Wedding Kurat

There are many areas within health care design that need to be addressed. Unfortunately the current designers prefer to persist with approaches that will not address the outcomes improvements needed. The pay for performance bandwagon marches on, but the evidence basis has long fallen short. Those truly dedicated to improvements in health care outcomes must review the evidence and move on to areas that do need to be addressed. A Quick Summary: Pay for Performance Has failed to deliver on promised improvements in health outcomes (strong evidence including major reviews) Has been costly (EHR, digitalization, management, administration, maintenance, and security for data collection) Has consumed delivery personnel workforce (nurses for example) with conversion to non-delivery personnel Has resulted in further discrimination against the providers where health care delivery is most needed and is already least supported (evidence consistent in dozens of studies) Has distracted health care fro

When you are the first person to know that a patient has a terminally ill disease and is likely to die soon, how do you communicate this to the patient or his/her family members? This is one daunting task which many doctors face on a very frequent basis. This is not just a piece of information, but an information that is going to severely affect the emotions of receiver and can have an adverse effect on their psychological status if not given with due care. And yet, there is hardly any formal training that doctors receive on how to break a bad news.  My post on ‘Dealingwith relatives in case of patient’s death’ , identifies the need of communicating the bad news in a proper way with patient and family members. Here I going to write about what should be the proper way, which is based upon an article published in ‘The Oncologist’ on ‘A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer’. Although the article is specially for dealing with unfavourable news

As stated by many, a return to abusive work hours during residency is a setback for "health" care. It is another indication that health care is not really about health or care or caring. One would think that health care leaders would not want to expose such truths or how insensitive they are. Today with yet another article indicating the increased health risks for those with even 1 hour less sleep a day, there is more than just another bad mental health day at stake. There is a large body of evidence, but then evidence basis denied is apparently OK for those who lead health science efforts. Residents are dying, most assuredly they are dying.  Some die in accidents. Others die in family tragedies. Yet others have long lasting sleep disruptions. Mental health issues are increasing. Their lives are dying and drying up.  The title of a blog can make all the difference.  Killing Our Residents Softly was an easy title to choose. The singing of Roberta Flack is easily heard in the b

Patients’ deaths are a routine thing in most hospitals, especially those catering to critically ill patients. But for patient’s relative it could be the only event and they may have very strong sentiments towards it. There could be a sea difference in the way a patient’s death is taken by hospital in comparison to his/her relatives. This difference, at times, become a reason for dissatisfaction, blame and even litigation on hospital by relatives In my study on online reviews of different hospitals, posted by patients and their relatives, I found that significantly high number of negative reviews and low ratings were given by those whose patients died in a hospital. The reviews largely blamed hospital/doctor for death of their patients and alleged them with negligence and incompetency.   (For detailed on this studyplease read article  on ‘Avoiding poor online rating of your hospital') Most of these blames and allegation seems to appear due to the ineffective ways in which hospital d

It has become common to promote innovations as solutions without sufficient testing and without really considering the possibility that the intervention might not work as planned. After decades of failure to resolve cost, quality, and access woes across medical error focus, managed care, managed cost, EHR/HIT, PCMH, alternatives to physicians, insurance expansion, and numerous forms of Pay for Performance - the cost, quality, and access problems remain. Telehealth deserves to be critically examined as a solution for rural or underserved populations. First of all, telehealth will be priced in a way that supports expensive medical personnel, managers, CEOs, and investors. There is no intent for service for those low or no pay or with worst insurance. This will require payment. Medicare and Medicaid patients will play a major role as they are concentrated in places with lowest concentrations of physicians. Indeed this is a major reason for shortages. These are the places receiving low

With a sizable number of accredited and a long list of applicant hospitals, NABH accreditation is on its way to soon become a norm for hospital industry in India. Almost all for profit hospitals and a large number of charitable hospitals in India aspires for accreditation and most of them have either revamped or in process of revamping their organization in accordance to accreditation standards. I have written a long post on 'How to prepare for accreditation' , but equally important is also to know, how not to prepare for it. Below, I have covered this topic explaining what could happen if wrong approach is followed for accreditation preparation. Effect of accreditation on workload and complexity While accreditation standards and systems has been designed to improve quality and safety of healthcare, it was never intended to increase the complexity of hospital functioning and burden of work on employees of the hospitals. On the contrary, well developed and documented policies an

My heart is heaviest when my family members are treated poorly, especially by those who are supposed to support them. As a nation we should have heavy hearts for teachers, nurses, physicians, and others prevented from teaching by the basic designs of our nation. Hopefully the school in question will come to its senses and support my remaining family members who are still teachers. There are few left as most have been driven away from teaching by a combination of chronic poor support, lack of backup, and acute events that resulted in departure. Our family, your family, and students lose by design. Schools and school districts must support teachers. During this time period near the end of the school year, it is critically important to support teachers. It is a time when many teachers and their family members wonder whether it is worth it for all the additional efforts that are not supported, including the efforts that can make a difference in the lives of students. As a primary care phys

Healthcare is considered be a recession free industry and hospitals are thought of as stable business organization. Hospital management studies generally teaches students on how to manage operations effectively with large and increasing volume of patient coming to hospital. However not getting sufficient patient is an equally likely possibility and continuing with this situation for even few months may adversely affect the sustainability of hospital. Beside many other risk factors, there are 3 factors which are very relevant to hospital business and must be taken into consideration by managers. Excessive reliance on star doctors –  Many hospitals in India depends on one or few of their star doctors to generate 70%-90% of their revenue. When these star doctors leave, most of their patient just stops coming to the hospital and go wherever the doctor goes. This impacts the top-line severely and hospitals must be cognizant of this risk. While hospitals may take good care of their star doc

Science denial is a popular topic right now. It is convenient to punish some who deny some scientific findings while preserving the right to disagree with science in other areas. Sadly there is science denial rampant in health care. Many treatments have no evidence basis, others are significant but not relevant, but mostly there is ever higher cost for little gain in outcomes. New innovations have been some of the worst distractions because the evidence basis is ignored. In the name of better health, our designers are shaping worse health outcomes. It is difficult to tell which is worse - Science Denial that profits Big Business or Science Denial that profits Health Care Business. Science denial works for higher profits for both.  Business Profit Focus destroys the external environment that shapes future human health largely by impacting environments negatively. Health Care Profit Focus destroys the internal human environments and interactions between people and their environment that