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• My Patients Are Dying… And I’ve Never Been Prouder

  I’m on clinical service now and my patients are dying left and right. And I’ve never been prouder of my own care, and that delivered by my colleagues and hospital.When I was in training, a patient’s death was invariably considered a medical failure, and Read More... Posted Thu, Nov 27 2008 8:16 PM by Bob Wachter | 6 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Health Policy, Medical Ethics

• The New (CMO) Math: Passion + Power = Progress

  In his five years on the job, Dr. Ernie Ring taught me why the Chief Medical Officer role is crucial, and how to do it right. Since Ernie is retiring at week’s end, it seems like an opportune time to share what I’ve learned.A bit of background. UCSF Medical Read More... Posted Wed, Jun 25 2008 8:36 AM by Bob Wachter | 3 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• Why Diagnostic Errors Don’t Get Any Respect… And What Can Be Done About It

  I gave a keynote yesterday to the first-ever meeting on “Diagnostic Error in Medicine.” I hope the confab helps put diagnostic errors on the safety map. But, as Ricky Ricardo would say, the experts and advocates in the audience have some ‘splainin’ to Read More... Posted Mon, Jun 02 2008 4:20 AM by Bob Wachter | 5 Comments Filed under: Quality Measurement, Medical Education/Academia, Diagnosis/Clinical Reasoning, Information Technology, Patient Safety/Medical Errors, Industry/Pharma, Health Policy, Media/Press Coverage

• The Great Quality Debate: Berwick’s Plea for Action vs. Evidence-Based Medicine

  In this week’s JAMA, Dr. Don Berwick, CEO of the Institute for Healthcare Improvement, argues that evidence-based standards should be relaxed for quality improvement practices. Ironically, a few pages away, a Swiss study finds than an IHI-endorsed MRSA Read More... Posted Mon, Mar 17 2008 11:59 PM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• The Checklist Saga: Victory!

  I must admit, I didn’t hold out high hopes that a ragtag band of committed clinicians and other quality improvers could change federal policy. But we’ve done just that. If the Feds are capable of rectifying this mistake, who knows what might be next! Read More... Posted Sat, Feb 16 2008 7:24 PM by Bob Wachter | 5 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• Time to Write Congress re: The Checklist Debacle

  Thanks to all of you who have taken the time to write, blog, and rant about the OHRP's horrific decision to shut down the Hopkins-Michigan ICU checklist study, a decision that threatens the future of quality improvement and safety efforts in American Read More... Posted Fri, Feb 15 2008 5:52 AM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• Is Medicare’s “No Pay for Errors” Plan a Good Idea?

  In this month’s issue of the Joint Commission Journal of Quality and Patient Safety, I (with UCSF’s Adams Dudley and the American Hospital Association's Nancy Foster) tackle this provocative question. The answer may surprise you: yes (probably). The devil Read More... Posted Mon, Feb 11 2008 7:34 AM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Pay-for-performance, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Nurses/Nursing, Media/Press Coverage

• Did I Violate Federal Regulations Today? (I Hope So)

  The patient safety and quality movements are precious and fragile. Just as IOM reports I and II spawned these modern, life-saving revolutions, the Federal shutdown of the Hopkins/Michigan checklist program may help extinguish them. After all, Tipping Read More... Posted Wed, Jan 16 2008 7:39 AM by Bob Wachter | 8 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• Bureaucracy Run Amok: Can Checklists Kill?

  As you may know, I’ve argued that that the quality and safety of healthcare have traditionally been underregulated. But regulators are like patients with Parkinson’s: it’s hard to get them unglued, but once they’re moving, it’s hard to stop them. Welcome Read More... Posted Fri, Jan 11 2008 4:16 AM by Bob Wachter | 10 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• Today’s New England Journal Hospitalist Study

  Today my pals Peter Lindenauer and Andy Auerbach (and colleagues) published the largest hospitalist outcomes study to date, in the New England Journal of Medicine. It is a rigorous, important piece of work. Let me try to add a bit of context. First, the Read More... Posted Thu, Dec 20 2007 9:05 AM by Bob Wachter | 2 Comments Filed under: Hospital Care, Quality Measurement, Efficiency, Medical Education/Academia, Hospitalists/Hospital Medicine, Ambulatory/Primary Care, Health Policy

• More on Quality Reports: Lessons From SAT Scores

  My older son is gearing up to apply to college (:-\ and so I bought him one of the Bibles, the Fiske Guide. The book is cleverly written – enough academic factoids to get parents to spring for it, leavened with enough social scene skinny to get kids to Read More... Posted Fri, Dec 14 2007 2:42 AM by Bob Wachter | 1 Comments Filed under: Transparency and Reporting, Quality Measurement, Medical Education/Academia, Health Policy

• Rating Doctors Like Restaurants

  So Zagat will now be rating doctors, using the methods it perfected helping you find the best sushi in Brooklyn Heights. What’s next, Consumer Reports rating grad schools? Fodor rating auto mechanics? Whatever you think of Zagat’s cross-dressing, it again Read More... Posted Sun, Oct 28 2007 5:57 AM by Bob Wachter | 4 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Information Technology, Ambulatory/Primary Care

• Are Hospitalists Killing Primary Care, Redux

  The comments to my original post on this topic are so striking and passionate that I wanted to answer them in a new post rather than as another comment. First, "LPrieto" wrote, "I think the death of outpatient general Internal Medicine is inevitable." Read More... Posted Thu, Oct 25 2007 11:12 PM by Bob Wachter | 9 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Ambulatory/Primary Care

• Can Computerized Decision Support Get Docs to Toe the Line on Quality?

  A humorous and telling story about quality measurement, decision support, and human nature: I was visiting professor at a very good academic medical center a year or so ago. On these trips, one of the fun things I get to do is meet with the residents. Read More... Posted Wed, Oct 10 2007 3:47 AM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Information Technology

• No Patient Left Behind?

  While driving into work earlier this week, I heard a wonderful interview with Jim Dierke, principal of Visitation Valley Middle School here in San Francisco. VV is one of the poorest neighborhoods in the city, and this gentleman – who recently won a national Read More... Posted Tue, Oct 09 2007 9:57 PM by Bob Wachter | 0 Comments Filed under: Hospital Care, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Diagnosis/Clinical Reasoning, Health Policy