Sunday, May 31, 2009

Main Line Health and Quality

I am very pleased to report that after one year on the Board of Governors of the Main Line Health hospital system in suburban Philadelphia, I have now been appointed the Chair of the Board Quality and Safety Committee and a member of the Board Executive Committee. MLH is a very successful system of five acute care hospitals and one rehab hospital. They are largely a private practice based physician culture with partially salaried chiefs of service across the hospitals. They have a consolidated medical staff and a robust quality and safety apparatus already in place. I hope to bring my ten year experience as a Board member of Catholic Healthcare Partners , in Cincinnati OH, to MLH. At Catholic Healthcare Partners we began the quality journey of the Board nearly seven years ago and now, CHP is a national leader in governance engagement in quality. MLH will one day share this distinction, I am sure. With health reform looming, with a less than stellar ten year effort post the IOM report "To Err is Human," MLH has a real governance challenge ahead. I am humbled and excited to be a part of this wonderful organization and I look forward to the work ahead. How is your system managing the governance challenges of qualitya and safety?? DAVID NASH

Sunday, May 17, 2009

What Health Reform Plan??

The Obama administration is working in overdrive to create a health reform package that could possibly be passed this summer. That is the headline we are all reading. The challenge, among many, is "what exactly is the proposed plan?"Like you, I am very concerned that the real work is being done in the basement of the White House by a very small number of non elected leaders. Sure, the press has been pretty good to date with a "down payment" on reform via the ARRA and lots of talk about the benefits of the infusion for information technology. However, the actual proposed legislation is leaking out in bits and pieces as the various interest groups inside the Beltway try hard to get their hands on real information. I hope we keep our eye on the four pillars of reform---create value, insure everyone, change the payment system and promote coordination. The pillars represent real reform, everything else is tinkering around the edges. At the Jefferson School of Population Health we are tracking these developments carefully but we need your help too. We must continue to press for transparency here and we must make sure that the four pillars are embodied in any legislative proposal. I am interested in your views too. DAVID NASH

Sunday, May 10, 2009

The 18th Annual Grandon Lecture

Each year for the past 18, we have sponsored a nationally prominent person in the broad field of health policy to come to Jefferson and deliver a talk on a timely topic. Past speakers have included persons such as John Iglehart, Peggy O'Kane, Jack Rowe, and others. This year, Dr Tom Nasca, the CEO of the ACGME in Chicago, delivered the address. He linked the work of the ACGME, the group that accredits every residency program in the nation, to the need for improved quality and safety in the delivery of health care. He demonstrated that professionalism today also means an awareness of these issues and an ability to allocate resources appropriately and furthermore, a deeper understanding of the "systems" nature of care. He also met with all of our residency program directors from our teaching hospital, nearly 80 individuals who represent almost 750 trainees across all disciplines, to discuss the challenges of accreditation such as limited duty hours and the like. Clearly, there are important links between accreditation, duty hours, professionalism and health care reform. We need to provide a health care work force ready to meet the challenges of a reformed system. The ACGME is a core component of meeting this challenge. What is your residency program doing to meet the challenges of health reform?? How are you working to promote accountability and a deeper understanding of the systems nature of care?? I am interested in your views, DAVID NASH

Sunday, May 3, 2009

OUTLIERS--The Story of Success

Malcolm Gladwell is one of my favorite authors. His last two books, the Tipping Point and Blink, became best sellers. I reviewed both books in our Jefferson Health Policy Newsletter in 2001 and 2005, respectively. His newest book, OUTLIERS-The Story of Success, is another hit!! I especially enjoyed chapter 7--The Ethnic Theory of Plane Crashes. This could serve as a primer on the basic tenets of Crew Resource Management--the study of improved cockpit communication and its connection to safer flights and fewer crashes. Essentially, CRM teaches pilots, copilots and other crew members a standardized form of communication that empowers everyone to participate in a safe flight. It reduces "mitigated speech" patterns and helps to preserve communication "against the authority gradient" with out punitive damages. I am convinced that healthcare teams could use a heafty dose of CRM and that training programs across most hospitals would benefit as well. Imagine for a moment a team making rounds that chooses to ignore the third year student who has a crucial piece of history, taken from the patient, that may dictate a change in therapy?? Would your team be willing to listen to the lowly third year student, especially if her information would contradict what the attending has already decided?? Think about it, and let me know!! DAVID NASH