The KHIT Blog: December 2010

Monday, December 13, 2010

My Excellent Adventure into the Mecca of Quality

American Society for Quality (ASQ) Healthcare Division Chairman Dr. Joe Fortuna (an enthusiastic REC supporter, it should be noted) invited me (no, emphatically, repeatedly implored me) to come and participate in the 2010 December weekend Strategic Planning Retreat of ASQ's Healthcare Division (HCD) Leadership.

You just can't say "no" to that (I was honored and flattered). So, above, here I am on final approach over Lake Michigan into snow-covered MKE. Below, downtown Milwaukee, the ASQ headquarters building.

Above, "River Walk," right outside HQ and the adjacent hotel. Yeah, it was cold. And got progressively colder across the weekend. By the time I flew out last night, the wind chill was 5 degrees F, with 40+ MPH wind gusts. My plane fishtailed down the runway and then seemed to just jump right up off the ground after only several hundred yards.

"...uh, yes, thanks, I would like a drink. What Scotch do you have? Dewars? That'll be fine. Rocks. Make it a double..."
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Below, a wall of ASQ history.

Above, in the foyer just outside the main conference room, a Deming Red Bead display.

Mecca for us QC/QA/QI types. I, in particular, am hardcore Deming. In addition to internalizing his acclaimed work "Out of the Crisis," I even own and have read "Some Theory of Sampling" (not that I fully grasp all of it).

My wife and I have been loyal ASQ members for more than two decades. We live and breathe this stuff.(BTW, you can click on any of the photos to see the original size shot).

We worked hard the whole time. A packed agenda (all focused on how the ASQ HCD can add tangible value and consequently grow the membership for the Division and ASQ more broadly). On Saturday we went straight through from 8 a.m. to 6 p.m., with a "working lunch" amid the proceedings. Dr. Joe was an active and forceful (and genial) taskmaster.

Everyone I met was utterly impressive, too. Lots of talent in that assemblage. Pretty cool weekend for this lowly REC grunt.
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ASQ REBRANDING INITIATIVE

We had a presentation regarding ASQ's strategic plan, part of which involves the organization's "re-branding" effort. We are to henceforth regard ourselves as "ASQ: The Global Voice of Quality." No more reference to the "American Society for Quality" long the descriptive phrase allusive of the ASQ acronym. It's now an explicity international effort.

ASQ CEO Paul Borawski, who presented to us on the current and upcoming ASQ strategic direction, blogs about ASQ's new path on his "View from the Q" blog.

Here's Paul speaking to the future of "quality" in 2009:

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We also had a nice presentation on the "Socially Responsible Organization" of which ASQ is an integral part.

"The SRO* is a new international movement to share insights and expertise on, and examples of, the evolving area of social responsibility, and to help define what it means to be a socially responsible organization.

"The SRO* aims to explain the business case for social responsibility and the role of quality to achieve results..."

"...ASQ was awarded the administration of the U.S. Technical Advisory Group (TAG) on Social Responsibility by the American National Standards Institute. The U.S. TAG is the U.S. member of an international working group chartered with developing an international standard on social responsibility. ASQ’s involvement is a direct extension of its existing leadership role in standards development."

"The social responsibility guidelines will be released in mid- to late 2010 as ISO 26000. The ISO 26000 guidelines will cover seven core areas:

organizational governance

human rights

labor practices

fair operating practices

environment

consumer issues

contribution to the community and society..."

I signed up to participate. We'll see what ensues.
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THE ASQ MEANINGFUL USE / BALDRIGE
SELF-ASSESSMENT CROSSWALK APP

This was a very interesting demo presentation of a web app built by ASQ wherein clinical providers can sign up, enter data, and receive continually updating dashboard status feedback regarding their readiness for both ARRA / HITECH Meaningful Use and Baldrige criteria. This was to have been presented to ONC brass in DC the week following our conference, and, as soon as I learn of the upshot, I will report on it.
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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Monday, December 13, 2010

My Excellent Adventure into the Mecca of Quality