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. ...

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 ...

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 ...

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!For those unfamiliar with the Hopkins-Michigan-OHRP checklist story, it is described on my prior ...

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 healthcare. Today, the major hospital-based societies – representing over 100,000 clinicians and ...

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 ...

My friend Mark Smith, who runs the California HealthCare Foundation, once wryly observed, “Have you ever noticed that the doctors who talk about how much fun primary care is only practice it one afternoon a week?” I may have become the hospitalist version of Mark’s Ivory Tower internists, but I’ll take my chances.I just finished a two-week stint ...

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 ...