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Measuring the Quality of Doctors and Hospitals: When Is Good Enough, Good Enough?

In the past, neither hospitals nor practicing physicians were accustomed to being measured and judged. Aside from periodic inspections by the Joint Commission (for which they had years of notice and on which failures were rare), hospitals did not publicly report their quality data, and payment was based on volume, not performance. Physicians endured an […]

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Pay for Performance in Healthcare: Do We Need Less, More, or Different?

The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical. Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that it doesn’t. We’ve […]

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The Patient Will Rate You Now

The Patient Will Rate You Now

These days, I’d never consider trying a new restaurant or hotel without reading the on-line ratings on TripAdvisor or Yelp. I seldom even bother with professional restaurant or travel critics. Until recently, there was little patient-generated information about doctors, practices or hospitals to help inform patient decisions. But that is rapidly changing, and the results […]

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Never Say Never (Events)

Never Say Never (Events)

Earlier this month, the National Quality Forum released its revised list of “Serious Reportable Events in Healthcare, 2011,” with four new events added to the list. While the NQF no longer refers to this list as “Never Events,” it doesn’t really matter, since everyone else does. And this shorthand has helped make this list, which […]

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Nurse Staffing, Patient Mortality, And A “Lady” Named Louise

Nurse Staffing, Patient Mortality, And A “Lady” Named Louise

How many nurses does it take to care for a hospitalized patient? No, that’s not a bad version of a light bulb joke; it’s a serious question, with thousands of lives and billions of dollars resting on the answer. Several studies (such as here and here) published over the last decade have shown that having […]

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Three Short Stories That Illustrate Key Healthcare Lessons

In my travels, I frequently hear short stories that help illuminate my work and world. Here are three recent examples; think of them as little health policy tapas. I recently spoke in a session with Peter Pronovost, the Johns Hopkins intensivist who is the world’s top researcher in safety and quality. We were talking about […]

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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 Journal of Medicine, two of the Biggest Kahunas in the safety and quality worlds – […]

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Is Don Berwick The One?

The Blogosphere Rumor Factory is heating up with reports that Don Berwick, the world’s most prominent advocate for healthcare quality and safety, will be the next administrator of the Centers for Medicare & Medicaid Services (CMS). (Take this with a grain of salt, because the same Rumor Factory blew it last time on Glenn Steele.) […]

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Strapping Grandma to the Bed: The Unintended Consequences of “No Pay for Errors”

Medicare’s policy to withhold payment for “never events” – the first effort to use the payment system to promote patient safety – remains intriguing and controversial. To date, most of the discussion has focused on the policy itself at a macro level (including two articles by yours truly, here and here). In the past month, […]

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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 quality measures until the science improves. I hope we don’t. I think we’re seeing a […]

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