Beginning of PADM 5322 in Fall of 2013

It has been a while since I have posted anything here. I spent the summer teaching an online course and completing an internship in the Master of Public Health program at Georgia Regents University. My intent now is to use this blog for learning purposes in the context of a course in foundations of healthcare administration at Albany State University this fall of 2013. Each week I plan to post one or more new items here and ask my students to each reply. I hope that each reply will be a substantial contribution and will include at least one link to a relevant URL. Each reply (or set of replies) will be due by a specified Sunday evening. The course home page will soon be available at this URL. http://www.robertcat.net/fall2013/padm5322/

Atul Gawande addresses ACO formation

The following link is to a lengthy presentation by surgeon and author Atul Gawande which is well worth watching. You may want to skip over the first seven minutes or so which includes the introduction of Dr. Gwande to the audience at Cleveland Clinic.

One hour and one minute into the presentation he responds to a question from the audience regarding the future of healthcare delivery in the United States and says that, in his opinion, the prospect of who is going to lead the way forward is being battled now among three kinds of players. They are the insurers, the physician groups and the hospitals. He believes that it is the physician groups that are most likely to lead in making the changes necessary to address our nation's healthcare needs.

http://www.youtube.com/watch?v=VSWQtOjsiXo

Begin at the one hour mark. Atul Gawande addresses the question of who will lead the way forward and survive in the new policy and market realities.

This post was edited on August 29, 2012.

Transforming sickness care to health care

Rebecca Onie at TEDMED 2012 made the case that college and university students can become organized to make a very significant difference helping link patients with community resources. She concluded saying, "I believe that we all have a vision for health care in this country. I believe that at the end of the day when we measure our health care it will not be by the diseases cured but by the diseases prevented. It will not be by the excellence of our technologies or the sophistication of our specialists but by how rarely we needed them. And most of all, I believe that when we measure health care it will not be by what the system was but by what we chose it to be."

http://www.tedmed.com/videos-info?name=Rebecca_Onie_at_TEDMED_2012&q=updated&year=all

Publication of avian flu virus research?

CNN reported today that a science journal is poised to publish a study that some experts believe could give a recipe to bioterrorists. This takes the responsibility of peer reviewers to a whole new level.

http://www.cnn.com/2012/05/12/us/journal-avian-flu/index.html?hpt=hp_t1

I don't think such research results should be published. An argument can be made that humanity faces a threat in an "arms race" between human ingenuity and viral adaptations that may cause pandemics. But our existing method of sharing most scientific knowledge through publication does not limit the scope of knowledge distribution. The usual defense of publishing such information is that no bioterrorist is irrational enough to unleash a deadly virus that could destroy the very people whose interests motivate the terrorist. To trust the fate of mankind upon a belief in the sanity and rationality of every potential bioterrorist in the world who may have the skills and resources to design a deadly virus is to trust a very thin thread. Who, if anyone, will be legally responsible if the information published is used by bioterrorists to unleash a pandemic, assuming enough people survive to consider possible litigation?

Scaling Care through Digital Health Coaching

Dr. Vic Strecher of the University of Michigan addresses the important topic of digital health coaching in the video below. When addressing TEDMED recently he spoke of the potential to create personalized online messages for patients to help then change their health-related behaviors. While this may not qualify as "rocket science" it is huge as our nation's healthcare delivery system becomes increasignly financed by capitation and as we try to scale up delivery of services to larger numbers of people. The bottom line in the presentation is that people are more likely to pay attention to (and act upon) highly personalized messages even if those messages were in fact computer-generated.



Additional information about Dr. Strecher is available here. http://www.ur.umich.edu/update/archives/100122/innovator

Forgiveness, Trust and a Culture of Quality

In this video presentation, Paul F. Levy, recent CEO for the Beth Israel Deaconess Medical Center in Boston, makes a case for forgiveness in the culture of a medical institution striving for quality care. I suppose that to somehow punish a physician or other care provider for a serious mistake may be safe behavior for an administrator. People tend to admire active administrators who can make decisive decisions. But the quality of the services provided by a caregiver is more evident in the pattern of his or her work than in the exception. Physicians tend not to identify the mistakes and near-misses of others, realizing that they each are imperfect and may someday make a mistake. A culture of punishment does not promote a culture of trust, which is necessary to create continual learning and improvement.

From social networks to social robots

At her recent TED Talk Sherry Turkle describes how she believes our electronic social and communication devices are becoming problems as we try to substitute connections for real relationships. About half way through her presentation she refers to the use of social robots in a nursing home.



I have not yet digested the relevance of her thoughts to health and administration. But I wonder if the connection (no pun intended) may be to the notion of, "patient centered care." Medical care is now team-based and individual patients sail through an entire trajectory of teams in an episode of acute care. Sooner or later someone will probably invent some charming robot that patients can carry with them through the experience and perhaps even carry home with them. It will be programmed to help the patient understand what is happening to them now and why. It may even become the repository of some data useful to medical caregivers along the way and may monitor the patient's vital signs. Those of us who remember the joys of early social technology in the era when Turkle wrote her book Life on the Screen remember fascination with live online communications. The very idea that a computer could reproduce the sound of a baby's cry or the gesture of person on the other side of the earth was exciting.

Now I observe my students who almost always have their mobile telephones in hand. I share a concern that we may be losing more than we are gaining. If someday I slowly walk or roll the corridors of a nursing home I want good meals and broadband internet access! But I hope for myself and others for more than a cute robot to talk to as I reflect upon life and circumstances. The healthcare delivery system is not friendship service. But I do believe that "patient centered" is about being person centered and that we may have used the phrase, "patient centered" to gloss a dimension that cannot scale through technology or process design.