I think I’m a pessimist. I have come to believe that most things in this world are driven by the incentive to make money. I imagine that current HROs such as aviation are driven by the high cost associated with failure, but such analyses are not readily available in health care. The idea of creating a high reliability organization in health care appears to oppose the current constant push to increase productivity in hospitals. However, improving outcomes, decreasing litigation, increasing compliance, and decreasing complications should inevitably decrease costs to hospitals. By presenting these ideas from the cost decreasing aspect, I wonder if we could align our interests towards patient safety and quality improvement with the purely economic interests of policy makers and care organizations. We would be able to incentivize existing leadership in our organizations by speaking their language, rather than trying to change the game. Cost analysis of… Continue reading →

During the Health IT presentation, I was struck by the discussion to hold EMR systems accountable for patient outcomes. Furthermore, I had trouble with the acceptance of a provider’s tendency to not double check an order when an EMR is present. At first, this seemed like an unacceptable reliance on technology in lieu of addressing the underlying issue of medical decision making. It was not until our second to last presentation, with the example of fighter aircrafts being managed by 18-22 year olds, that I understood the rationale behind this. They are able to optimize their delivery system despite the operator. I realized that when we view “the system” as an accountable aspect of patient care, this includes sub-optimal support systems such as the EMR. By not providing the optimal support system, we are undermining the delivery of optimal care.