The difference between empathy and sympathy

As I head off into a blogging break through New Year's Day, I pass along this view by Dr. Brené Brown of the difference between empathy and sympathy, a distinction that those of us in the health care world would be wise to understand. "Empathy fuels connection. Sympathy drives disconnection." Animation by Katy Davis. Happy New Ye...

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The sun is not only a painter but a sculptor.

With thanks to Judy Miller--one of the finest nursing administrators I have met--now at Galloway Consulting.  Look at this lovely excerpt from Florence Nightingale:Light essential to both health and recovery.   It is the unqualified result of all my experience with the sick, that second only to their need of fresh air is their need of light; that, after a close...

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Can you help this pregnant woman?

A friend called to ask for help on an issue related to her pregnancy. Do you know anyone who might be able to provide advice? Here is the situation:A bad termite infestation has been discovered in her apartment, as well as the other units in her block in San Franciso. The entire block of apartments will need to be tented and sealed while a pressurized gas called...

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On learning organizations

Please check out this new article I wrote for the Athenahealth Leadership Forum.  The lede:A colleague once said, “Every plan is excellent, until it’s tested. It’s execution that’s the problem.” And so it is. Excerpts: Project advocates enter every endeavor with a theory of the case, a vision of how things should be. But, as my late colleague Donald Schön noted, reflective practitioners are constantly reviewing the evidence to modify...

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A turning point for Partners Healthcare?

As we look back at the history of Partners Healthcare System (PHS) in Massachusetts, it is useful to consider what it is and what it might have been.  What it is is an extraordinary collection of extremely dedicated and talented people--clinicians, researchers, and teachers--who do their best to serve humanity.  What it is also is an incredibly successful business enterprise, carrying out a series of strategic plans that have led to market...

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The next patent cliff

Much attention has focused on the "patent cliff" faced by pharmaceutical companies. As their proprietary drugs lose patent protect, the drug companies face competition from low-cost generic drugs.  With an exceptionally high cost and long lead time for new drug development, the pharmaceutical companies face significant strategic problems.There is another patent cliff approaching that has not yet received much attention--the end of patent protection...

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Outsourcing as an element of the private equity model

One of the things to consider about private equity ownership of a hospital system--given the inevitable desire of the investment firm to flip the system--is what it is has done to the cababilities of the organization during the holding period.For example, one such firm has a policy of outsourcing as many of the hospital functions as possible.  It removes staff from the payroll and shifts their functions to a third party.  Examples are campus...

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Sign of the times

Here's a sign in the Jacksonville, FL, airport. I've always had the highest regard for hospitalists, as I believe they make a substantial difference in the quality of care offered in hospitals.  But I never realized that they had risen in stature to being viewed as a competitive differentiator in the obstetrics world, in which women often comparison shop before deciding...

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For students: Telluride Patient Safety Summer Camps Applications for 2014

David Mayer has just posted a request for applications for medical and nursing students for the Telluride Patient Safety Camps for this coming summer.  Excerpt:Through the generous support of The Doctor’s Company Foundation and MedStar Health, scholarships are now available for 40 medical and 20 nursing student leaders to engage in an immersive experience with leaders, educators, and advocates in patient safety at the 10th Annual Telluride,...

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Oatmeal at IHI: The sequel

I never thought that I would be compelled to write another post about the manner in which oatmeal is served at the IHI Annual National Forum at the Marriott World Center in Orlando.Let me take you back to the original posts from 2010: 1, 2, 3, 4.  Short version: The ladles (see above) provided to guests on the breakfast buffet were too large relative to the bowls, so...

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Evans: Let's make our day harder

Check out this great animation from Mike Eva...

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How to learn nothing from patients

As we consider again the expertise shown by the folks at Legoland in responding to customers, consider this alternative view presented by Rob Markey on the HBR Blog Network.  The article is called "Five Ways to Learn Nothing from Your Customers' Feedback."  I'm struck by how often hospitals behave in these ways--sometimes on their own volition, but often with the...

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Echoes of Telluride

As we turn to the final day of the IHI Annual National Forum on Quality Improvement in Health Care, our intrepid band of Telluride graduates prepares for their session, "Student- and Resident-Driven Patient Safety Programs"  The presentation will draw on their experience at Telluride in examining issues of quality, safety, disclosure, and apology--as well as work they...

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A fantastical experience at Legoland

One of the highlights of IHI's annual National Forum on Quality Improvement in Health Care is the opportunity for attendees to take a full-day excursion to one of the major theme parks in the vicinity. I had the pleasure of helping to lead one yesterday to Legoland.  We all know about Legos, those versatile, creativity-building blocks, and this park is a physical embodiment...

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Will OpenBiome be #1 in the #2 business?

I recently learned of a fascinating non-profit start-up based at MIT called OpenBiome. The lead organizers are Mark Smith, a bio-science Ph.D. candidate and James Burgess, an MBA candidate.  The topic? Fecal microbiota transplant (FMT), which is now recognized as an effective cure for C. difficile patients.  In fact, its about 90% effective in patients that have...

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Mom, this is how Twitter works.

Here's a site that gives an excellent and easily understood description of some of the aspects of Twitter that might not be known to all.For example, did you kn...

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Do portals lead to a better view?

I very much enjoy the "contrarian, brainy and literature-based resource by Jaan Sidorov" over at The Disease Management Care Blog.  A recent post provides an example of how he makes us think. The lede:In the November 19 issue of the Annals of Internal Medicine, Caroline Lubick Goldzweig and colleagues examined the published science on the purported advantages of electronic health record (EHR) portals.Recall that portals are web-based entryways...

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The SEIU is back: This time with ballot initiatives

As you watch the Service Employees International Union in action, you are inevitably left with the feeling that this is a union that has such substantial trouble relating to workers that it has to resort to powerful political tactics to accomplish its enrollment goals.  I documented one such tactic--the corporate campaign--in my book How a Blog Held Off The Most Powerful Union in America.  The object is to publicly denigrate a hospital...

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Sensible thoughts on concussions

Given our inability to accurately measure the neurological damage from concussions, this seems like a prudent step.  From ScienceDaily:Any athlete with concussion symptoms should not be allowed to return to play on the same day, according to the latest consensus statement on sports-related concussion. The updated guidelines are summarized in Neurosurgery, official journal of the Congress of Neurological Surgeons.The fourth consensus report...

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Heavenly start-up?

My friend Dhaya Lakshminarayanan's mother offers this comment about Nelson Mandela:"He had a long life. He was 95 and did many good things. Now in heaven maybe he and Gandhi and King will do start-up company for freedom."&nb...

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Dear health care reporters: Look this way

I bet Robert Langreth (and his colleague Shannon Pettypiece) over at Bloomberg News never thought they would become experts in robotic surgery, but the travails of Intituitive Surgical. Inc. keep providing fodder for these business reporters.  How ironic.  What a sad statement about the lack of depth and coverage by many health care reporters that this business media outlet becomes dominant on this topic.The latest? Here's their article...

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Is a different kind of collective bargaining possible?

The New York Professional Nurses Union has an interesting history.  Among other things, it accomplished something unusual, decertifying the SEIU, which had previously represented its members.  From its website:The Registered Nurses at Lenox Hill Hospital were first organized into a union in 1980 by Local 1199, the Health Care Workers Union. By 1984 a number of...

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Pro Publica tells the prisoners' health care story

Some part of the 18% of GNP spent by the United States on health care is the medical care given to prisoners in state and federal correctional facilities. A recent article by Christie Thompson at Pro Publica provides a summary of the problem:And as the elderly population in prison grows, so do their medical bills. Housing an inmate in a prison medical center costs taxpayers nearly $60,000 a year — more than twice the cost of housing an inmate...

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MVP is a most valuable principle

A few weeks ago, I wrote about the tendency of many start-up companies who try to sell their wares to hospitals to ignore the needs of the various constituencies and therefore fail to make sales.  I concluded:It is possible to sell great new ideas to hospitals, but they need to satisfy the interests of several constituencies in those organizations.  They must improve...

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Joining Lean practitioners in Israel

Many thanks to Boaz Tamir, head of Israel Lean Enterprise (part of the Lean Global Network), for an invitation to present at a session for a number of businesses that are involved in adopting the Lean process improvement philosophy in their organizations.  Examples included Intel, the Strauss Group (food and beverage supplier), Bank Hapoalim, and yes (satellite broadcasting.) ...

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MIT SDM deals with the prisoner's dilemma

This looks really fascinating for those of us interested in how incentives do or do not work:Systems Thinking and the Inevitability of the Dreamliner DelaysMIT SDM Systems Thinking Webinar SeriesYao Zhao, Ph.D.Associate Professor, Rutgers UniversityDate: December 2, 2013Time: Noon – 1 p.m. EDTFree and open to allRegister About the Presentation Although the Boeing 787 Dreamliner was the fastest-selling plane in the history of commercial...

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How to deal with performance anxiety

Here's a really interesting insight from a musician about one way to deal with performance anxiety.  Or Ben-Natan is a vocalist who sings bass in classical and other music concerts in Israel. At a recent rehearsal with a chamber group in Zichron Ya'akov, his wife made sure that their little granddaughter was sitting near her in the front row to watch the performance.When...

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Shaking the hubris of the profession

My friend Danny Sands writes a remarkable story about a recent medical problem he faced. It's called "On The Ultimate Loss of Control, Living with Uncertainty, Reflecting on the Future, and Being a Patient."  It is beautifully written and worth a look.I have been struck by a number of similar types of stories recently in which doctors have become patients or have been with close families members in that situation.  I think it is a wonderful...

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In memoriam: Arik Einstein

The story goes that, on his 70th birthday, Arik Einstein was invited to lunch by the president of Israel. "Mr. President," he replied, "please let me stay home."This week this legendary performer, an icon in the country, died from a ruptured aneurysm at age 74.  The outpouring of grief and appreciation has been truly remarkable.  For example, thousands of people attended hours-long open-air concerts in Tel Aviv, singing the well-known lyrics...

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Happy holidays!

My friend Lisa Popick Coll offers this version of a Thanksgivukkiah on Facebook.Reportedly the two holidays will not coincide for another 70,000 years.  More or less. The explanation:The overlap this year is because according to the Jewish calendar, this is a leap year, meaning that an entire extra month is added to the calendar. Because of that, most major Jewish holidays...

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Ma, can we go to the hospital mall?

Traveling in Chicago recently, I saw these ads on the side of a major hospital.  I was struck by the idea that advertising for a mall was getting equal billing to advertising for orthopaedic services.  Orthopaedics has always been a high profit item for hospitals.  I guess dining and shopping has now reached that same lev...

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Remembering Monique Doyle Spencer

A reminder of some of the impact of Monique Doyle Spencer, noted on the second yarzheit (anniversary of her death.)  The Sunshine Girls, a breast cancer support group in Southeast US, with copies of The Courage Muscle.  We'd often laugh about how she was always misplacing her reading glasses!  Here's part of the collection she maintained by her bedside just...

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The future of simulation is to be found in Tel Hashomer

Simulation centers have been popping up in hospitals across the world.  These are useful, but for the most part their function is to provide technical training in surgical and other interventional techniques, as well as to practice resucitation and the like. Sometimes, too, they are used to study teams in stressful situations to provide lessons in team dynamics.Amitai...

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Scott Adams: I hope my father dies soon.

Dilbert's Scott Adams writes an entirely serious (and angrily raw) post about an important topic, doctor-assisted suicide.  Excerpts: I hope my father dies soon.And while I'm at it, I might want you to die a painful death too.I'm entirely serious on both counts.My father, age 86, is on the final approach to the long dirt nap (to use his own phrase). His mind is 98% gone, and all he has left is hours or possibly months of hideous unpleasantness...

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New medical device emerges

At first, I thought it was an isolated incident.  @Bob_Wachter from UCSF reported on Twitter:Lines betwn personal/professional contnue 2 blur, as I now use my @iPhone flashlght 2 look into my patients mouths. OK 2 clean it w/ alcohl?I jokingly responded:This makes me feel a bit uneasy, Bob. What if the phone rings? Or worse, buzzes! :)He answered:Good point, tho its not...

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Exploring Lean in Tel Aviv

A colleague and I are in the midst of an introductory training session about the Lean process improvement philosophy at Sheba Medical Center on the outskirts of Tel Aviv, Israel.  We were invited by Dr. Eyal Zimlichman, head of quality management for the hospital (seen here with Jessica Livneh, head nurse of the oncology outpatient unit.) As is often the case, we find...

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Competition matters on both sides of the Atlantic

There is often a lot to learn by comparing the US and UK health care systems, but as often as not we revert to Shaw’s “two nations separated by a common language” when looking for lessons. Let me give one example.Although the UK has had a single payer, nationalized system for over six decades, there also exits a small but vibrant private sector system. In this sector, private insurance companies—supported by premiums paid by individuals or corporations...

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