广西新农村商务信息服务体系建设.ppt

Tom Peters Health(care) Excellence! Part I Leaders in Healthcare/Dubai/22January2006 (Long Version),Slides at ,Part I: Healthcare “Manifesto” Part II: Getting It Done!,Health(care): Seven Main Messages 1. Quality (Error reduction/ Evidence-based Medicine) 2. “Healthcare” vs. “Health” (Wellness + Prevention) 3. “Models of Excellence” available 4. Life sciences (“Singularity”) 5. Dubai as global/unique/“insanely great” “Center of Excellence” 6. Avian flu 7. Africa,Manifesto(s),“Healthcare” vs “Health”,TPs Healing & Wellness Manifesto2006 (1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.) (3) There are three primary aims for “all this”: Wellness-Healing-Health. (WE KNOW WHAT TO DO.) (4) Im mad as hell and Im not going to take it anymore. (I KNOW WHAT TO DO.),Toms Rant2006 Hospital “quality control,” at least in the U.S.A., is a bad, bad joke: Depending on whose stats you believe, hospitals kill 100,000 or so of us a yearand wound many times that number. Finally, “they” are “getting around to” dealing with the issue. Well, thanks. And what is it weve been buying for our Trillion or so bucks a year? The fix is eminently do-able which makes the condition even more intolerable. (“Disgrace” is far too kind a label for the “condition.” Whos to blame? Just about everybody, starting with the docs who consider oversight from anyone other than fellow clan members to be unacceptable.) 2. The “system”training, docs, insurance incentives, “culture,” “patients” themselvesis hopelessly-mindlessly-insanely (as I see it) skewed toward fixing things (e.g. me) that are brokennot preventing the problem in the first place and providing the Maintenance Tools necessary for a healthy lifestyle. Sure, bio-medicine will soon allow us to understand and deal with individual genetic pre-dispositions. (And hooray!) But take it from this 63-year old, decades of physical and psychological self-abuse can literally be reversed in relatively short order by an encompassing approach to life that can only be described as a “Passion for Wellness (and Well-being).” Patientslike meare catching on in record numbers; but “the system” is highly resistant. (Again, the doctors are among the biggest sinnersno surprise, following years of acculturation as the “man-with-the-white-coat-who-will-now-miraculously-dispense-fix it-pills-and-surgical-incisions-for-you-the-unwashed.” (Come to think of it, maybe Ill start wearing a White Coat to my doctors officeafter all, I am the Professional-in-Charge when it comes to my Body & Soul. Right?),“Quality”: COULD IT TRULY BE THIS AWFUL?,“When I climb Mount Rainier I face less risk of death than Ill face on the operating table.” Don Berwick, “Six Keys to Safer Hospitals: A Set of Simple Precautions Could Prevent 100,000 Needless Deaths Every Year,” Newsweek (1212.2005),CDC 1998: 90,000 killed and 2,000,000 injured from hospital-caused drug errors & infections,HealthGrades/Denver: 195,000 hospital deaths per year in the U.S., 2000-2002 = 390 full jumbos/747s in the drink per year. Comments: “This should give you pause when you go to the hospital.” Dr. Kenneth Kizer, National Quality Forum. “There is little evidence that patient safety has improved in the last five years.” Dr. Samantha Collier Source: Boston Globe/07.27.04,Welcome to the Homer Simpson Hospital a/k/a The Killing Fields,1,000,000 “serious medication errors per year” “illegible handwriting, misplaced decimal points, and missed drug interactions and allergies.” Source: Wall Street Journal/Institute of Medicine,YE GADS! New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate (1 of 4 negligence). “Subsequent investigations around the country have confirmed the ubiquity of error.” “In one small study of how clinicians perform when patients have a sudden cardiac arrest, 27 of 30 clinicians made an error in using the defibrillator.” Mistakes in administering drugs (1995 study) “average once every hospital admission.” “Lucian Leape, medicines leading expert on error, points out that many other industrieswhether the task is manufacturing semiconductors or serving customers at the Ritz Carltonsimply wouldnt countenance error rates like those in hospitals.” Complications, Atul Gawande,RAND (1998): 50%, appropriate preventive care. 60%, recommended treatment, per medical studies, for chronic conditions. 20% chronic care treatment that is wrong. 30% acute care treatment that is wrong.,Various studies: 1 in 3, 1 in 5, 1 in 7, 1 in 20 patients “harmed by treatment” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson,“In a disturbing 1991 study, 110 nurses of varying experience levels took a written test of their ability to calculate medication doses. Eight out of 10 made calculation mistakes at least 10% of the time, while four out of 10 made mistakes 30% of the time.” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson,20%: not get prescriptions filled 50%: use meds inconsistently Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,“In health care, geography is destiny.” Source: Dartmouth Medical School 1996 report,Geography Is Destiny “Often all one must do to acquire a disease is to enter a country where a disease is recognizedleaving the country will either cure the malady or turn it into something else. Blood pressure considered treatably high in the United States might be considered normal in England; and the low blood pressure treated with 85 drugs as well as hydrotherapy and spa treatments in Germany would entitle its sufferer to lower life insurance rates in the United States.” Lynn Payer, Medicine & Culture,Geography Is Destiny E.g.: Ft. Myers 4X Manhattanback surgery. Newark 2X New Havenprostatectomy. Rapid City SD 34X Elyria OHbreast-conserving surgery. VT, ME, IA: 3X differences in hysterectomy by age 70; 8X tonsillectomy; 4X prostatectomy Breast cancer screening: 4X NE, FL, MI vs. SE, SW. (Source: various),“A healthcare delivery system characterized by idiosyncratic and often ill-informed judgments must be restructured according to evidence-based medical practice.” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson,“Without being disrespectful, I consider the U.S. healthcare delivery system the largest cottage industry in the world. There are virtually no performance measurements and no standards. Trying to measure performance is the next revolution in healthcare.” Richard Huber, former CEO, Aetna,“Practice variation is not caused by bad or ignorant doctors. Rather, it is a natural consequence of a system that systematically tracks neither its processes nor its outcomes, preferring to presume that good facilities, good intentions and good training lead automatically to good results. Providers remain more comfortable with the habits of a guild, where each craftsman trusts his fellows, than with the demands of the information age.” Michael Millenson, Demanding Medical Excellence,“As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called ignorant care. A surprising 85% of everyday medical treatments have never been scientifically validated. For instance, when family practitioners in Washington State were queried about treating a simple urinary tract infection, 82 physicians came up with an extraordinary 137 strategies.” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson,“Most physicians believe that diagnosis cant be reduced to a set of generalizationsto a cookbook. How often does my intuition lead me astray? The radical implication of the Swedish study is that the individualized, intuitive approach that lies at the center of modern medicine is flawedit causes more mistakes than it prevents.” Atul Gawande, Complications,Deep Blue Redux*: 2,240 EKGs 1,120 heart attacks. Hans Ohlin (50 yr old chief of coronary care, Univ of Lund/SW) : 620. Lars Edenbrandts software: 738. *Only this time it matters!,Dr Larry Weed/POMR (“problem-oriented medical record”)/Etc: “Its impossible to keep up with the avalanche of knowledge. Therefore its essential to use a valid diagnostic-decision aid like Larrys” Neil de Crescenzo, VP Global Healthcare/IBM Consulting “There is no other profession that tries to operate in the fashion we do. We go on hallucinating about what we can do.” Dr Charles Burger (using Weeds software for 20 years),Probable parole violations: Simple model (age, # of previous offenses, type of crime) beats M.D. shrinks. 100 studies: Statistical formulas Human judgment. “In virtually all cases, statistical thinking equaled or surpassed human judgment.”Atul Gawande, Complications,PARADOX: Many, many formal case reviews failure to systematically/ systemically/ statistically look at and act on evidence. Source: Complications, Atul Gawande,Genius Required?,Leapfrog Group: CPOE/Computerized Physician Order Entry* ICU staffing by trained intensivists* EHR/Evidence-based Hospital Referral* *Duh I: Welcome to the computer age. *Duh II: How about using experts? *Duh III: If you do stuff a lotta times, you tend to get/be better. Source: HealthLeaders,The Benefits of FOCUSED EXCELLENCE Shouldice/Hernia Repair: 30-45 min, 1% recurrence. Avg: 90 min, 10%-15% recurrence. Source: Complications, Atul Gawande,Hospitals Pay Appropriate Attention To Medical Errors Yes . 1% Aware and Trying Hard . 8% Aware But Tepid Response 22% No . 25% An Inexcusable Tragedy 44% Source: 12.2005 Poll/,About Time! 100,000 Lives Campaign* *Don Berwick/Institute for Healthcare Improvement,Whats your name? Whens your birthday?,The Necessary IS/Web REVOLUTION,We all live in Dell-Wal*Mart-eBay-Google World!,We almost all live in Dell-Wal*Mart-eBay-Google World!,“Some grocery stores have better technology than our hospitals and clinics.” Tommy Thompson, HHS Secretary Source: Special Report on technology in healthcare, U.S. News & World Report (07.04),Computerized Physician Order Entry/CPOE: 5% of U.S. hospitals source: HealthLeaders/06.02,Henry Lowe, U. of Pitt. School of Medicine: “Broadband, Internet-based, multimedia electronic medical records”,Telemedicine: E.g. HANC* Home Assisted Nursing Care *BP, ECG, pulse, temp,Telemedicine Reduces days/1000 patients and physician visits for the chronically ill Decreases costs of managing chronic disease Expands service areas for providers Reduces travel costs to and from medical ed seminars Douglas Goldstein, e-Healthcare,“Our entire facility is digital. No paper, no film, no medical records. Nothing. And its all integratedfrom the lab to X-ray to records to physician order entry. Patients dont have to wait for anything. The information from the physicians office is in registration and vice versa. The referring physician is immediately sent an email telling him his patient has shown up. Its wireless in-house. We have 800 notebook computers that are wireless. Physicians can walk around with a computer thats pre-programmed. If the physician wants, well go out and wire their house so they can sit on the couch and connect to the network. They can review a chart from 100 miles away.” David Veillette, CEO, Indiana Heart Hospital (HealthLeaders/12.2002),Health,“Gwen has wonderful health insurance and an abundance of healthcare. What Gwen does not have is health. And there is nothing our health system can do to give it to her.” “The battle cry is always health, but in fact the struggle has always been over healthcare.” “For all its inspiring, high-tech cures, medicine is just not very effective at curing our eras major killers.” “Medicine doesnt do much for chronic disease.” “When the most common killers of our era are mostly incurable and our preventive treatments pretty feeble, you have to wonder about medical care as a whole.” “There is a widely held view that medical care contributes little to health.” (John Bunker/ Journal of the Royal College of Physicians) Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,Part 1: “The Leading Causes of Health” Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,“Our mistake is not that we value medical carebut that we have misunderstood what it can and cannot do.” Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,Smoking, drinking, exercise, diet: 40% of deaths Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,“Sanitary revolution”: mortality in major cities down 55% between 1850 and 1915 Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,“Curve Shifting” Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,Context Change: The Most Powerful Force (?) Wastebaskets: Japan v U.S.; Christchurch NZ v Sydney AUS* *“Broken windows”,“Bump into factor”: Extra-size portions, eat more. Higher % shelf space snacks, more obesity. More liquor stores, more crime. High vs low fat: Japanese who emigrate to U.S. suffer 3X increase in heart disease. Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation,+10: Sardinians, Adventists, Okinawans Dont smoke. Put family first. Be active every day. Keep socially engaged. Eat fruits, vegetables, whole grains. Other: nuts, red wine, pecorino cheese, small portions. Source: National Geographic (National Institute on Aging), November 2005,Wellness,“The curative model narrowly focuses on the goal of cure. From many quarters comes evidence that the view of health should be expanded to encompass mental, social and spiritual well-being.” Institute for the Future,“An estimated 60 to 90 percent of doctor visits involve stress-related complaints.” Newsweek/09.27.2004,“Ontario To Split Health Ministry” Headline/ Globe And Mail /06.05 (New ministry will focus on Prevention/ Wellness/Eldercare),“Savior for the Sick” vs. “Partner for Good Health” Source: NPR,“Companies Step Up Wellness Efforts: Rising health costs provide incentive to promote healthier employee lifestyles” headline/USA Today/08.05,“Prevention Program At Dow Chemical Aims To Save Money” IBD/08.05,Sprint/Overland Park KS: Slow elevators, distant parking lots with infrequent buses, “food court” as “poorly” placed as possible, etc. Source: New York Times,Toms Story,Obese/-79(-36); BP (140-85 to 90-60); Blood sugar (180-87); Blood chemistry (normal); Cholesterol (140-58); Metabolic rate/RMR (+250); Mental state (dramatic improvement),Aging reversal!* *Why wasnt I “informed” until age 59?,“Fixes” Diet Extreme exercise Meditation Supplements Teetotaler (Meds),Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Source: Institute for the Future,Planetree: A Radical Model for New Healthcare/Healing/Health/ Wellness Excellence,“It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer.” Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel,“Much of our current healthcare is about curing. Curing is good. But healing is spiritual, and healing is better, because we can heal many people we cannot cure.” Leland Kaiser, “Holistic Hospitals” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel,The Nine Planetree Practices 1. The Importance of Human Interaction 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 3. Healing Partnerships: The importance of Including Friends and Family 4. Nutrition: The Nurturing Aspect of Food 5. Spirituality: Inner Resources for Healing 6. Human Touch: The Essentials of Communicating Caring Through Massage 7. Healing Arts: Nutrition for the Soul 8. Integrating Complementary and Alternative Practices into Conventional Care 9. Healing Environments: Architecture and Design Conducive to Health Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel,1. The Importance of Human Interaction,“There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget. Kindness is free. Listening to patients or answering their questions costs nothing. It can be argued that negative interactionsalienating patients, being non-responsive to their needs or limiting their sense of controlcan be very costly. Angry, frustrated or frightened patients may be combative, withdrawn and less cooperativerequiring far more time than it would have taken to interact with them initially in a positive way.” Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel,Press Ganey Assoc/1999: 139,380 former patients from 225 hospitals 0 of top 15 factors determining Patient Satisfaction referred to patients health outcome PS directly related to Staff Interaction PS directly correlated with ES (Employee Satisfaction) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel,“Perhaps the simplest and most profound of all human interactions is KINDNESS. But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. Many staff members report verbal abuse by physicians, managers and coworkers.” Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel,“Planetree is about human beings caring for other human beings.” Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies and gentlemen”4S credo),2. Informing and