Improving leadership in healthcare: a strategy for everyone else

In my previous blog, I made the argument that whatever strategy we use to improve care in hospitals will not be implemented and executed well without proper focus by hospital leadership.  So, it is in this context, that we recently published some pretty disappointing findings that are worth reflecting on. We examined the pay of CEOs across U.S. hospitals and found that some CEOs got paid a lot more than…

Leadership and learning (but not too much) from the best hospitals

I was recently chastised by a colleague for being too negative in one of my pieces on hospital care. His is a remarkable story of what happens when things go well, and it has made me think a lot about why, in some places, things seem to work while in others, not so much. He told me how a few months ago, soon after returning to Boston from a trip to…

In the Race for ‘Fanciest Hospital In Town’, Patient Safety Loses Out

The following two paragraphs are an excerpt from a post on Cognoscenti (cognoscenti.wbur.org). Read the full post.  Did you hear about the hospital that spent $100 million to eliminate medical errors? Or the large healthcare system that guaranteed patient safety, fully compensating any patient who was harmed?  You might have missed these stories because, as far as I know, they didn’t happen. But as hypothetical scenarios they make an interesting…

Readmissions and Surgical Quality: Finally some good news

Co-written with Thomas Tsai, MD, MPH, Department of Surgery, Brigham and Women’s Hospital       Why readmission penalties are controversial Penalizing hospitals for high readmission rates has been pretty controversial.  Critics of the program have argued that readmissions have little to do with what happens while the patient is in the hospital and are driven primarily by how sick or how poor the patient is.  Advocates of the readmissions…

Average care at a typical hospital on an ordinary Sunday

The Bike Path: On a warm and sunny August Sunday, I was rollerblading with my kids on the Shining Sea Bikeway. On mile nine on the trip, I hit a tree root, went flying, and landed on my shoulder.  I could tell immediately that something was wrong — I couldn’t move my arm and was in the worst pain of my life. Feeling for my left shoulder, it was obvious…

A strong start on a long path

Just a little over four years ago, President Obama, in his inaugural address, challenged us a nation to “wield technology’s wonders to raise health care’s quality and lower its costs.”  This was an awe-inspiring, “we will go to the moon” moment for the healthcare delivery system.  But the next thought that ran through the minds of so many of us who work on health IT issues was this: how were…

“Healthcare” lands: Announcing the Journal of Delivery Science and Innovation

There is an old saying that every unsustainable trend, by definition, comes to an end.  The U.S. healthcare system has been on an unsustainable trajectory, consuming more and more of our national income while failing to deliver the kind of care that Americans need and deserve.  But although every unsustainable trend eventually ends, how it ends is up to us.  The healthcare system has the potential to collapse under its…

Racial Disparities In Health Care: Justin Dimick And Coauthors’ June Health Affairs Study

Racial disparities in health and healthcare are a persistent and troubling problem for the U.S.  Despite substantial policy efforts to the contrary, racial and ethnic minorities, especially African-Americans, often receive a lower quality of care and have worse outcomes.  The key questions, of course, are why do these disparities exist, and what might we do about them? Over the past decade, two primary theories have emerged to explain disparities and…

Oregon Revisited

It has been a couple of weeks since the landmark Oregon Experiment paper came out, and the buzz around it has subsided.  So what now?  First, with passage of time, I think it is worth reflecting on what worked in Oregon.  Second, we should take a step back, and recognize that what Oregon really exposed is that health insurance is a small part of a much bigger story about health…

Misunderstanding Oregon

Much has already been written about the Oregon Medicaid study that just came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection.  The study seems to serve as a Rorschach test of sorts, confirming people’s biases about whether Medicaid is “good” or “bad”.  The proponents of Medicaid point to all the ways in which Medicaid seems to help those who were enrolled…