Thursday, January 26, 2012

#CISummit - Dr. Atul Gawande - How do doctors get good?

From the Care Innovations Summit:

Dr. Atul Gawande, Surgeon, Writer, Public Health Researcher.

How do Doctors get to be good at what they do?

In last 10 years an ordinary Family has seen a rise in pay of $23k but all but $85/month has gone to paying higher health care costs.

The same has been seen in MA in the education sector. Every penny of increased investment has been diverted to health care for teachers.

Health Care (cost) is destroying the American Dream

in 1937 (pre-penicillin days) Health Care was cheap and ineffective.Hospitalization's major benefit was food and warmth.

Since then we have discovered 13,600 diagnoses and 4,000 surgical procedures and 6,000 medications.

No other industry has to deliver on 13,600 product lines to every person in every community.

Our delivery methods have not significantly changed despite this explosion in diagnosis and treatment.

We trained and rewarded independent cowboys when we want pit crews for patients.

The medical community can't cope on their own. Clinicians are baffled by the cost discussion.

We forget the bell curve of impact and cost. The two curves do not match.
This is a sign of hope. If the curves matched we would be talking about rationing of care. But that is not the case.We need to identify the positive deviants. The most successful behave like systems and not independents.
Data is an under utilized resource in Health Care. Data is the window to answers.

HealthCare today is like driving a car with a speedo that tells what speed we were traveling 4 years ago.

The major illnesses of the 5% highest cost medicare beneficiaries in 2010:

Ischemic Heart failure 32% of all beneficiaries and 68% of high cost beneficiaries.

Airlines and Restaurants use Checklists.
Applying checklists to surgery can make a big impact. Average reduction in deaths was 47%. VA has adopted this approach. leading to 18% reduction in deaths.
Implementing Discoveries:

We have to deal with resistance.
We must change who we train, how we work together and how we get our jobs done.

1. Humility (we all make mistakes)
2. Discipline (Repeat practice)
3. Teamwork (More knowledge than we can handle alone)

We need to define what great performance and great care looks like and then design the payment system to support that outcome.

We are battling for the soul of American Medicine. The fundamental issue of this century.

In early 1900's Food was 40% of a family budget.
Government provided data. Weather, crop reports, prices etc.
Incentives: eg. Farmer cooperative banks.
Comparative Effectiveness studies. Cost effectiveness studies.

Intending to bend the cost curve they halved the cost within 20 years.

We face the same challenge in Health care today. This is a 20 year journey that starts by setting out to bend the cost curve.

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