[No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic

Robert Bell rmsbell200 at YAHOO.COM
Thu Aug 9 15:59:48 UTC 2018


 Precisely Bob,
You should be an insider, not an outsider. Perhaps even our leader.
Does the US need to learn why their health care statistics are often worse than the rest of the developed world? 
Why do single payer systems, that are not perfect, work better than what we have in the US?
Rob Bell

   On Thursday, August 9, 2018, 7:57:48 AM MST, Bob Latino <blatino at reliability.com> wrote: 
 
 
from  Rory's Post - "Reduced cost should be a fortuitous outcome of improved/more efficient care, not a primary goal"
 
  
 
I'm an outsider that specializes in Operational Reliability in the high hazard industries (i.e. - Oil and Gas, Chemicals, Nuclear).  I am quite familiar with the 'triple aim'.  I agree with Rory's statement above as it is practiced daily in many of the industries I deal in.
 
  
 
While I understand the 'operations' are different between HC and these continuous process industries, they are all 'systems' when broken down into their manageable components and process flows.  
 
  
 
My friend Ron Moore is a Reliability pioneer and has studied the relationship between Reliability and Safety in detail.  I have attached a paper of his entitled 'A Reliability Plant is a Safe Plant is a Cost-Effective Plant'.  Is a Reliable Hospital a safe and cost-effective hospital?
 
  
 
In my experience HC tends to resist comparing themselves to outside industries, but from a system's perspective, I think there may be applicable analogies here. What do you all think?
 
  
 
Bob
 
  
 
Robert J. Latino, CEO
 
Reliability Center, Inc.
 
1.800.457.0645
 
blatino at reliability.com
 
www.reliability.com
 

 
  
 
From: ROBERT M BELL [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG] 
Sent: Tuesday, August 07, 2018 12:02 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
 
 
 
Is labor action or some other way forward necessary. If they knew what was going on would our patients want us to do something?
 
 
 
Rob Bell, M.D.
 

On Aug 6, 2018, at 10:13 AM, Rory Jaffe <rjaffe at CHPSO.ORG> wrote:
 
  
 
Not to go further off-track, but, I hate the triple aim. Reduced cost should be a fortuitous outcome of improved/more efficient care, not a primary goal.
 
 
 
Rory Jaffe, MD MBA, Executive Director, CHPSO
 
1215 K Street, Suite 930
Sacramento, CA 95814
rjaffe at chpso.org
(916) 552-2600
 
 
 
<image001.jpg>
 
 
 
Subscribe to CHPSO newsletters and announcements
 
<image004.jpg>
 
 
 
From: Xavier Prida <dr.xavier.prida at GMAIL.COM> 
Sent: Monday, August 06, 2018 9:30 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
 
 
 
The traditional mantra in QI- "Your outcome(s) is precisely predicated on your processes " satisfies this. Rather than looking back and recognizing this epoch as the "information and evidence age of medicine", it shall be remembered as the economic and business model age. And, it mirrors the capitalist model with many causalties along the way(patients, physicians, systems and communities of care disrupted). 
 
 
 
And, the most disingenuous part is the corruption of the "triple aim" - the basis of this is the iron triangle(cost, quality, speed)- extension to the "quadruple aim" by CMS. An evolved market model is untesed and unproven as to its ability deliver a quadruple aim.
 


 
 praesent superare odio  (rise above)
 
 
 
Xavier E. Prida MD FACC FSCAI
 
Assistant Professor of Medicine
 
Program Director Cardiology Fellowship Training 
 
USF Morsani College of Medicine
 
Department of Cardiovascular Sciences
 
2 Tampa General Circle
 
STC 5 th Floor 
 
Tampa, Fl 33606
 
813 259 0992(O)
 
 
 
 
 
On Mon, Aug 6, 2018 at 10:08 AM, Bruno, Michael <mbruno at pennstatehealth.psu.edu> wrote:
 

Very insightful of Upton Sinclair, and of you too, Dr. Swerlick! 
 
 
 
We’ve created healthcare systems that do exactly what they were designed to do: maximize revenue.  And they do it quite well, and despite a challenging economic environment in healthcare.  The tradeoff for this very tangible benefit is high levels of physician burnout, a poor patient experience, and sub-optimal quality and safety in patient care.  If we want our healthcare systems to do other things instead, such as provide excellent healthcare to patients, or if we perhaps want our systems to become the kind of working environment that does not produce physician burnout on a massive scale, then we will need to fundamentally redesign them.
 
 
 
It is the same reasoning that has been applied to the electronic medical record (see the attached article).
 
 
 
All the best,
 
 
 
<image005.png>
 
Michael A. Bruno, M.S., M.D., F.A.C.R.   
Professor of Radiology & Medicine
 
Vice Chair for Quality & Patient Safety
 
Chief, Division of Emergency Radiology
 
Penn State Milton S. Hershey Medical Center
( (717) 531-8703  |  6 (717) 531-5737
 
* mbruno at pennstatehealth.psu.edu  |  
<image006.png>
 
 
 
*****E-Mail Confidentiality Notice*****
This message (including any attachments) contains information intended for a specific individual(s) and purpose that may be privileged, confidential or otherwise protected from disclosure pursuant to applicable law.  Any inappropriate use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalty.  If you have received this transmission in error, please reply to the sender indicating this error and delete the transmission from your system immediately.
 
 
 
 
 
From: Swerlick, Robert A [mailto:rswerli at EMORY.EDU] 
Sent: Sunday, August 05, 2018 3:44 PM
 

To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
 
 
 
The skepticism regarding de-biasing is not a either it works or doesn't. It may work in specific circumstances with specific populations. In healthcare delivery, the question is where are those circumstances where training people results is meaningful return on investment and where are the circumstances where the environment (system issues) are so overwhelming that it does not make sense to try to de-bias those who embedded in such systems. 
 
 
 
The environments I observe are volume driven and financially reward heavy dependence on system one engagement. De-biasing will almost certainly require engagement of system 2 translating to less volume less volume and fewer $'s. Unless there are meaningful changes in how we reward practice activities, this will be a hard sell. I can't help but recall a quote from Upton SInclair:
 
 
 
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” 
― Upton Sinclair, I, Candidate for Governor: And How I Got Licked
 
 
 
Robert A. Swerlick, MD
 
Alicia Leizman Stonecipher Chair of Dermatology
 
Professor and Chairman, Department of Dermatology
 
Emory University School of Medicine
 
404-727-3669
 
 
 
 
 
From: Pat Croskerry <croskerry at EASTLINK.CA>
Sent: Sunday, August 5, 2018 11:50:39 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
 
 
 
Thanks for the link.
 
 
 
Evidence that the pessimism about bias mitigation is unwarranted is accumulating. Nobody said it would be easy, but nobody should say it can’t be done.
 
 
 
Nisbett’s work is acknowledged in this piece – his recent book describes a number of strategies: Mindware: Tools for Smart Thinking . 
 
Further, a recent review in Medical Decision Making found that most of 74 interventions in 13 studies were effective:
 
(Ludolph R, Schulz PJ. Debiasing health-related judgments and decision making: A systematic review. Medical Decision Making 2017; 38 3–13).
 
 
 
  
 
 
 
From: mgraber <graber.mark at GMAIL.COM> 
Sent: August 5, 2018 11:25 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
 
 
 
Thanks to Eta Berner for this …..
 
 
 
https://www.theatlantic.com/magazine/archive/2018/09/cognitive-bias/565775/
 
 
 
 
 
 
 
 
 

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