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

Mark Paradies paradies at TAPROOT.COM
Thu Aug 9 21:15:21 UTC 2018


Interesting statistics.

Of course, statistics don’t say anything about the cause.

Wonder what these would look like if we broke the stats down by states since most of these countries are smaller than the average state.  Also, I don’t see China or Russia in the stats. That would be interesting as well. 

Best Regards,

Mark

Mark Paradies
President, System Improvements, Inc.
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> On Aug 9, 2018, at 1:52 PM, Rory Jaffe <rjaffe at CHPSO.ORG> wrote:
> 
> Note that the distinction between the USA and other industrialized nations is not about single payer but about universal coverage.  Those two issues tend to get conflated, but they’re quite separate. Many of the other nations have universal coverage without single payer. All the other nations have much lower health care expenditures as a portion of GDP and per capita. They don’t necessarily have better outcomes.
>  
> Believe it or not, it has been difficult to identify exactly health care costs so much more here in the USA. Some evidence is that it is because of higher prices rather than higher resource utilization. https://www.nytimes.com/2018/03/13/upshot/united-states-health-care-resembles-rest-of-world.html <https://www.nytimes.com/2018/03/13/upshot/united-states-health-care-resembles-rest-of-world.html>
>  
> Here’s the 2008 total health expenditures as % of GDP. Second chart is 2008 expenditures per capita, adjusted for purchasing price parity.
>  
> <image006.png>
> <image007.png>
>  
> From: Robert Bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG <mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> 
> Sent: Thursday, August 09, 2018 9:00 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: [No SPF Record] Re: [IMPROVEDX] [No SPF Record] Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic
>  
> 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 <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/>
> <image001.jpg> <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.linkedin.com_company_958495-3Ftrk-3Dtyah-26trkInfo-3DclickedVertical-253Acompany-252CclickedEntityId-253A958495-252Cidx-253A1-2D1-2D1-252CtarId-253A1464096807851-252Ctas-253Areliability-2520center-252C-2520inc.&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=lvyisqnL09h46aWVF5JpCdrgFE1HAeDiG5wvE79VgAw&s=qM7V5rT5BBXu046J4lzPAY23WpACsT-NMORwyxe0IVk&e=>
>  
> 
> 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>
> <image004.jpg> <http://www.hqinstitute.org/hqi2018>
>  
> 
> 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)
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>  
> 
>  
> 
> 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>  |  
> <image006.png>
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>  
> 
> *****E-Mail Confidentiality Notice*****
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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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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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