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• Atul Gawande and the Art of Medical Writing

  Don’t read this. That is, if you have a limited amount of time for reading today, I’d rather you read Atul Gawande’s essay on end-of-life care in this month’s New Yorker than this blog.But if you can spare a little time, I’ll be focusing on some of the Read More... Posted Fri, Aug 13 2010 9:01 PM by Bob Wachter | 9 Comments Filed under: Quality Improvement, Hospital Care, Ambulatory/Primary Care, Health Policy, Media/Press Coverage, Medical Ethics

• 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

• 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

• My Interview on The Health Care Blog

  If for some reason you haven't gotten enough of me on Wachter's World, I just did a long, fun interview with Matthew Holt on the always-interesting THCB. We cover patient safety, the future of IT, the demise of primary care, Death Panels, and more. I Read More... Posted Wed, Aug 19 2009 3:48 PM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Efficiency, Medical Education/Academia, Hospitalists/Hospital Medicine, Information Technology, Ambulatory/Primary Care, Patient Safety/Medical Errors, Health Policy

• Gawande Nails It on Healthcare Costs

  I just finished reading Atul Gawande’s June 1st New Yorker piece – it's the Talk of the Health Policy Town – on healthcare’s “Cost Conundrum.” Like most of Atul’s work, the article is lyrical, powerful, insightful, and correct.As you’ve probably heard, Read More... Posted Fri, Jun 05 2009 10:55 PM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Efficiency, Health Policy, Media/Press Coverage, Medical Ethics

• On Quality Measurement, Babies, and Bathwater

  Quality Measurement mavens are reeling these days, as a result of the air being let out of high-profile measures such as tight glucose control, door-to-antibiotic time, and beta-blockers. Some critics have even suggested that we put a moratorium on new Read More... Posted Thu, Apr 16 2009 7:17 AM by Bob Wachter | 6 Comments Filed under: Quality Improvement, Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Health Policy, Media/Press Coverage

• “Mr. Obama, Tear Down These (Hospital) Walls”: Readmissions in Context

  I like readmissions. Well, that didn’t come out quite right, did it? What I mean is that I like focusing on readmissions as a potentially actionable quality measure. I believe that it’s possible to prevent many readmissions, thereby improving quality Read More... Posted Sat, Apr 04 2009 12:36 AM by Bob Wachter | 10 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Efficiency, Hospitalists/Hospital Medicine, Information Technology, Ambulatory/Primary Care, Patient Safety/Medical Errors, Health Policy

• ICU Glycemic Control: Another Can’t Miss Quality Measure Bites the Dust

  A disconcerting pattern has emerged: a blockbuster study finds that a certain practice leads to improved outcomes. Large national organizations codify the practice into a quality measure, forcing widespread adoption. Later studies prove the practice to Read More... Posted Mon, Mar 30 2009 7:03 AM by Bob Wachter | 6 Comments Filed under: Quality Improvement, Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Nurses/Nursing, Health Policy

• Will Academic Medical Centers Show the Love to Their Faculty Quality Improvers?

  When we launched our hospitalist program in 1995, I dreamed that many of our faculty would become leaders in quality and patient safety. That dream has come true, but we now must leap over two hurdles: getting these superb physicians paid and promoted. Read More... Posted Sat, Feb 28 2009 9:52 AM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors

• Checklists (The Sequel), 5 Million Lives, and the Magic of Measurable Results

  Last month’s New England Journal included another astounding checklist study, an international extravaganza that found nearly 50% reductions in mortality and complications after implementation of pre- and post-op surgical safety checklists. Wow. Coincidentally, Read More... Posted Fri, Feb 13 2009 8:22 AM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• How the Newly Vigorous Patient Safety Regulatory Environment May Be Harming the Cause of Safety

  In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has.Note that this comes from someone Read More... Posted Sun, Oct 19 2008 8:34 PM by Bob Wachter | 6 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• NPR’s “Talk of the Nation,” Featuring Don Berwick and Yours Truly

  Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important, since "Talk of the Nation" spent 30 minutes yesterday interviewing Don Berwick and me about it… on the day of Hillary’s speech! Read More... Posted Wed, Aug 27 2008 7:08 PM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Information Technology, Health Policy, Media/Press Coverage

• Post-Vacation Potpourri: Items Interesting, International, and Ineffably Sad

  Just returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced. Read More... Posted Thu, Aug 14 2008 3:07 AM by Bob Wachter | 0 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• The New (CMO) Math: Passion + Power = Progress

  In his five years on the job, Dr. Ernie Ring taught me why the Chief Medical Officer role is crucial, and how to do it right. Since Ernie is retiring at week’s end, it seems like an opportune time to share what I’ve learned.A bit of background. UCSF Medical Read More... Posted Wed, Jun 25 2008 8:36 AM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy