[EXTERNAL] Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture

Tom Benzoni benzonit at GMAIL.COM
Thu Jun 14 19:41:04 UTC 2018


And how do we know this?
Gold standard?
Knowable?
tom

On Thu, Jun 14, 2018 at 2:38 PM Grefe, Rosemary <
RGrefe at childrensnational.org> wrote:

> I am responsible for running a diagnostic service that does not fall under
> CLIA requirements.  Testing quality is totally dependent on the desire of
> the individual provider running the service rather than guaranteed by
> standards that must be met.  This allows many short cuts to save time and
> money.  It also results in a lot of poorly collected  data that is used in
> the diagnosis and treatment of patients.
>
>
>
> Rosemary
>
>
>
> *From:* NANCY GENN [mailto:nancy.genn at COMCAST.NET]
> *Sent:* Thursday, June 14, 2018 1:53 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [EXTERNAL] Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture
>
>
>
> ATTENTION: External Email! Do not click attachments/links unless sender is
> known.
> ------------------------------
>
> There was a study, either Harvard or Johns Hopkins, contrasting PCP's and
> specialists, along 2 variables, diagnostic accuracy and diagnostic
> certainty.   Although specialists had a greater degree of accuracy than
> PCP's, their error rate was still measured very high (I remember it being
> about 17%), but they were astoundingly certain that their diagnosis had
> been correct and rejected  the notion that they needed either further
> objective testing or another opinion (70%).  The interpretation of the
> researchers was that it was arrogance that contributed to the high rate of
> diagnostic error.  It was about 5 years ago.  If I find it, I'll send you
> the citation.
>
>
>
> Nancy Genn
>
> On June 14, 2018 at 12:51 PM ROBERT M BELL <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:
>
> Thanks Tom and Bob,
>
>
>
> Is that the the lack of caution that comes with any degree of arrogance?
>
>
>
> Does arrogance itself have a role in diagnostic error?
>
>
>
> Has that ever been studied?
>
>
>
> Does anyone know?
>
>
>
> Rob Bell
>
>
>
>
>
>
>
>
>
> On Jun 13, 2018, at 8:52 PM, Tom Benzoni <benzonit at GMAIL.COM> wrote:
>
>
>
> From 35+ years in the front lines of health care, this is for sure so.
>
> And the arc is increasing.
>
> I've recently moved from an area that always felt a bit inadequate to one
> that is self-assured.
>
> The prior was much safer than the latter.
>
> Ever hear the phrase "Fat, dumb and happy?"
>
>
>
> tom benzoni
>
>
>
> On Tue, Jun 12, 2018 at 12:26 PM Bob Latino <blatino at reliability.com>
> wrote:
>
> While this is referencing the Oil & Gas industry, there are some
> interesting stats related to the 'zero commitments' we were talking about
> earlier.
>
>
>
> "Unsurpirsingly, there is even a correlation between committing to a ‘zero
> accident’ vision on a project and killing more people. In a thoughtful
> recent study, British colleagues have demonstrated that projects subject to
> a ‘zero safety’ policy or program actually slightly increase the likelihood
> of having a serious life-changing accident or fatality (Sheratt & Dainty,
> 2017)."
>
>
>
> Just an FYI.
>
>
>
>
> http://www.safetydifferently.com/oil-and-gas-safety-in-a-post-truth-world/#comment-3802
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.safetydifferently.com_oil-2Dand-2Dgas-2Dsafety-2Din-2Da-2Dpost-2Dtruth-2Dworld_-23comment-2D3802&d=DwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=AwdxkIfJWQ0pgMs0A60cHAjX-od1OKpfyg9GNaoJR68&s=GcmZmRT46VUGhX98B-C4DKF8CvdBf0p4ld24z2U82Xo&e=>
>
>
>
> *Robert J. Latino, CEO*
>
> Reliability Center, Inc.
>
> 1.800.457.0645
>
> blatino at reliability.com
>
> www.reliability.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.reliability.com_&d=DwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=AwdxkIfJWQ0pgMs0A60cHAjX-od1OKpfyg9GNaoJR68&s=fjtlKbTgiGFqfMlkNDcaqqFz1SJzuZmXMGl7hlc0PY4&e=>
>
>
>
>
>
> *From:* Mark Graber [mailto:Mark.Graber at Improvediagnosis.org]
> *Sent:* Tuesday, June 12, 2018 11:07 AM
> *To:* Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; Bob Latino <blatino at reliability.com>
> *Subject:* Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture
>
>
>
> That Decker article on ‘getting to zero’ is amazing – thanks for
> forwarding it Bob.
>
>
> It was exactly this question, can we get to zero, that prompted my
> first-ever paper on diagnostic errors, arising from assertions at national
> meetings that we could completely eliminate serious safety events.   Don
> Berwick had it right: “The search for zero error rates is doomed from the
> start”.
>
>
>
> Its also the wrong question; Better questions are:  How can we make
> progress, and how can we measure that?  And… now with the knowledge that
> unintended consequences will accompany whatever we do, how do we minimize
> those while maximizing accuracy, timeliness, and safety?
>
>
>
> Mark
>
>
>
> Mark L Graber MD FACP
>
> President, SIDM
>
> Senior Fellow, RTI International
>
> Professor Emeritus, Stony Brook University
>
>
>
>
>
>
>
>
>
> *From: *Bob Latino <blatino at RELIABILITY.COM>
> *Reply-To: *Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Bob
> Latino <blatino at RELIABILITY.COM>
> *Date: *Tuesday, June 12, 2018 at 10:03 AM
> *To: *Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject: *Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture
>
>
>
> Along this thread I thought this article may be of interest.  Declarations
> of 'zero' metrics, often has unintended consequences.  While on the surface
> they seem logical and admirable, they can suppress feedback loops for fear
> of affecting the zero metric (such as zero harm).
>
>
>
> The article is authored by noted safety researcher Sidney Dekker.
>
>
>
> Does this 'zero' mentality fall into the realm of how success in reducing
> Dx error is measured?  Is it applicable?
>
>
>
> Regards
>
> Bob Latino
>
>
>
> *Robert J. Latino, CEO*
>
> Reliability Center, Inc.
>
> 1.800.457.0645
>
> blatino at reliability.com
>
> www.reliability.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.reliability.com_&d=DwMFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=iMpVRgI4Jb8qPZsZHXUj0g&m=AwdxkIfJWQ0pgMs0A60cHAjX-od1OKpfyg9GNaoJR68&s=fjtlKbTgiGFqfMlkNDcaqqFz1SJzuZmXMGl7hlc0PY4&e=>
>
>
>
>
>
> *From:* Rory Jaffe [mailto:rjaffe at CHPSO.ORG <rjaffe at CHPSO.ORG>]
> *Sent:* Monday, June 11, 2018 3:04 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture
>
>
>
> The other studies show a reasonably strong link.
>
>
>
> Some of the problems in making an overall assessment is that culture is
> very local, varying broadly from department to department within an
> organization. Within-organization variability is generally much higher than
> between-organization vulnerability on safety culture surveys. So studies
> that look at “culture” in the organization as a whole tend to have weaker
> results. The specific papers do show a decent link.
>
>
>
> Also backing this conclusion is that, in other industries, this has been
> studied and there is a definite link between culture and safety.
>
>
>
> I think there is a consensus in health care that there’s a link. Look at
> “to err is human” and subsequent publications from the National Academy of
> Medicine. These publications strongly presume that culture is important
> driver of safety.
>
>
>
>
>
> *From:* ROBERT M BELL <rmsbell200 at yahoo.com>
> *Sent:* Monday, June 11, 2018 10:47 AM
> *To:* Society to Improve Diagnosis in Medicine <
> IMPROVEDX at list.improvediagnosis.org>; Rory Jaffe <rjaffe at chpso.org>
> *Subject:* Re: [No SPF Record] [IMPROVEDX] Culture
>
>
>
> Thanks Rory Jaffe,
>
>
>
> Very kind.
>
>
>
> Do you yourself have an overall opinion? I looked at the Weaver article
> which evaluated many studies. and, from my limited interpretation, that did
> not seem too positive.
>
>
>
> Is there a general consensus amongst the medical profession as to whether
> culture is important in preventing errors?
>
>
>
> Is to ERR more resistant to intervention than we think?
>
>
>
> Rob Bell
>
>
>
>
>
> On Jun 11, 2018, at 9:58 AM, Rory Jaffe <rjaffe at chpso.org> wrote:
>
>
>
> Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting
> a culture of safety as a patient safety strategy: a systematic review. *Ann
> Intern Med*. 2013;158(5 Pt 2):369-374.
> doi:10.7326/0003-4819-158-5-201303051-00002.
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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