The Institute of Medicine just released its long-awaited report on trainee duty hours. It is well researched and balanced, and its recommendations appropriately reflect what we know vs. what we believe. Now the fun begins. Let’s start with a little background, some of it drawn from my book Understanding Patient Safety: Let’s be honest. ...

August 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 ...

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 ...

Yet 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 ...

This is one of the most commonly asked questions in IT World, and my answer has always been “CPOE first” – largely because that has always been David Bates’s (the world’s leading IT/safety researcher) answer. But I’ve changed my mind. Here’s why.Before I start, I promised that I’d let you know if I ever blogged on a topic in which I have a ...

Should doctors and nurses be subject to different penalties for precisely the same infraction? Of course not. Are they? Sure. Just ask Britney Spears.Britney was hospitalized at UCLA at least twice in the past few years – once when she gave birth to her first son in 2005, and again in early 2008 for psychiatric care. Both times, dozens of UCLA ...

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 will be in the details.I hope you’ll have a chance to read the full article (the Joint ...

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 Points can tip both ways.I laid out the issues in this prior post. Those of you who know me know ...

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 to Exhibit A.Last month, I described Atul Gawande’s thrilling New Yorker article recounting ...

Great quote by USC cardiologist Leslie Saxon (a reporter reached her on her cell phone as Leslie was shopping) on this week’s NEJM study on delayed defibrillation: “You’re better off having your arrest [here] at Nordstrom [than in a hospital]… because there are 15 people around me.”You’ve probably seen the study, a detailed analysis of ...