BETTER HEALTH CARE AND LOWER COSTS @leadmedit @medici_Manager @pash22 @WRicciardi


Executive Summary

In recent years there has been success in expanding access to the health-care system, with millions gaining coverage in the past year due to the Affordable Care Act. With greater access, emphasis now turns to guaranteeing that care is both affordable and high-quality. Rising health-care costs are an important determinant of the Nation’s fiscal future, and they also affect the budgets for States, businesses, and families across the country. Health-care costs now approach a fifth of the economy, and careful reviews suggest that a significant portion of those costs does not lead to better health or better care.

Other industries have used a range of systems-engineering approaches to reduce waste and increase reliability, and health care could benefit from adopting some of these approaches. As in those other industries, systems engineering has often produced dramatically positive results in the small number of health-care organizations that have implemented such concepts. These efforts have transformed health care at a small scale, such as improving the efficiency of a hospital pharmacy, and at much larger scales, such as coordinating operations across an entire hospital system or across a community. Systems tools and methods, moreover, can be used to ensure that care is reliably safe, to eliminate inefficient processes that do not improve care quality or people’s health, and to ensure that health care is centered on patients and their families. Notwithstanding the instances in which these methods and techniques have been applied successfully, they remain underutilized throughout the broader system.

The primary barrier to greater use of systems methods and tools is the predominant fee-for-service payment system, which is a major disincentive to more efficient care. That system rewards procedures, not personalized care. To support needed change, the Nation needs to move more quickly to payment models that pay for value rather than volume. These new payment models depend on metrics to identify high-value care, which means that strong quality measures are needed, especially about health outcomes. With payment incentives aligned and quality information available, health care can take advantage of an array of approaches using systems engineering to redesign processes of care around the patient and bring community resources, as well as medical resources, together in support of that goal.

Additional barriers limit the spread and dissemination of systems methods and tools, such as insufficient data infrastructure and limited technical capabilities. These barriers are especially acute for practices with only one or a few physicians (small practices) or for community-wide efforts. To address these barriers, PCAST proposes the following overarching approaches where the Administration could make a difference:

  1. Accelerate alignment of payment systems with desired outcomes,
  2. Increase access to relevant health data and analytics,
  3. Provide technical assistance in systems-engineering approaches,
  4. Involve communities in improving health-care delivery,
  5. Share lessons learned from successful improvement efforts, and
  6. Train health professionals in new skills and approaches.

Through implementation of these strategies, systems tools and methods can play a major role in improving the value of the health-care system and improving the health of all Americans.

Summary of Recommendations

Recommendation 1: Accelerate the alignment of payment incentives and reported information with better outcomes for individuals and populations.


1.1  HealthandHumanServices(HHS)shouldconvenepublicandprivatepayers(includingMedicare,Medicaid, State programs, and commercial insurers) and employers to discuss how to accelerate the transition to outcomes-based payment, promote transparency, and provide tools and supports for practice transformation. This work could build on current alignment and measurement-improvement efforts at the Center for Medicare and Medicaid Services (CMS) and HHS broadly.

1.2  CMS should collaborate with the Agency for Healthcare Research and Quality (AHRQ) to develop the best measures (including outcomes) for patients and populations that can be readily assessed using current and future digital data sources. Such measures would create more meaningful information for providers and patients.

Recommendation 2: Accelerate efforts to develop the Nation’s health-data infrastructure.
2.1 HHS should continue, and accelerate, the creation of a robust health-data infrastructure through widespread adoption of interoperable electronic health records and accessible health information. Specific actions in this vein were proposed in the 2010 PCAST report on health information technology and the related 2014 JASON report to the Office of the National Coordinator for Health Information Technology (ONC).

Recommendation 3: Provide national leadership in systems engineering by increasing the supply of data available to benchmark performance, understand a community’s health, and examine broader regional or national trends.

3.1 HHS should create a senior leadership position, at the Assistant Secretary level, focused on health-care transformation to advance information science and data analytics. The duties for this position should include:

  • Inventory existing data sources, identify opportunities for alignment and integration, and increase awareness of their potential;
  • Expand access to existing data through open data initiatives;
  • Promote collaboration with other Federal partners and private organizations; and
  • Create a more focused and deep data-science capability through advancing data analytics and
  • implementation of systems engineering.

3.2 HHS should work with the private sector to accelerate public- and private-payer release of provider-level data about quality, safety, and cost to increase transparency and enable patients to make more informed decisions.

Recommendation 4: Increase technical assistance (for a defined period—3-5 years) to health-care professionals and communities in applying systems approaches.

4.1 HHS should launch a large-scale initiative to provide hands-on support to small practices to develop the capabilities, skills, and tools to provide better, more coordinated care to their patients. This initiative should build on existing initiatives, such as the ONC Regional Extension Centers and the Department of Commerce’s Manufacturing Extension Partnership.

Recommendation 5: Support efforts to engage communities in systematic health-care improvement.


5.1  HHSshouldcontinuetosupportStateandlocaleffortstotransformhealthcaresystemstoprovidebetter

care quality and overall value.

5.2  Future CMS Innovation Center programs should, as appropriate, incorporate systems-engineering

principles at the community level; set, assess, and achieve population-level goals; and encourage grantees

to engage stakeholders outside of the traditional health-care system.

5.3  HHS should leverage existing community needs assessment and planning processes, such as the

community health-needs assessments for non-profit hospitals, Accountable Care Organization (ACO) standards, health-department accreditation, and community health-center needs assessments, to promote systems thinking at the community level.

Recommendation 6: Establish awards, challenges, and prizes to promote the use of systems methods and tools in health care.

6.1 HHS and the Department of Commerce should build on the Baldrige awards to recognize health-care providers successfully applying system engineering approaches.

Recommendation 7: Build competencies and workforce for redesigning health care.


7.1  HHS should use a wide range of funding, program, and partnership levers to educate clinicians about

systems-engineering competencies for scalable health-care improvement.

7.2  HHS should collect, inventory, and disseminate best practices in curricular and learning activities, as well as encourage knowledge sharing through regional learning communities. These functions could be accomplished through the new extension-center functions.

7.3  HHS should create grant programs for developing innovative health professional curricula that include systems engineering and implementation science, and HHS should disseminate the grant products broadly.

7.4  HHS should fund systems-engineering centers of excellence to build a robust specialty in Health-

Improvement Science for physicians, nurses, health professionals, and administrators.

Full Report:


Ten Simple Rules for Chairing a Scientific Session @WRicciardi @RSiliquini @drsilenzi @redhenry88

by Alex Bateman1, Philip E. Bourne2* 1 Wellcome Trust Sanger Institute, Cambridge, United Kingdom, 2 Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego, La Jolla, California, United States of America

Chairing a session at a scientific conference is a thankless task. If you get it right, no one is likely to notice. But there are many ways to get it wrong and a little preparation goes a long way to making the session a success. Here are a few pointers that we have picked up over the years.

Rule 1: Don’t Let Things Overrun Probably the main role of the session chair is to keep the meeting running on time. Time is a strange and elastic concept when people are under pressure. Some speakers will talk much faster than normal and finish a talk in half the expected time. Others will ramble on without knowing that time is running out and they have only just finished their introduction. Timing is important to ensure that a meeting runs smoothly. Delegates should leave the session at just the right time so that lunches are still fresh, bars still open, etc. Timing is particularly acute if there are multiple parallel sessions and delegates would want to switch between talks in different sessions.

Rule 2: Let Your Speakers Know the Rules A session will run more smoothly if you let all the speakers know how you plan to run your session. This could be done by email before the event or you might want to gather up the speakers just before the session. Reminding them how much time they have to speak, how much time to allow for questions, and how you will let them know time is up will stop confusion later on. Beyond the rules, encourage speakers to review what others in the session will say. The less redundancy, the better the session will be for everyone, including the chair.

Rule 3: Be Prepared to Give a Short Introduction Be prepared to give a short introduction to the session, and, of course, introduce yourself as well. Be sure to review the abstracts of the talks and then give a succinct summary of what will be presented. It is your job to excite people at the session and have them stay in the auditorium. Regarding the speakers, introduce each one before they begin, providing their background and highlighting their major accomplishments. Speakers love to be properly introduced and the audience likes to feel they know the person speaking. But for the sake of both the timing of the session and your speakers, do keep it brief. Are you expected to give any housekeeping messages or to remind people to switch off their phones? Allow time for that if so.

Rule 4: Write Down the Actual Start Times of the Speakers If you don’t know what time a speaker started, it is difficult to know when to ask them to stop. So always write down the start and finish times of speakers throughout the session.

Rule 5: Do Have a Watch It sounds obvious, but it is very difficult to chair a session if you don’t have a watch and don’t know the time. Yes, one of us has done this! It is embarrassing to have to ask your neighbor for a watch. Actually, it is probably best to have two watches, just in case.

Rule 6: Communicate How Much Time is Left to the Speaker Letting the speaker know their time is up is crucial in keeping time. A simple sign held up at the right time is usually fine. Have one saying, ‘‘5 minutes to go’’ and another saying ‘‘time is up’’. Beyond that time, standing up on the stage is a good sign that the speaker should wrap up.

Rule 7: Don’t Be Afraid to Move on Without Questions

A good scientific session is characterized by a lively question and answer session. In fact, some speakers believe it is their right to expect to answer questions even after their allotted time is up. If you are running over time, you should not be afraid to move on to the next talk without questions. You will be more confident in enforcing this principle if you have warned the speaker beforehand that running over will require foregoing taking questions at that time. You can stay on schedule by diplomatically saying that the speaker will be happy to take questions at the break.

Rule 8: Get to the Venue Early and Be Audiovisually Aware Make sure to know where everything is, like pointers, microphones, projectors, and computers and who to turn to if it all goes wrong. It is worth checking that all these things work so that you can swiftly fix them yourself. Knowing ahead of time any unusual requests from speakers to show movies and sound clips requiring special attention. Be sure the venue supports the needs of speakers. If not, let them know before they get to the venue. If each speaker is expected to load their presentation on a single computer associated with the podium, allow time for that and have the speaker run through their slides to be sure everything is working properly.

Rule 9: Prepare Some Questions in Advance

It can take an audience a few seconds to digest the contents of a talk and think of questions. So, it is always good to have one or two ready to ask.

prepared beforehand from the abstracts and supplemented from ones that occur to you during the talk. This is a very good reason for paying attention during the talk. Also, it is worth thinking of one or two general purpose questions such as ‘‘What do you plan to do next?’’ Rule 10: Keep Control of the Question and Answer Sessions It is difficult for the session chair to keep things on time if the speaker is in control of taking questions. Make sure you are the one who selects the next questioner. Also, be prepared to step in if the speaker and questioner are getting into a long-winded, technical discussion. Hopefully with a bit of preparation and a little luck, you will get through the ordeal of chairing a scientific session unscathed. And remember, if no one thanks you, you have probably done an excellent job. PLoS Computational Biology | 2 September 2009 | Volume 5 | Issue 9 | e1000517

These can be Citation: Bateman A, Bourne PE (2009) Ten Simple Rules for Chairing a Scientific Session. PLoS Comput Biol 5(9): e1000517. doi:10.1371/journal.pcbi.1000517 Published September 25, 2009 Copyright: 2009 Bateman, Bourne. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Competing Interests: The authors have declared that no competing interests exist. * E-mail: PLoS Computational Biology | 1 September 2009 | Volume 5 | Issue 9 | e1000517 prepared beforehand from the abstracts and supplemented from ones that occur to you during the talk. This is a very good reason for paying attention during the talk. Also, it is worth thinking of one or two general purpose questions such as ‘‘What do you plan to do next?’’ Rule 10: Keep Control of the Question and Answer Sessions It is difficult for the session chair to keep things on time if the speaker is in control of taking questions. Make sure you are the one who selects the next questioner. Also, be prepared to step in if the speaker and questioner are getting into a long-winded, technical discussion. Hopefully with a bit of preparation and a little luck, you will get through the ordeal of chairing a scientific session unscathed. And remember, if no one thanks you, you have probably done an excellent job. PLoS Computational Biology | 2 September 2009 | Volume 5 | Issue 9 | e1000517

The Five Biggest Problems In Health Care Today @WRicciardi @Medici_Manager @LeadMedIt

Leah Binder Contributor

I named this blog “Losing Patients” as a play on words. But in all seriousness, our health care system is literally losing “patients,” killing more than 500 per day from errors, accidents and infections in hospitals alone, not to mention the mortality and suffering from millions of procedures that never needed to be done in the first place. At the same time, the employers and other purchasers paying for this care are losing “patience” with the slow pace of change in cleaning up the mess.

Think I’m a bit too pessimistic? Take the example of early elective deliveries.  These are births scheduled without a medical reason between 37 and 39 completed weeks of pregnancy. The prevalence of these unsafe deliveries perfectly embodies the five biggest problems in our health system. Below I explain how — but keep reading, because I do have some words of optimism in the end.

Problem 1: Too Much Unnecessary Care

Overuse and unnecessary care accounts for anywhere from one-third to one-half of all health care costs, which equal hundreds of billions of dollars, in addition to the half-a-trillion per year experts attribute to lost productivity and disability.

Early elective deliveries are unnecessary, according to advice by the American College of Obstetricians and Gynecologists, that has been repeated for more than 30 years (that’s not a typo – 30 years), a point reinforced today at a press conference. This is a message carried by several other highly respected organizations like Childbirth Connectionthe March of Dimes and the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN). All national health plans concur. Nonetheless, we saw a dramatic escalation in the rates of these deliveries from the 1990s to the first decade of the new century.

Problem 2: Avoidable Harm to Patients

This is one of health care’s most common problems. The statistics are staggering. Here’s an example: one in four Medicare beneficiaries that are admitted to a hospital suffers some form of harm during their stay. Would you get in your car if you thought you had a one in four chance of harm during the drive?

Early elective deliveries harm women and newborns. Babies born at 37-39 completed weeks gestation are at much higher risk of death. They are also at a far higher risk for harms like respiratory problems and admission to the  (NICU).

Problem 3: Billions of Dollars are Being Wasted  

A report by the Institute of Medicine Health suggests a third or more of health costs are wasted. The cost of these unnecessary, harmful early elective deliveries was estimated in a study in the American Journal of Obstetrics and Gynecology to be nearly $1 billion per year.

Problem 4: Perverse Incentives in How We Pay for Care

Traditionally, health plans, Medicare and Medicaid pay providers for whatever services they deliver, regardless of whether the service truly benefits the patient. As an excellent new book called “The Incentive Cure” points out (as does a plethora of other literature that could fill several libraries), how we end up with an epidemic of perverse incentives.

The harsh truth about early elective deliveries is that our payment system encourages them. They generate admissions to NICUs, and NICUs are profit centers. Studies suggest that reducing the rate of these deliveries to a reasonable number could eliminate as many as one-half million NICU days, which could lower health costs for the U.S. But this would force hospitals to take a big financial hit. To their credit, in my experience, once hospitals recognize they have a problem with early elective deliveries, they don’t think twice about taking that hit. States like South Carolina and Texas are trying to reverse the incentives, as are many employers. Unfortunately, they are the exception that proves the terrible rule of insane payment incentives.

Problem 5: Lack of Transparency

We have far more information available to us to compare and select a new car than we do to choose where to go for lifesaving health care.

Transparency galvanizes change like nothing else. Early elective deliveries exemplify that: Despite warnings over the years from medical societies and highly respected national organizations, the rates of these deliveries have been rising for decades. That stopped when a purchaser-driven organization, The Leapfrog Group (my organization), started reporting early elective delivery rates by hospitals in 2010. Suddenly, the rates started declining. Just today, Leapfrog released the 2012 data showing that the national rate for early elective deliveries is 11.2 percent, down from 17 percent in 2010. This is a voluntary survey, with nearly 800 hospitals providing the data willingly. Consumers deserve to know these rates for every hospital delivering babies in the country.

Now for a Dose of Optimism

We have a glimpse of success in ending early elective deliveries. Sparked by public reporting, we have seen a growing cadre of providers, policymakers and consumer advocates uniting to address this problem, and the Department of Health & Human Services declared early elective deliveries as a top priority issue. Regional coalitions are also vowing to end the practice in their community.

The next step is for purchasers and consumers to keep up the pressure because that will only help in encouraging real change. And we need to apply that model across the board – the  business community should also work together to address the five big problems in health care that have a direct impact on their own employees’ health and their business’ bottom line. The key message here for all groups is this: don’t financially reward the wrong care and demand transparency.

What is the system? (Systems Leadership)


What is the system? is part of our Systems Leadership series, wrote by John Atkinson.

To a definition…. and beyond

Systems leadership has come to mean working beyond organisational boundaries to address issues of mutual concern.

This raises questions that challenge many assumptions about how to address issues that are of interest beyond the individual. Particularly it raises questions about the nature of society, what we choose to do together and thus the role and function of public services.

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Rebel Jam LIVE! – Rebels wanted

So who was Kurt Lewin?


Kurt Lewin’s influence on modern thinking about change is often underestimated. Simple phrases like ‘the whole is greater than the sum of the parts’ and ‘group dynamics’ have their origins in his work. Invalided out of the front line in WW1 he returned to Berlin to complete his PhD. There he was involved in the schools of behavioural psychology and an influencer in the Gestalt school of psychology.

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I tagli alla sanità del governo sono l’applicazione dell’austerità espansiva

Keynes blog


In genere i keynesiani rifiutano la dottrina dell’austerità espansiva come ricetta di applicazione generale. Tuttavia va detto che in alcuni casi essa ha funzionato. Ad esempio è accaduto con Clinton negli Stati Uniti e ora con Cameron in Gran Bretagna. Ma come funziona l’austerità espansiva? 

Supponiamo che lo Stato decida di tagliare la spesa sanitaria. Poiché la salute è un bene irrinunciabile, i cittadini saranno costretti a stipulare assicurazioni private. In genere le polizze sono piuttosto care, pertanto lo Stato può incentivare i cittadini attraverso sgravi fiscali e garantendo i prestiti necessari alle famiglie per stipulare le polizze. Lo stesso principio può applicarsi a molti altri settori della spesa pubblica come l’istruzione, l’edilizia popolare, la previdenza. L’esperienza anglosassone sembra indicare che le garanzie pubbliche per i prestiti sono una ricetta quasi infallibile per alimentare una bolla immobiliare o i debiti studenteschi.

Lo Stato quindi da un lato taglia la spesa, ma dall’altro incentiva i…

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Contro l’ideologia islamista – Cameron insegna. Cultura e consapevolezza delle radici culturali


Contro l’ideologia islamista.

Per l’intellettuale islamica Hirsi Ali, Cameron, che ha tenuto lunedì un discorso sull’estremismo, è l’unico leader occidentale a capire che il cuore del problema è la riforma dell’islam.

L’endorsement di Hirsi Ali al discorso di Cameron sull’islam.

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Move over teamwork: other forms of co-operative working? @pash22 @leadmedit @muirgray

Taken very broadly, there are two kinds of management or business research thinking when it comes to teams: perspectives that think teams are a decent functional way to organise workers to work effectively, and perspectives that are much more critical of the very concept of teamwork.

Instinctively, anecdotally, and from much research over the last few decades – we all know that teams often don’t work. ‘Dream teams’ of exceptional individuals can turn out to be nightmare units, groupthink and other faulty decision-making biases can make the whole less than the sum of its parts, and sometimes people end up in too many teams or don’t even know whether they’re in or out. I would argue that this is because teams are relatively artificial constructs; they are often no more than idealistic ‘boxes’ that exist unevenly only in the minds of some managers and workers.

Frequently, organisations are not like traditional sporting events or the inside of rowboats – they are much more variable, overlapping, organically changing configurations of people. Being inside a team or outside a team is not a neat shift from one state to another – teams or groupings vary continually in how ‘groupy’ or cohesive they actually are. Most management research, however, has focused on teams as neat boxes or islands that sometimes conflict a bit, but generally agree in their perceptions, have stability of membership, and have a relatively fixed relationship with their external environments. In short, it has been a romance of teams, a science of convenience, and an exercise in wishful thinking.

However, none of this is to say that teams are always doomed or flawed. With the right culture, tasks, and aligned sets of HR practices, teams can innovate and achieve highly effective working patterns. As with all social and workplace issues: it depends on the context and getting the conditions and circumstances right. However, many of these favourable initial ingredients or conditions for optimising teamwork either remain elusive or appear in an implausibly long list. It is no mean feat to ensure the selection of diverse members, extensive team-building and clear unifying goals. Teams themselves are also a moving target; in general they are changing: members come and go more often, technology encourages collaboration over almost any distance, and traditional hierarchies have become much flatter.

What I wish to say is that teams should be considered more dynamically as sitting within a broader spectrum of many cooperative working options simultaneously; as one work arrangement among many. The guiding word here being cooperation. There are multiple ‘building blocks’ of cooperation, from small-scale to large-scale, guiding how people work together, that managers can consider as part of a broader, customisable repertoire. I tend to refer to them as a ‘cooperative value chain’ or a ‘high-cooperation HR menu’. This cooperative toolkit consists of the five following components:

1) The individual. I want to be alone. Many job descriptions, rewards packages and other parts of the psychological contract bestowed via HR practices still revolve around individuals and their needs or talents. Many artists, technical problem-solvers, leaders and so on, may find they work most effectively as a demarcated, unique individual. Western, individualistic cultures may also favour personalised working this way, for at least significant portions of employees’ time, as proactivity, autonomy, and flexibility are emphasised in their roles. Single individuals are still cooperating, but in their own reflective way; they may also occupy special positions in social networks (see below) or fulfil boundary-spanning roles, where they are the individual link bridging units of cooperation that would otherwise have no way to interface.

2) The dyad. Two heads are better than one, but three’s a crowd. Some work roles explicitly involve pairs – software programmers check each other’s work, police officers patrol in pairs, and mentoring and other partnerships can occur in this way. But more exploitation of this unique two-person unit may be possible in workplaces than is currently realised. Some would argue that a dyad/couple is a small team, but I would argue it constitutes a special relationship. Two people cut a fruitful compromise, a middle ground between the egoistic isolation of working alone and the potentially biasing social pressures of a larger group.  Of course such pairs need to be carefully matched to each other and the workflow to get the most out of the pairing.

3) The classic team. The whole is greater than the sum of the parts – go team! As discussed above, in some situations, a neatly bounded, interdependent team with a clear goal may be possible. But a team charter or checklist should be carefully put in place to ensure the key conditions are right before proceeding with what is a larger, more elaborate cooperative endeavour in terms of the numbers of people involved. Social and task criteria to keep it working effectively together will need to be addressed, including a meaningful shared purpose, a differentiated mix of suitable members, clear rules or norms, wider resource-based support, and adequate coaching. Leadership, technology, lifespan, and competing teams or other boundary memberships in the wider environment will need to be addressed, in line with the other cooperative options above and below.

4) The multi-team system. Teams don’t exist in a vacuum, but in a ‘team of teams’.Beyond single teams, research is increasingly considering multi-team systems (MTSs) or ‘teams of teams’. Army, Navy, and Air Force; or Police, Ambulance, Fire would be obvious examples, but of course most organisations contain multiple groups, divisions, functions, layers etc. with potential for forming and/or recognising MTSs. One commanding team might lead several subsidiary teams, or teams with specific goals might come together to achieve a higher goal. As with single teams, structures need to be made crystal clear and cooperative flows and linkages choreographed and monitored carefully. People may need to be cross-trained, or to attend multiple team events, but without taking on too much workload. The relationship between the immediate goals of one team and the higher goals of the set of teams need to be clarified, as well as prioritised in various scenarios.

5) The social network. The wisdom of crowds. In a sense here we come full circle as individual employees occupy distinctive positions within collaborative networks, but in an increasingly interconnected world with more permeable communication boundaries, anyone can be meaningfully connected with up to 150 others at any one time. We enter the realm of crowd-sourcing, flash mobs, consortia, and other self-organising forms of social movement or widespread cooperative organisation. The boundaries of entire businesses and sectors may be transcended, co-operators may never meet or be totally aware of each other, and finished products may be complex mosaic or snowball outputs, difficult to link directly back to the inputs and processes of diverse contributors. Yet impressive tasks and economies of scale can be achieved, sometimes on goodwill and intrinsic motivation alone.

In conclusion, HR practitioners should try to take advantage of mapping this broader array of cooperative building blocks simultaneously. Rather than simply asking ‘to team or not to team?’ they should consider offering employees a greater range of performance opportunities via these other cooperative value chain options, enabling them to work more naturalistically and fully unlock their talents.

“Per App sanitarie prevedere l’obbligo di supervisione del medico”

Andrea Silenzi, MD, MPH

Da prevedere obbligo supervisione del medico per App a scopi medici. No a video visite e riduzione relazione interpersonale. Per le applicazioni a scopi medici (diagnostici, terapeutici, assistenziali) per il Consiglio Nazionale Bio-Medico “dovrebbe esserci un obbligo di supervisione del medico (informazione al momento di scaricare la app/condizione per scaricare app)”.

Leggi tutto su QuotidianoSanità

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General Practice after the election

A Better NHS

General Practice after the election. (First published on the LMC Newsletter)

In 2008, Professor Don Berwick wrote in the British Medical Journal,

Reinvest in general practice and primary care—These, not hospital care, are the soul of a proper, community oriented, health preserving care system. General practice is the jewel in the crown of the NHS. Save it. Build it.

His advice was ignored. The NHS has an unprecedented funding-gap of this governement’s own making and it has no credible plan to fill it. General Practice is in a parlous state one in three training posts and one in six vacancies unfilled while older GPs are retiring early and younger ones are emigrating or choosing to work part-time. The loss of MPIG could force dozens of practices to close. The consequence is that the remaining GPs cannot cope. Something has to give.

What GPs want, according to the recent BMA…

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How to do a SWOT


In the most strategic of rooms in my building, I found an agenda on a flipchart. It is not exceptional, it is typical. This probably happens in your building. This is how decisions are made….

*the photo is real
**the words totes stolen from the brilliant W1a and 2012 .

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Il movimento fisico è indispensabile per la salute fisica e mentale

Girolamo Sirchia

Il WHO (Organizzazione Mondiale della Sanità) definisce come “insufficiente” l’attività fisica moderata di 150 minuti la settimana o meno per i soggetti adulti. E’ a queste persone che bisogna rivolgersi in particolare perché aumentino anche di poco la loro attività fisica, ricordando loro che il movimento promuove la salute fisica e mentale a tutte le età e previene malattie croniche e disabilità. Le persone totalmente inattive sono circa il 25% della popolazione e queste presentano i rischi maggiori in termini di mortalità globale, diabete di tipo 2 e alcuni tipi di tumore. In un gruppo di 252.925 adulti statunitensi è stato osservato che un’attività fisica moderata anche modesta (1 ora la settimana o meno) riduce del 15% il rischio di mortalità da ogni causa, e valori analoghi si sono ottenuti anche per la mortalità da tumore o da incidenti cardiovascolari in altre popolazioni. E’ l’inattività totale quindi il vero rischio…

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The Courage And Triumph Of The Patient @Medici_Manager @acpatient @leadmedit @pash22

Leah Binder Contributor

Improving the “patient experience” is a trending topic in health policy circles these days, the subject of many new conferences and journal articles. Providers puzzle over this. How can they improve patient “compliance” and “adherence” to doctor’s orders? What are the techniques to educate patients on “self-management”? How can we better coordinate the various services offered to each patient so the patient doesn’t fall through the cracks?

It is gratifying to see this emphasis on patients. Yet many providers still do not grasp that improving patient experience requires something more than studying the issue and implementing a few new policies. It requires nothing short of a paradigm shift in the way they think about their role in the patient’s life and the fundamentals of their practice.

The best example of providers misunderstanding the depth of this issue is how the influential provider-governed Beryl Institute defines the patient experience: “the sum of all interactions, shaped by an organization’s culture that influence patient perceptions across the continuum of care.” In other words, Beryl believes that the patient experience is the patient’s reaction to what providers do.

Trust me, that is not how patients view their own experience.

“Momma had her last radiation treatment today,” a young woman I’ll call Karen posted on Facebook last June. “Can’t even explain the amount of strength and courage that crazy lady has shown and I couldn’t be more proud to call her my Mom.”

Patients and their families see their experiences as Karen did, as the act of summoning every last reserve of strength and courage to endure each minute, one day at a time. Patients don’t see themselves as mere recipients of services. Patients and their families don’t talk about self-management or compliance or adherence. They find themselves in an epic story of survival and adventure. They are the reluctant heroes of that personal drama, Odysseus setting forth on the ultimate journey. Some patients are ready and some aren’t, but every patient is forced to try their best, since the road is before them.

One of the country’s leading thinkers on the patient experience is Dave deBronkart, who miraculously survived Stage 4 kidney cancer. His mantra (and the title of the book he coauthored): “Let Patients Help.” DeBronkart advises providers to recognize patients as journeymen, not baggage, in the quest toward recovery. He speaks to provider groups throughout the world, and gave one of the most popular TED talks ever, all with an eye toward reframing the way the health care system engages patients and insisting that patients are part of the cure, not passive recipients of care. He says that patient knowledge and wisdom and willingness to research are a wealth of untapped resources.

Most of us know someone like Karen, Karen’s mom or Dave, who stood up and squarely faced the worst news imaginable. Though doctors work with patients every day, there is something very different about being on the other side of the fence, as deBronkart’s co-author Dr. Danny Sands movingly recounts in his blog about suffering life-threatening seizures.

Providers can nurture, coach, mentor, guide and be humble enough to realize they have only a small – though critical – role to play in the larger life story of the human beings they call patients. Providers succeed when they recognize they aren’t treating a disease or filling an empty vessel with “services,” but coaching a complex person with a destiny and a legacy who, for better or worse, is the hero of her own life.

I’m sad to report that Karen’s “crazy lady” mother, Susan, 52, died from breast cancer a few days ago. Susan was beloved throughout her rural Maine community, an exceptional teacher, community volunteer, mother. She had a very special gift with children, many of whom are traveling from far and wide to come to the funeral of this woman they revered.

“I believed a miracle would happen and she would beat this beast,” said Susan’s dear friend Kathleen, “She fought the most courageous fight I’ve ever witnessed. Heaven is so lucky to have this new angel.”

In my opinion, Susan did win, though not the way we all hoped for. But a life well-lived is the ultimate triumph. “To have been given 22 years with you was such a blessing.” Karen wrote in an open letter the day her mother died. “I promise with all my heart to be the fun loving, positive and slightly wacky person you’ve taught me to be. Thank you for all the amazing memories Momma Bear.”

Susan’s a winner and so are the many excellent physicians and nurses who cared for her through her battle with cancer. As the famous doctor Patch Adams once said, “You treat a disease, you win, you lose. You treat a person, I guarantee you’ll win.” The patient experience is more the stuff of Shakespeare than Gray’s Anatomy. Providers with that wisdom will transform health care forever.

how to measure a professor


“Many of those personal qualities that we hold dear….are exceedingly difficult to assess. And so, unfortunately, we are apt to measure what we can, and eventually come to value what is measured over what is left unmeasured. The shift is subtle and occurs gradually”. So wrote Robert Glaser of the USA National Academy of Education in 1987.

Those words – written about the standardised tests used in American schools in the 1980s – ring so true today for the way we assess academics. The things we tend to measure, because they are easy to measure, are things like publication numbers, impact factors, H-index (regrettably not the Happiness index), citations, grant income. And we tend to value most those who have big grants and papers in big name journals. Are we “driving out the very people we need to retain: those who are interested in science as an end in itself…“?…

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