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• Today’s Big ACGME and Joint Commission Announcements: The Courage To – and Not To – Change

  One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations?A few moments ago in the on-line version of the New England Read More... Posted Wed, Jun 23 2010 7:18 PM by Bob Wachter | 9 Comments Filed under: Quality Improvement, Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• UCSF Benioff Children’s Hospital: A Tale of Great Leadership in Three Acts

  This is an amazing tale of leadership – by my hospital CEO, our former chancellor, and, most importantly, a remarkable philanthropist. I’ll start with the latter, veer off to describe the former two, and then return, on this special day, to the philanthropist.The Read More... Posted Thu, Jun 17 2010 8:33 AM by Bob Wachter | 4 Comments Filed under: Hospital Care, Medical Education/Academia, Industry/Pharma, Media/Press Coverage

• The Times Hits the Right Notes on Hospitalists

  You probably saw yesterday’s hospitalist piece in the New York Times, arguably the best lay article on the movement to date. It hit all the right notes, and did so with uncommon grace and fairness. The piece, written by the Times’ Jane Gross, profiled Read More... Posted Fri, May 28 2010 8:05 AM by Bob Wachter | 5 Comments Filed under: Hospital Care, Hospitalists/Hospital Medicine, Ambulatory/Primary Care, Media/Press Coverage

• In Defense of Paul Levy

  Paul Levy, the blogging CEO of Boston’s Beth Israel Deaconess Medical Center, found himself in hot water last month over an inappropriate relationship with a female subordinate. While some of the details of the transgression remain sketchy, I think I Read More... Posted Mon, May 24 2010 7:07 AM by Bob Wachter | 6 Comments Filed under: Hospital Care, Transparency and Reporting, Medical Education/Academia, Health Policy, Media/Press Coverage, Medical Ethics

• Badness in Baltimore: Can Peer Review Catch Rogue Doctors?

  A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb. A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t Read More... Posted Tue, May 11 2010 6:42 AM by Bob Wachter | 15 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Health Policy, Media/Press Coverage, Medical Ethics

• The New Joint Commission: Much Improved, With Room for More

  Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly. Hospitals were given a couple of years' notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, Read More... Posted Fri, Apr 23 2010 6:06 AM by Bob Wachter | 6 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• Hope for the Future: The Society of Hospital Medicine’s Annual Meeting

  I vividly recall attending a faculty meeting at San Francisco General Hospital in the mid-1990s, soon after I joined the UCSF faculty. Our late, great chief of medicine Merle Sande was chronicling all the recent and predicted changes in the healthcare Read More... Posted Sat, Apr 17 2010 7:13 PM by Bob Wachter | 5 Comments Filed under: Hospital Care, Medical Education/Academia, Hospitalists/Hospital Medicine, Health Policy

• Show Me the Money: Can We Afford Education-Oriented Residency Programs?

  In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Read More... Posted Thu, Apr 08 2010 8:35 PM by Bob Wachter | 10 Comments Filed under: Hospital Care, Efficiency, Medical Education/Academia, Health Policy

• Verb-alizing

  One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. Read More... Posted Thu, Mar 04 2010 3:22 PM by Bob Wachter | 14 Comments Filed under: Hospital Care, Medical Education/Academia, Information Technology, Ambulatory/Primary Care

• Rainy Day Interviews, Oscar Winners’ Mortality, and a Randomized Trial of Niceness in the ER: The Extraordinary Mind of Don Redelmeier

  One of the great joys of a life in academic medicine is the opportunity to work with lots of very smart people. But one regret is that there is something about academia that tends to homogenize – faculty learn that, when it comes to competing for the Read More... Posted Mon, Dec 21 2009 3:53 PM by Bob Wachter | 10 Comments Filed under: Hospital Care, Medical Education/Academia, Diagnosis/Clinical Reasoning, Health Policy, Media/Press Coverage

• How UCSF’s Root Cause Analysis Process Became Our Most Useful Patient Safety Activity

  Hospitals face so many urgent tasks in safety – computerize, promote teamwork, implement evidence-based safety practices, discover unsafe conditions – that it’s hard to know where to start. If you’re struggling, I recommend that you put your Root Cause Read More... Posted Thu, Dec 17 2009 6:33 AM by Bob Wachter | 16 Comments Filed under: Hospital Care, Transparency and Reporting, Patient Safety/Medical Errors

• December 1, 2009: The Patient Safety Field Turns Ten

  On December 1, 1999, the Institute of Medicine released a report entitled To Err is Human: Building a Safer Health System. Although its authors hoped to spark a national movement, they had little cause for optimism. After all, early efforts by advocates Read More... Posted Tue, Dec 01 2009 7:22 AM by Bob Wachter | 4 Comments Filed under: Hospital Care, Information Technology, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• Singapore: Pragmatism, Noah’s Ark and the Relentless Search for Best Practices

  From Tokyo, I flew on to Singapore, where I had the honor of being visiting professor at the massive (1500-bed) Singapore General Hospital, a guest of Dr. Kheng Hock Lee. Kheng Hock, one of Singapore’s leading family physicians, has been charged with Read More... Posted Thu, Nov 12 2009 10:55 PM by Bob Wachter | 2 Comments Filed under: Hospital Care, Medical Education/Academia, Hospitalists/Hospital Medicine, Health Policy, Outsourcing/Medical Tourism

• A Week in Asia: Today, Japan; Tomorrow, Singapore

  A couple of weeks ago, I had the chance to visit Tokyo and Singapore – the former to speak at a conference on “Training of the Generalist Physician,” and the latter as visiting professor at Singapore General Hospital. Today: some observations on the medical Read More... Posted Wed, Nov 11 2009 8:56 PM by Bob Wachter | 3 Comments Filed under: Hospital Care, Hospitalists/Hospital Medicine, Ambulatory/Primary Care, Health Policy, Outsourcing/Medical Tourism

• Is Healthcare IT Ready for its Big Coming Out Party?

  In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided Read More... Posted Sun, Oct 25 2009 9:15 PM by Bob Wachter | 7 Comments Filed under: Hospital Care, Information Technology, Ambulatory/Primary Care, Patient Safety/Medical Errors, Industry/Pharma, Health Policy