In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has. Note that this comes from someone who believes that healthcare was under-regulated until recently, not a popular viewpoint ...

Medicare 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 ...

Just 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 ...

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 Center didn’t have a Chief Medical Officer until about 8 years ago; indeed, even today ...

As I mentioned in my last post, these should be the best of times for ''Infection Preventionists'' (formerly known as Infection Control Officers). After years of trying to get someone – anyone – to pay attention to their work, their day in the sun has finally arrived. But they are far from a joyful bunch. Why?In my talk to 4,000 members of the ...

Of all the structural (how care is organized) “evidence-based markers of high quality care,” perhaps the most ironclad has been the involvement of critical care physicians in the care of ICU patients. That is, until now.In a sophisticated study in today’s Annals of Internal Medicine, Levy and colleagues mine a decade-old, 100-hospital, 123-ICU ...

A few random observations from the Society of Hospital Medicine’s annual meeting in San Diego:There are about 1600 people here, most of whom I don’t know. How did this happen?People still seem pretty jazzed about their jobs and lives. The meeting has not lost its soul, nor its sense of wonderment or of family. That’s a very good thing, since these ...

Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.” But when did we turn into the Holiday Inn?Let’s start by appreciating where this comes from. Many hospitals, including mine, tend to run ...

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 prevention strategy doesn't work.What’s a person or hospital to do?A little background on both ...

''You can’t manage what you don’t measure.'' This well-worn business axiom has been embraced by the healthcare quality movement, a trend this is healthy and long past due. But it comes with a risk:   Yin without Yang. What do I mean? With the (still scanty) evidence that tight glucose control improves the outcomes of med-surg (as opposed to ...