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

Ruth Ryan ruth at RYAN-GRAHAM.COM
Thu Aug 9 17:49:56 UTC 2018


Tom and all,

We can’t blame the patients/public for not demanding one or another type or any reporting.  Have you ever tried to find out a hospital’s or surgeon’s safety record for a procedure?  Unless it’s CABGs in NY state, good luck.  Patients are swamped with reports they can’t rely on or even make heads or tails of.  Witness the recent discovery that nursing homes have been systematically lying when they report their staffing levels.  So much for Nursing Home Compare, a much vaunted public reporting system.

This is the same mistake as saying patients are blinded to healthcare costs because of insurance and they don’t care or comparison shop (see e.g., Wall Street Journal, August 1). Have you ever tried to find out the cost of a service in advance?  It’s more deliberately opaque, complicated and error-prone than even PBM/hospital drug price deals.

Patients must be involved front and center in defining what information is useful to patients, but it’s our responsibility in healthcare to change the institutional cultures of shame and blame, and design/produce reports that are reliable and useful to the patients and public.  Publishing hospital prices should be the first step but will be bitterly fought.

Ruth Ryan

From: Mark Gusack <gusackm at COMCAST.NET>
Sent: Thursday, August 09, 2018 12:48 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic

Good Afternoon:

I agree with this dystopian scenario.  I’ve seen it happen.  However, I have also seen hospitals buy up these outlying clinics because procedures done at them can be broken down by individual CPT codes generating lots of additional income over what can be billed in the hospital setting.  And, of course, when they move in and take over, they make the clinics more ‘efficient’ and, therefore, often less safe.

Mark Gusack, M.D.
President
MANX Enterprises, Ltd.
304 521-1980

From: Tom Benzoni <benzonit at GMAIL.COM<mailto:benzonit at GMAIL.COM>>
Sent: Thursday, August 9, 2018 11:57 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic

As the dystopian:
When a plant makes an error, the cost of that error is born by that entity.
When an error occurs in a hospital, it profits.

Former life, a tale of 2 patients, 2 physicians, same hospital:

Capable physician #1 performs a procedure at an outpatient facility; patient goes home, does fine.

Doc #2, same procedure, same risk factors, less capable, does same procedure with less expertise using hospital facilities.
3 procedures later, 3 ICU days, complications galore, patient is transferred out.

Which physician is preferred by the hospital?

It's OK to go there in your thoughts. Because one made no money for the hospital, the other did.
And the hospital has the same pressures as any industry: make money or die.

The public is not really interested in having these reported, despite what is said.
This is evidenced by the erosion in support of confidential reporting.
If the public really wanted this handled, there would be solid support for a system to permit reports without fear of retribution, but the safe harbors for reporting have vanished.

tom benzoni




On Thu, Aug 9, 2018 at 10:44 AM Bob Latino <blatino at reliability.com<mailto: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<mailto:blatino at reliability.com>
www.reliability.com<http://www.reliability.com>
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From: ROBERT M BELL [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
Sent: Tuesday, August 07, 2018 12:02 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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<mailto: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<http://www.chpso.org/>
1215 K Street, Suite 930
Sacramento, CA 95814
rjaffe at chpso.org<mailto:rjaffe at chpso.org>
(916) 552-2600

<image001.jpg><http://chpso.org/>

Subscribe to CHPSO newsletters and announcements<https://urldefense.proofpoint.com/v1/url?u=http://eepurl.com/rNG3T&k=q2ic6PGnSSvGRm9uYENyDA%3D%3D%0A&r=1aaywgLlHZ49GLomgN2gpcNMVuk1qp9k63bo%2BqwiIHQ%3D%0A&m=nPo4DNBluQoKznFSpyRgz65%2Ffkdcc45e0bJdcK4fOdA%3D%0A&s=002145da16c17f816d8bd5309d7966b755c6462eb3621af67612bf8c116d1f8a>
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From: Xavier Prida <dr.xavier.prida at GMAIL.COM<mailto:dr.xavier.prida at GMAIL.COM>>
Sent: Monday, August 06, 2018 9:30 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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<mailto: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<mailto:mbruno at pennstatehealth.psu.edu>  |
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From: Swerlick, Robert A [mailto:rswerli at EMORY.EDU<mailto:rswerli at EMORY.EDU>]
Sent: Sunday, August 05, 2018 3:44 PM

To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.goodreads.com_author_show_23510.Upton-5FSinclair&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=vh01PhKHRcQstqbed504RXqt50ai90tBBh83uy2UDpA&e=>, I, Candidate for Governor: And How I Got Licked<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.goodreads.com_work_quotes_254630&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=XZ61zou8nqPQXpmbb3MVC1kaTox-9nNHUZr68ZLZUE4&e=>

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<mailto:croskerry at EASTLINK.CA>>
Sent: Sunday, August 5, 2018 11:50:39 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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<mailto:graber.mark at GMAIL.COM>>
Sent: August 5, 2018 11:25 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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/<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.theatlantic.com_magazine_archive_2018_09_cognitive-2Dbias_565775_&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=oWuNHkGyR7TsA0rPByYlKZaVcQqjE98ixZvlTvnIw5g&s=wjcIaC0bj66hhEbrccbPsYAXAeWEvywbC_PzMFSvvbs&e=>







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