Ten Simple Rules

[Greenbeard]

One of the more frustrating things about political discussions is the focus on minutia and news cycles over context and perspective. So indulge a brief trip in the Wayback Machine.

Ten years ago this month, the Institute of Medicine, one of the National Academies, released a groundbreaking report on quality in the U.S. health care system called Crossing the Quality Chasm. This came on the heels of another huge IOM report, To Err is Human, which was a pretty sobering look at patient safety in our system. The overall point of Crossing the Quality Chasm was that we can do a great deal better, but our system needs to evolve--that is, we need to try new approaches. Or, from one of the quality experts and clinicians involved in the work, a better summation of the Institute of Medicine's point:

This is a major transition in the IOM’s conclusions: from merely asserting that health care quality is not what it could be (which the Roundtable said) to asserting that the current care system cannot make it what it should be (which the Committee on Quality of Health Care in America said). This latter conclusion appeared first not in the Quality Chasm report, but in To Err Is Human, which concluded likewise that current rates of injury from care are inherent properties of current system designs and that safer care will require new designs.

That quote comes from an old paper I stumbled over recently, a "user's manual" to understanding that "Quality Chasm" report. But more interesting is the outline in that paper of the vision of a new, improved, smarter health care system. These are the pillars such a system would be based on:

Knowledge-based care. Such care is committed to using the best scientific and clinical information available in the service of the patient. The committee found that current care is insufficiently reliable in its use of the best science and best-known practices because it lacks information systems that put that knowledge at the point of use and because it honors and protects unscientific variations in care based on local habits, unquestioned forms of autonomy, and insufficient curiosity.

Patient-centered care. Such care respects the individuality, values, ethnicity, social endowments, and information needs of each patient. The primary design idea is to put each patient in control of his or her own care. The aim is customization of care, according to individual needs, desires, and circumstances. It also implies transparency, with a high level of accountability of the care system to the patient.

Systems-minded care. This kind of care assumes responsibility for coordination, integration, and efficiency across traditional boundaries of organization, discipline, and role. It is especially relevant to patients with chronic illnesses, whose needs extend across time and space. To work well as a system, this kind of care requires high degrees of cooperation, with a higher value attached to cooperation than to local prerogatives.

Ten simple rules. Reaching once again outside health care for guidance, the committee drew on the currently popular theory of "Complex Adaptive Systems" to develop some modern "simple rules" for microsystem redesign. "Simple rules" are basic guiding principles for design, which can powerfully shape adaptive self-regulation and detailed problem solving in a human system. For example, the simple rule, "Keep patients and their loved ones physically together throughout the care process," would lead to entirely different detailed designs from the rule, "Families do not belong in technical care areas."

The Quality Chasm report proposes ten new simple rules as a framework for the enhancement of the effectiveness of microsystems. Each rule is presented in juxtaposition to the prevailing, and less helpful, current design rule.

(1) Current: Care is based primarily on visits. New: Care is based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the health care system should be responsive at all times and that access to care should be provided over the Internet, by telephone, and by other means in addition to face-to-face visits.

(2) Current: Professional autonomy drives variability. New: Care is customized according to patients’ needs and values. The system of care should be designed to meet the most common types of needs but have the capacity to respond to individual patients’ choices and preferences.

(3) Current: Professionals control care. New: The patient is the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over the decisions that affect them. The health care system should be able to accommodate differences in patients’ preferences and encourage shared decision making. (I interpret this to mean that "permission" begins in the patient’s hands, and caregivers assume control only by specific delegation. This would, for example, make the idea of "visiting hours" a thing of the past.)

(4) Current: Information is a record. New: Knowledge is shared freely. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.

(5) Current: Decision making is based on training and experience. New: Decision making is based on evidence. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.

(6) Current: "Do no harm" is an individual responsibility. New: Safety is a system property. Patients should be safe from injury caused by the care system. Ensuring safety requires greater attention to systems that help to prevent and mitigate errors.

(7) Current: Secrecy is necessary. New: Transparency is necessary. The health care system should make information available to patients and their families that allows them to make informed decisions when selecting a health plan, hospital, or clinical practice or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction.

(8) Current: The system reacts to needs. New: Needs are anticipated. The health care system should anticipate patients’ needs rather than simply reacting to events.

(9) Current: Cost reduction is sought. New: Waste is continuously decreased. The health care system should not waste resources or patients’ time.

(10) Current: Preference is given to professional roles over the system. New: Cooperation among clinicians is a priority. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care. (This renders cooperation a primary professional obligation, "trumping" the prerogatives traditionally associated with degree, profession, role, or gender.)

It's been a decade but the efforts to build an intelligent, coordinated, and evidence-based system that revolves around the needs and input of the patient still have a ways to go. But it's a lovely dream.

 

[boedicca]

What a bunch of pablum.

(11) Current: some days it's sunny and some days it's rainy and some days it's foggy and some days it snows. New: The weather is always perfect for whatever the individual wishes it to be that day.

 

[Greenbeard]

I take it you're not a fan of patient-centered care. There's quite a bit of irony lurking in there.

 

[boedicca]

It's inane:

(8) Current: The system reacts to needs. New: Needs are anticipated. The health care system should anticipate patients’ needs rather than simply reacting to events.


WTF does this mean? Is the health care system supposed to be able to predict who might get cancer and need treatment? Or know when one may be in a care accident?

It's a bunch of feel good nonsense dreamed up by utopian bureaucrats who are willing to destroy what works in order to replace it with their version of the way they think we should live.

 

[Oddball]

Who gets to define who is in "need" and who isn't?

Death panels, anyone?

 

[boedicca]

Who gets to define who is in "need" and who isn't?

Death panels, anyone?

Clearly, if one decides one needs something that the Overseers didn't anticipate, it's not a valid need.

 

[Trajan]

These are the pillars such a system would be based on:

do we have such a system in the offing anywhere on the horizon?

It's been a decade but the efforts to build an intelligent, coordinated, and evidence-based system that revolves around the needs and input of the patient still have a ways to go. But it's a lovely dream.

my way back quote machine asks; do they dream with their eyes open, or shut?

 

[Oddball]

It's been a decade but the efforts to build an intelligent, coordinated, and evidence-based system that revolves around the needs and input of the patient still have a ways to go. But it's a lovely dream.

It's a pipe dream as long as politicians and bureaucrats are in charge.

What recommends them to decide what medical procedures I will or won't have performed on me, anyways?

 

[Trajan]

Who gets to define who is in "need" and who isn't?

Death panels, anyone?

I do......now sit down and don't piss me off.

 

[Greenbeard]

It's inane:

(8) Current: The system reacts to needs. New: Needs are anticipated. The health care system should anticipate patients’ needs rather than simply reacting to events.


WTF does this mean? Is the health care system supposed to be able to predict who might get cancer and need treatment? Or know when one may be in a care accident?

A curious person who has a question like that would refer to the relevant piece of the IOM's report (cough) for context and perspective.

I'm not sure what someone like you would do. But I really just intended this thread for curious people. Back to the sandbox with you.

 

[Oddball]

You intend this thread to be gobbled up by gullible fools, rather than have pointed questions asked where the nebulous bureaucratic doublespeak fails you...Which is everywhere.

 

[boedicca]

It's inane:

(8) Current: The system reacts to needs. New: Needs are anticipated. The health care system should anticipate patients’ needs rather than simply reacting to events.


WTF does this mean? Is the health care system supposed to be able to predict who might get cancer and need treatment? Or know when one may be in a care accident?

A curious person who has a question like that would refer to the relevant piece of the IOM's report (cough) for context and perspective.

I'm not sure what someone like you would do. But I really just intended this thread for curious people. Back to the sandbox with you.

B'loney. You intended this thread for unrealistic, logic challenged moonbats to fawn all over the concept of Benevolent Overseers anticipating and satisfying Their Needs.

Back to the playpen for you.

 

[Greenbeard]

While I'm not shocked that the concept of empowering patients to take a leadership role in making care decisions is taken to mean something about bureaucracy and centralized care by the usual crew of idiots, it's still fascinating to watch. There's something impressive in that.

 

[boedicca]

If you truly wish patients to be in a leadership role, then you should support repeal of ObamaCare, reform of malpractice tort law, reform of the tax code so that insurance is decoupled from employment, and increases in HSAs with the ability to roll over unused balances instead of the use it or lose it theft currently in place.

 

[Mad Scientist]

Who gets to define who is in "need" and who isn't? Death panels, anyone?

Clearly, if one decides one needs something that the Overseers didn't anticipate, it's not a valid need.

This (These)

 

[Mad Scientist]

While I'm not shocked that the concept of empowering patients to take a leadership role in making care decisions is taken to mean something about bureaucracy and centralized care by the usual crew of idiots, it's still fascinating to watch. There's something impressive in that.

See how the arrogant Liberal control freak responds to valid complaints about his "ideas"? Instead of explaining himself and his moronic ideas further he falls back to that lazy old excuse of "Well, you're just too stupid to understand!"

Translation: I don't understand either.

It's like when the fuckin' Liberals respond to any criticism of thier Messiah Barack Hussein Obama by calling people racists.

Ya' know what? You fuckin' Liberals need to grow the fuck up and realize that you aren't the only people whose opinions count.

 

[Greenbeard]

See how the arrogant Liberal control freak responds to valid complaints about his "ideas"? Instead of explaining himself and his moronic ideas further he falls back to that lazy old excuse of "Well, you're just too stupid to understand!"

In fairness, when someone asks if using technology to grant patients 24-hour access to medical professionals implies clairvoyance about "know[ing] when one may be in a care [sic?] accident?," declares that proposing patients define their needs is another way of suggesting bureaucrat-helmed death panels, and implies that HSA funds don't roll over from one year to the next or that tort reform isn't specifically endorsed in the article this thread is about, there actually is a chance they're simply not intellectually equipped to handle some of the concepts here.

I'd first chalk it up to partisanship and ideological blindness but it's worth exploring all the possibilities.

 

[Mad Scientist]

See how the arrogant Liberal control freak responds to valid complaints about his "ideas"? Instead of explaining himself and his moronic ideas further he falls back to that lazy old excuse of "Well, you're just too stupid to understand!"

In fairness, when someone asks if using technology to grant patients 24-hour access to medical professionals implies clairvoyance about "know[ing] when one may be in a care [sic?] accident?," declares that proposing patients define their needs is another way of suggesting bureaucrat-helmed death panels, and implies that HSA funds don't roll over from one year to the next or that tort reform isn't specifically endorsed in the article this thread is about, there actually is a chance they're simply not intellectually equipped to handle some of the concepts here.

I'd first chalk it up to partisanship and ideological blindness but it's worth exploring all the possibilities.

You're an ObamaCare advocate. ObamaCare means government health care. The majority of Americans don't want it. A year into the ObamaCare law the American public still doesn't want it.

ObamaCare is just like like bombing Libya, no one is in charge, no one knows what's going on and no one knows how it'll turn out.

 

[asterism]

I take it you're not a fan of patient-centered care. There's quite a bit of irony lurking in there.

Where is the patient-centered care here? I see a paper with nothing but lofty concepts and little on actual substance.

 

[Quantum Windbag]

I take it you're not a fan of patient-centered care. There's quite a bit of irony lurking in there.

I am a big fan of patient centered care, I just don't understand why anyone thinks the government can mandate it and make it happen.