http://www.the-hospitalist.org/blogs/wachters_world/atom.aspxCommunity Server2008-06-25T08:36:00Zhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/10/03/a-year-of-blogging-dangerously.aspx2008-10-03T04:41:00Z2008-10-03T04:41:00ZWell, folks, time flies. Today marks the first anniversary of the launch of Wachter’s World. I’ve learned a lot in a year. For example, a year ago, I thought you became a Russia expert by reading books and newspapers, not by trans-waterway osmosis. Anyway, I thought I’d use the occasion of the anniversary to recount some of the blog's statistics and accomplishments, and to talk a bit about where we might be going in the year to come. I recognize that this comes in the midst of the Wall Street meltdown,...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/10/03/a-year-of-blogging-dangerously.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=409" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/30/the-color-coded-wristband-saga.aspx2008-09-29T23:27:00Z2008-09-29T23:27:00ZLast week’s New York Times front-page piece on colored wristbands highlighted an issue I’ve been fretting about for years. We can achieve consensus on a $700B bailout in 3 days (well, perhaps not), but can’t agree on what color a DNR wristband should be? Wow.My interest in this subject began with a remarkable case I first described in Internal Bleeding and later in Understanding Patient Safety. The story went like this:A young nurse in a teaching hospital goes in to visit her patient, an elderly...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/30/the-color-coded-wristband-saga.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=402" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/23/big-brother-arrives-monitoring-patient-safety-compliance-by-remote-video.aspx2008-09-23T07:18:00Z2008-09-23T07:18:00ZToday came the announcement that Suzanne Delbanco, founding director of the Leapfrog Group, has assumed the presidency of a company that tracks compliance with safety and quality practices via remote video. Big Brother, meet the Joint Commission.The report, in today’s Modern Healthcare, describes the process this way: Video auditing refers to a system in which cameras are mounted in targeted locations to continuously capture specific clinical processes, such as observing handwashing and hand-sanitizing...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/23/big-brother-arrives-monitoring-patient-safety-compliance-by-remote-video.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=387" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/11/why-the-medical-record-needs-to-become-more-like-facebook.aspx2008-09-11T05:29:00Z2008-09-11T05:29:00ZThe explosive growth of Facebook and MySpace illustrates the market for electronic tools to enhance communication and collaboration. Could there possibly be another workplace more in need of social networking tools than the modern hospital? If you are not familiar with Facebook, find yourself a teenager and take a look over his shoulder while he is using it (mine are available for rent if you get desperate; the best time to catch them is when they should be doing homework). In one thrilling, chaotic...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/11/why-the-medical-record-needs-to-become-more-like-facebook.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=380" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/03/the-latest-jibjab-campaign-satire.aspx2008-09-03T05:32:00Z2008-09-03T05:32:00ZMy Olympics addiction has been replaced by "All Conventions, All The Time." If you're a politics junkie like me, you'll love the latest hilarious campaign satire from the folks at JibJab, the ones who brought you the groundbreaking "This Land" knee-slapper in 2004.Check out the face on the guy who gets goosed by the politicians toward the very end of the video. Thanks to my colleague, UCSF hospitalist and IT-guru Russ Cucina, for bringing this new JibJab offering to my attention, and for the surprise...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/09/03/the-latest-jibjab-campaign-satire.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=377" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/27/npr-s-talk-of-the-nation-featuring-don-berwick-and-moi.aspx2008-08-27T18:08:00Z2008-08-27T18:08:00ZMedicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important, since "Talk of the Nation" spent 30 minutes yesterday interviewing Don Berwick and me about it… on the day of Hillary’s speech! To listen to the show, click here. Also, here’s an article from USA Today that got the ball rolling, as well as Avery Comarow’s thoughtful blog on these new reports. Here are a few observations about the new CMS (Centers for Medicare &amp; Medicaid...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/27/npr-s-talk-of-the-nation-featuring-don-berwick-and-moi.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=373" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/20/my-colonoscopy-and-dave-barry-s.aspx2008-08-20T22:49:00Z2008-08-20T22:49:00ZWhen I launched this blog, I vowed not to dwell on personal matters – you’ve heard nothing about my older son's lab work (remarkable), my younger son’s cartooning (awesome), or my golf game (never mind). But I simply must tell you about my colonoscopy today. Well, actually I won’t. But I wanted to raise the topic to implore you to do two things: Most importantly, if you’re due for one, go ahead and get it. It could save your life. Remember, the evidence supports a colonoscopy at age 50 if you are...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/20/my-colonoscopy-and-dave-barry-s.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=369" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/19/is-it-macaca-time-in-healthcare.aspx2008-08-19T07:00:00Z2008-08-19T07:00:00ZAugust 11th was the 2nd anniversary of the epic implosion of George Allen's presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether healthcare has also entered the YouTube era. Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/19/is-it-macaca-time-in-healthcare.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=367" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/14/post-vacation-potpourri-items-interesting-international-and-ineffably-sad.aspx2008-08-14T02:07:00Z2008-08-14T02:07:00ZJust returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced. First, the final “no pay” list. I’m not sure if this was CMS’s intent, but their trial balloon of possible additions to the “no pay” list included so many ludicrous items that the final list seems nearly rational. You’ll recall the proposed list;...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/14/post-vacation-potpourri-items-interesting-international-and-ineffably-sad.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=365" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/04/is-patient-centeredness-a-healthcare-macguffin.aspx2008-08-04T03:16:00Z2008-08-04T03:16:00ZLast week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin? What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Chicago’s Hines VA reminded us that the MacGuffin was one of Alfred Hitchcock’s favorite directorial strategies. Hitchcock defined the term this way: MacGuffin: a plot device that motivates the characters or advances the story, but the details of which...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/08/04/is-patient-centeredness-a-healthcare-macguffin.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=356" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/25/will-knols-and-blogs-upend-the-cozy-world-of-medical-publishing.aspx2008-07-25T05:03:00Z2008-07-25T05:03:00ZYesterday, Google launched Knol, immediately branded as Google’s answer to Wikipedia. As healthcare advisor to the project, I’ll say a few words about Knol, but focus on how it – and other forms of electronic self-publishing – may signal the end of medical publishing as we have known it. First, a word about Knol (the name is short for “a unit of knowledge”). Google’s vision is that providing a tool for people to write about “things that they know” will make the world a better place. Unlike Wikipedia’s...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/25/will-knols-and-blogs-upend-the-cozy-world-of-medical-publishing.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=347" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/20/the-long-awaited-crisis-in-primary-care-it-s-heeere.aspx2008-07-20T18:36:00Z2008-07-20T18:36:00ZI recently heard from a UCSF physician who was flabbergasted when he sought an appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived.I’ve written about the roots of the problem previously, and won’t restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/20/the-long-awaited-crisis-in-primary-care-it-s-heeere.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=340" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/09/another-case-of-wrong-site-surgery-are-we-shying-away-from-the-real-root-causes.aspx2008-07-09T06:52:00Z2008-07-09T06:52:00ZYet another case of wrong-side surgery, this one at Boston’s Beth-Israel Deaconess Hospital. Though CEO Paul Levy does a nice job discussing the case on his blog, I’ll focus on two aspects Paul neglects: the role of production pressures in errors, and the tension between “no blame” and accountability. First, I hope you’ll read Paul’s piece (on his always-interesting blog), which includes a courageous memo he and BI-D’s chief of quality Kenneth Sands sent to the entire community describing the case...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/09/another-case-of-wrong-site-surgery-are-we-shying-away-from-the-real-root-causes.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=332" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/02/door-to-antibiotics-time-in-pneumonia-lessons-from-a-flawed-quality-measure.aspx2008-07-02T07:09:00Z2008-07-02T07:09:00ZIn today’s Annals of Internal Medicine, my colleagues and I describe the saga of the four-hour measure of door-to-antibiotics time for pneumonia – the first truly dangerous measure in the era of public quality reporting. It is an important cautionary tale.As I’ve discussed previously, the biggest surprise of the last decade in the quality field has been this: public reporting alone (even without pay-for-performance) leads to huge changes in the behavior of providers and healthcare organizations…...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/07/02/door-to-antibiotics-time-in-pneumonia-lessons-from-a-flawed-quality-measure.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=326" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspxhttp://www.the-hospitalist.org/blogs/wachters_world/archive/2008/06/25/the-new-cmo-math-passion-power-progress.aspx2008-06-25T07:36:00Z2008-06-25T07:36:00ZIn 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 Center didn’t have a Chief Medical Officer until about 8 years ago; indeed, even today many U.S. hospitals lack a senior physician who is compensated by and works for the hospital. It is easy to understand why.Through several accidents of nature...(<a href="http://www.the-hospitalist.org/blogs/wachters_world/archive/2008/06/25/the-new-cmo-math-passion-power-progress.aspx">read more</a>)<img src="http://www.the-hospitalist.org/aggbug.aspx?PostID=321" width="1" height="1">Bob Wachterhttp://www.the-hospitalist.org/members/Bob+Wachter.aspx