“Curmudge, I googled it. ‘Happy Talk’ is a song that was sung by Bloody Mary in the
musical, South Pacific. But I was
hoping that as you cleaned out your files this spring you’d find quotations
that were cheerful and encouraging.”
“For the most part, it didn’t turn out that way, Julie. And most of these quotes are fairly
recent. They suggest that health
care should still be in intensive care.”
“Well I hope that our readers realize that these are
quotations from notable authors and not original with you and me.”
“Julie, after 200 postings our readers should realize that nothing is original with you and
me. So sit back and shudder at
what you are hearing.”
“Health care
remains fundamentally unsafe.” (L.
Leape, runningahospital.com, 3/20/12)
“Too often, doctors
think they are infallible, communication between doctors and nurses is poor,
and accountability is virtually non-existent.” “There is difficulty admitting that well-meaning, highly
trained, competent doctors predictably and continuously make mistakes.” (Peter Pronovost, Wall St. Journal,
2/17/10)
“We (physicians)
can’t know it all. We can’t do it
all by ourselves.” “Holding on to
that old culture (complete autonomy) has been a disaster.” “We need pit crews, not cowboys.” (A. Gawande, TED talk, April 2012)
“You can’t practice
medicine by committee.”
“Uniformity of practice is a nonsensical goal that fails to allow for
differing expression of disease states.”
(S. Greenfield, Wall St. Journal, 9/07/10)
“It sounds,
Curmudge, as if Dr. Greenfield doesn’t favor standardized work, algorithms, and
checklists.”
“That’s why a goal
of evidence-based medicine is to accommodate variation between patients while
minimizing variation between clinicians.”
“Most clinicians
and nurses believe quality improvement is done to them rather than something they do.” “Without physician leadership, quality improvement efforts
are unlikely to succeed.” (P.
Pronovost, beckershospitalreview.com 2/28/12)
“The average
Medicare patient sees two physicians and five specialists a year.” “You (patient) have to be the central
communicator…there is no little Tinkerbell picking up your medical records and
automatically delivering them to the physicians in your life who should know
what is happening with you.” (B.
Gray, kevinmd.com 4/09/12)
“We don’t often
talk about money, Julie, but here are some ways to achieve big savings:”
“Decrease the practice of routinely administering untargeted
chemotherapeutic false hope and real suffering to patients with widespread
metastatic cancer. Recognize death
to be normal, and endeavor to make it as dignified and free from pain as
possible. Do not prolong dying to
keep the revenue flowing.” (George
Lundberg) “Stop overtreatment with
unneeded antibiotics, surgery, and intensive care, especially at the end of
life.” (Donald Berwick) (Both found in kevinmd.com 5/07/12)
“Whether happy or
not, physicians set the tone at their places of work.” (G. Hood, Survey of physician
happiness.)
“L.A.M.E. = Lean as
mistakenly executed.” (M. Graban,
LeanBlog 4/10/12)
“No one can
guarantee the right outcome from a treatment for an individual patient.” (P. Hartzband & J. Groopman, Wall
St. Journal, 3/31/12)
“Creating a culture
of safety includes: Admitting our own errors and mistakes when they occur, and
feeling empowered and supported to speak up when we see another’s. (and) Learning from errors so that we don’t
repeat them.” (O. Peskovitz,
runningahospital.com 3/16/12)
“Julie, you should
find this example of precise performance to be encouraging:”
“An aircraft
carrier is an airport on top of a nuclear power plant (run by) a bunch of
19-year olds.” (S. Patterson,
runningahospital.com 4/18/12)
“That’s an
oversimplification, Curmudge. You
know that those 19-year olds are led by the best of the best and that all
critical functions—especially on the flight deck—are exquisitely choreographed
and perfected by repetition.”
“Our local
hospitals will never go to sea, Julie, but I’ll bet that those kids could teach them a thing or two about the value of standard work.”
Kaizen Curmudgeon
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