Archivi del mese: dicembre 2013


Girolamo Sirchia

Accountability è un termine inglese che significa rendere conto o rispondere, ossia l’obbligazione di individui e organizzazioni a rispondere delle loro attività, accettarne la responsabilità, fornire i risultati in modo trasparente a chi di dovere, rispondere del denaro e di altre proprietà a loro affidate.

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L’austerità e la sanità

Girolamo Sirchia

Se l’austerità fosse stata sperimentata con i criteri scientifici usati per i farmaci, la sperimentazione sarebbe stata interrotta a causa dei suoi deleteri effetti collaterali (David Stuckler, economista politico). Questi sono molteplici: in Grecia, Spagna, Italia, Portogallo e Irlanda il numero dei suicidi è raddoppiato, le malattie mentali e quelle legate all’uso di alcol e droga sono cresciute. La malaria è riapparsa in Grecia dopo che la disinfestazione è stata ridotta. La mortalità infantile è aumentata. Le limitazioni imposte al Servizio Sanitario, oltre alla crescente disoccupazione e indebitamento delle persone, dovrebbero essere valutate per le loro future implicazioni; è possibile che i provvedimenti che riducono la spesa oggi comportino domani costi assai elevati.

(Brand H et al. Austerity policies in Europe. Bad for health. BMJ 346, 7, 2013)

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#stamina Perché dopo la decisione del Tar da giovane medico mi vergogno dell’Italia.

Andrea Silenzi, MD, MPH, PhD

Chiacchierate tra amici, punti di vista. Si parla del caso #stamina, soprattutto dopo che oggi il Tar del Lazio ha accolto il ricorso contro la legittimità della composizione del comitato di esperti che ha bocciato il “metodo” Vannoni. Colleghi sdegnati, lo sdegno e la rabbia di chi per fare ricerca in questo Paese deve scalare montagne e passare per la cruna di un ago.
Nasce naturale un senso di vergogna misto a sdegno, monta la rabbia. C’è da vergognarsi di questo Paese incapace di dare una risposta di sistema, da scappare a gambe levate come medico ed, ancor più, come cittadino/paziente.
Perché si sta giocando per business sulla pelle e sulla speranza delle persone. Di lestofanti come Vannoni negli USA sono pieni perché le staminali, rappresentando la grande speranza della ricerca biomedica, sono il nuovo grande mercato globale dove tutti vogliono entrare. Ma addirittura quel sistema, fondato sulla mercificazione della…

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Direttori Generali Medici per gli Ospedali

Girolamo Sirchia

Le migliori organizzazioni sanitarie in USA (Kaiser-Permanente in California, Intermountain Healthcare in Utah, Virginia Mason in Seattle) sono dirette da medici che uniscono ad un’alta credibilità da parte dei loro colleghi una conoscenza profonda di ciò che va fatto per migliorare la qualità e una capacità di motivare i medici a darsi come obiettivo principale la qualità dei servizi erogati al paziente. E’ un cambio culturale prima che tecnico e bisogna saperlo realizzare. Solo così si possono ridurre gli sprechi legati a scarsa attenzione al malato e alla preoccupazione di osservare standard e sanzioni imposti dall’alto (Ham C. BMJ 2013;346:f3668).

Recentemente sono stati sviluppati alcuni indicatori di spreco, che possono essere utili per aiutare i medici a perseguire il loro obiettivo di qualità (Am J Med Qualità 2013;doi:10.1177(1062860613486830).

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Clinician Engagement: The Role of the Physician @Medici_Manager

By Amy Collins, M.D.
HealthCare Sustainability Consultant, Vanguard Health Systems

I was living a pretty green life, or so I thought. I had been composting for years, was an avid recycler, was known for turning off lights and computers not in use and grew up using reusable grocery bags – doing it all because it just made sense. But my attitude towards greenness and reason to be environmentally responsible changed in one minute back in April of 2007. On one of my days off from my full time job as an emergency physician, I was sitting in my car in the pick up line at my son’s school, absent-mindedly texting and listening to the radio while IDLING! My very wise 4th grader took no time to begin reprimanding me for my lapse in environmental responsibility. “You are idling,” he scolded.  “Ms. Gruenfeld (his teacher) taught us about climate change today and what is happening to the polar bears.” He went on. “I better not catch you idling EVER again and there’s a lot more you should be doing about climate change and to help the polar bears.”  Shame faced, I agreed and assured him that I would get right to work to try and correct my wrong. As a family, we watched “An Inconvenient Truth,” then set out to make our home as green as possible. Inspired by the urgency in the movie and by a wise little boy, we started doing such things as changing all of our light bulbs to fluorescents, drying clothes on a clothes line, planting a vegetable garden, making homemade cleaning products and much more.

Soon it became uncomfortable living one way at home and another at the hospital. It grew harder and harder to leave my environmental conscience at the door when I went to work. In response to this discomfort, I set out to start a recycling program in my ER but was told by a fellow employee that recycling was “illegal” in a hospital. Not satisfied with this response, I turned to the Internet and learned that not only was recycling not illegal in a hospital and that there were many exciting and practical opportunities for a hospital to reduce it’s environmental impact. It was at this moment that I knew that I had found my calling. I wrote a letter to my administrators and requested that we take steps to become a more sustainable operation, was given permission to run, started a green team and so began my mid-life second career path.

I realize that not all physicians will share my passion for health care sustainability or have the time to commit to a leadership role at their hospital, but there are many important opportunities for physician engagement at local and broader levels. When speaking to physicians I focus on sustainability as a preventative health strategy and an opportunity for improved health and health care delivery.  Let’s look at some of the issues. According to The Lancet, “Climate change is the biggest global health threat of the 21st century – the impacts will be felt all round the world – and not just in some distant future but in our lifetimes and those of our children.” Physicians need to advocate for health to be at the center of the climate debate as the health impacts are anticipated to be significant, including increases in respiratory illnesses, allergies, food and water borne illnesses, infectious diseases along with health impacts of weather disasters and heat waves.  In addition, there is scientific evidence linking the combustion of fossil fuels to lung cancer, respiratory illness, heart disease and other chronic illnesses.  I think that Margaret Chen, Director General of the World Health Organization, says it best, “The health sector must add it’s voice loud and clear – and fight to place health issues at the center of the climate agenda.”

Let’s briefly look at some of the other things I have learned over the past few years that concern me as a parent and a physician. The US spends billions annually to treat chronic diseases such as obesity and diabetes, both of which are increasing in incidence at an alarming rate and burdening our health care system. Scientists now suspect that endocrine disrupting chemicals may play a role in the development of both diabetes and obesity. These chemicals even have a name – “obesogens” – chemicals that may promote weight gain and obesity. Bet you never learned about this in medical school! The incidence of other chronic diseases with potential environmental links, such as asthma, autism and certain cancers are increasing at alarming rates. A 2008 Associated Press study found traces of pharmaceuticals in the drinking water of millions of Americans.  A 2005 study by the Environmental Working Group found over 200 industrial chemicals in the cord blood of ten newborn infants. DEHP, a plasticizer, which is an androgen antagonist, is found in many medical devices including IV bags and tubing. A 2007 Lancet study showed that nurses have the highest incidence of occupational asthma of any profession.  We have mercury, a potent neurotoxin, in our clinical and facility devices, pharmaceuticals and lab reagents. Around 80% of the antibiotics used in this country are used non-therapeutically in livestock, which experts agree is linked to antibiotic resistance in humans. I could go on and on, but it is beyond the scope of this blog.

So, what’s a busy physician to do with all this disturbing information?

At The Bedside

  • Incorporate environmental history taking into practice
  • Evaluate diagnostic imaging ordering practices and reduce patient’s exposure to unnecessary radiation
  • Educate patients about environmental exposures, healthy food and beverage options, proper medication disposal and the public health impacts of climate change
  • Practice “Green Pharmacy” – evaluate personal prescription practices (i.e. limit refills and quantities), consider non-pharmaceutical treatments when appropriate, regularly review medications with patients

In the Hospital

  • Advocate for procurement of healthy, local and sustainable food and beverages and for the elimination of sugar sweetened beverages
  • Advocate for toxicity reduction
    • ​Use of Green Seal Certified cleaning products
    • Mercury elimination
    • DEHP reduction
    • Fragrance-free and no-smoking policies
  • Advocate for pharmaceutical waste management program and education about proper medication disposal
  • Advocate for Grand Rounds and educational programs about environmental topics (or give a talk yourself!)
  • Advocate for a climate policy and preparedness
  • Encourage reprocessing of single use surgical devices and other sustainable initiatives in the OR
  • Join or start a green team
  • Encourage your hospital to join PGH and enroll in HHI
  • Agree to be your hospital’s “Clinical Champion”
  • Lead by example – support your hospital’s recycling program, use red bags properly, turn off lights not in use, reduce your paper usage!

Get Educated!!

Most physicians haven’t had any formal training or education about health care sustainability but there are some great opportunities for education

Advancing sustainability in the health care sector

  • Engage in research activities – the industry is in need of science based evaluation of sustainable best practices
  • Publications – write an article for your hospital newsletter, local newspaper or write a peer –reviewed article
  • Speaking engagements – speak to a variety of health care audiences

National Advocacy: advocate for climate change policy, chemical reform, antibiotic legislation and more. Let your voice be heard!

More and more physicians are recognizing the link between environmental choices and health and the environmental impact of hospital operations. Physicians have many opportunities to advance sustainability within their organizations and the health care sector and to bring this important work to our patients. Sustainability broadens my understanding of the Hippocratic Oath, as in my practice I now consider “First, Do No Harm” to mean doing no harm to patients, workers, the community and the environment.

Four Principles to Successful Operational Leadership @toddbnielsen @Medici_Manager @WRicciardi


Operational Leadership

This picture here, while not a real highway infrastructure, is a good representation of how operations are often run in an organization and how it can feel to run the operations of complicated business that offers multiple products and services.

I have worked with over 50 business owners and colleagues over the last couple years on the topic of operations and operational leadership, in addition to running the operations of multiple companies. This has been primarily within the IT industry. It is so easy to get caught-up in the sales or growth of the business that operational leadership can fall by the wayside. Yet it is often the operations of a company that can cause and prevent the “fires” and headaches that leave many leaders in confusion and panic. Operations brings many aspects of a business into play, which is can be the source of the confusion. Aspects such as delivery and implementation, project management, cost reductions, efficiency, customer service, on-boarding, team building and others are, many times, at an opposing spectrum to the organizations objectives.

Success in operational leadership, whether it is data-center operations, service delivery operations, restaurant operations; or just about any operational capacity, comes down to four main components: People, Processes, Policies, and Systems. People, Process and Systems is nothing new.  Many books have been written on it, many companies like Toyota and others, model their company’s management after it.  It can and is applied to many industries and leadership situations.  I added “Policies” to this list, although many people group it with “Processes” I think it has a place of its own and I will explain why. I am going to touch on each of these operational leadership principles, briefly and hopefully provide some insight or at least a refresher for those that might be familiar with these concepts.

Four Principles to Successful Operational Leadership:

1. People in Operational Leadership

While technology might be in part taking over our lives and jobs, people are still at the heart of running an organization. It can be tough for leaders to focus on this though.  People are just so different and managing them and especially motivating them can bring even the best leader to tears.  I can’t even begin to touch upon the infinite number of problems to watch out for nor the infinite number of solutions to those problems.   What I want you to recognize is that it is very hard to have a great company, without great people.   As a leader, no matter what your specialty is, “people” is where you need to focus the majority of your time.  Learn about them, know them, understand what makes them tick, help them and serve them.  They can cause you the greatest pain or the greatest joy and success.

2. Processes in Operational Leadership

We need directions to put together toys for our children, why is it that many business owners do not take the time to write “directions” for their employees? You want to gain more time and spend less time “fighting fires”, write processes.   In working with business owners and employees, I have been amazed at the mass inability of people to write set processes. If you have to explain something to someone more than once, then it probably needs to be written down.  Want to be able to empower your employees with greater ability to get things done without coming to you, write processes. A process can be as simple as a checklist or  as complicated as an ITIL compliant flowchart.  Even if you area 1-man shop, you can start writing processes.  You cannot have scalability and exponential growth without a solid foundation of processes.

3. Policies in Operational Leadership

Processes generally apply to the “how” of getting things done.  You want something done a certain way, then write a process.  Policies though are the more official high-level things that one can or cannot do. You want your employees to dress a certain way to work, that is a policy.  You want them to be consistent with email signatures, that is a policy.  Many leaders are so busy that ”policy” ends up being verbal instruction that comes from the leader or colleagues.  More in the form of warnings and often not correct.  It can be grudgingly boring to write policies and one should consult a professional when dealing with the legal aspects of some policies.  I think that in great companies, people know what they are supposed to do, how they are supposed to do it and they know what they are not supposed to do.  Don’t wait until you have problems, to start writing policies.

4. Systems in Operational Leadership

Unfortunetly I think many people start with systems because it is “more fun”. Depending on what the business is, it may very well be the first thing to focus on.  We live in such a wonderful world of technology and innovation.  There is software and tools to do just about anything for you. Find those systems, whether it be software or technology.  And most important, when you get those systems, learn ,them, train others on them and use 100% of them.

I recognize that this is a very high-level list of success principles for operational leadership success.   Thousands of books have been written on all the granular details that go into these four principles. I hope that as a leader, you will take a step back, look at your priorities and and take the necessary steps to fill in the gaps of what you might be missing.