing how CQI and clinical data-driven leadership can create
resilient dialysis units capable of achieving superior clinical and financial results.
Clinical Microsystems
Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform.
Jaques' "Time Span of Discretion" and Physician Leadership.
Physicians choice of specialty is influenced by their tolerance for time-dependent complexity, which should be considered in choosing leadership projects.
Leadership in Medical Institutions -
A presentation to AMGA about physician leadership - why it is so rare and so difficult.
Leadership Styles -
A short presentation about medical leadership grafted onto a presentation.
Medical Director - Everything You Wanted To Know -
A presentation to DCI nurses as administrators on the effective medical director in removing
barriers that prevent the medical director from being effective.
Nursing Staff Turnover -
If empowered teams of clinicians is the key to effective, efficient care, then staff turnover is Achilles' heel. Nationally, RN turnover exceeds the cap needed to maintain patient safety and quality of care. The problem and approaches to a solution are considered.
On Being a Medical Director -
A presentation for nephrologists on being effective dialysis unit directors.
On Failure -
Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A
consideration of how to tolerate failure.
On Institutional Failure -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
On Institutional Failure Part 2 -
Institutions are not immortal. The failure of a local college is used to illustrate common pitfalls.
Restoring the Commons -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Teams and Learning Organizations -
A brief introduction to the concept of the learning organization for physicians.
Teamwork -
Teamwork, like Mom and apple pie, is something everybody says they are for. But do we really
mean it?
The Case for Physician Leadership -
Why the successful healthcare organization of the future must find a way to create physician
leadership if it is to achieve the IHI Triple Aim.
Quality Improvement
Activating Patients - The Achilles Heel of Heathcare Reform?-
Studies show 25% of the population is not involved in their healthcare, but reform efforts assume wider application of evidence-based medicine is the key to better value. Perhaps it is the Achilles' Heel?
Building Resilient Dialysis Units -
An extended presentation showing how CQI and clinical data-driven leadership can create
resilient dialysis units capable of achieving superior clinical and financial results.
CQI 1992 -
A paper describing initial results using CQI to improve patient outcomes in dialysis units.
CQI 1996 -
A paper describing initial results using CQI to improve patient outcomes in dialysis units.
CQI - Wave of the Future -
An editorial advocating CQI as a method of clinical accountability
Culture Matters -
The scandal at the VA shows the importance of choosing performance measures wisely and the
need to consider organizational culture in applying standard management techniques.
EBM in the Dialysis Unit -
A presentation of 15 years experience with CQI in the dialysis unit; advantages and limitations.
How did you know?
How do experts know? The roles of formal and tacit knowledge are considered.
Medical Evidence -
Medical evidence is a four-source: guidelines, registries, data mining and " in my experience".
Different clinical situations use different types of evidence and have different implications for
provider behavior. These implications are considered in detail.
Opting Out vs. Opting In -
EMR's have changed the way orders are given in ways that have unintended consequences. The
article considers the power of opting out vs. opting in as a means to improving care.
Patient-Centered Care -
A consideration of the interactions of patient preferences, evidence-based medicine and
peer review.
Productivity in the Dialysis Unit -
A presentation about the role of the team in producing improved financial results in a constrained reimbursement environment.