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 ...

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 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 have ''you can't manage what you don't measure'' on the brain – here's a piece I wrote this week for AHRQ's Guidelines/Quality Measures Clearinghouses called ''Is the Measurement Mandate Diverting the Patient Safety Revolution?'' Well, of course it is. In it, I make the point that our hunger for measurable targets – generally a good thing ...

''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 ...

I recently participated in a meeting whose aim was to develop safety measures for hospital units (ie, med-surg, ED, L&D). As various measures were being ticked off, I muttered that we should also try to capture errors that occur as patients move between units. One of my colleagues, quite sensibly, asked, “but who will be accountable for that?” ...