The KHIT Blog: "Standard work establishes a baseline for innovation." #HCsummit15 day two

Thursday, June 4, 2015

"Standard work establishes a baseline for innovation." #HCsummit15 day two

The headline quote for this post comes from the answer to an attendee question raised during the Learning Session "PAMF's Ambulatory Surgery Center Value Stream Approach to Improvement." Co-presenter M. Osman Akhtar didn't miss a beat in response to being asked to reconcile the seemingly adversarial concepts of "standard work" versus "innovation."

It was a deft reply. How can you know you're "innovating" if you don't even know the salient characteristics of the incumbent "best practice"?

To me, the idea tangentially conjurs up my venerable Deming 101, specifically his admonition with respect to "tampering" -- i.e., you first have to confirm that a candidate process is understood and empirically "stable" (emitting only non-assignable cause, random variation). Attempting to "improve" an unstable process is "tampering" and invariably makes things worse. Attempting to "improve" an unknown process is a contradiction in terms.

"Standard work" ("SW") is standard because it's been vetted in some rational fashion as the current best practice. Even the ancien SW antecedents of my before-indoor-plumbing salad days known as SOPs (Standard Operating Procedures) became "standard" predominantly (though not exclusively) via an interative consensus analytic process conducted by SMEs (Subject Matter Experts) prior to being placed into production.

Nowadays, we write verbose manuals full of "P&Ps" (Policies and Procedures), typically with the "Procedures" sections weighted down with redundant and irrelevant verbal diarrhea "Policy" statements, authors gleefully oblivious to the fact that "procedures" pertain only to how, who, and when (the "how" including requisite documentation methods). They are properly action statements, not "what (scope)" and "why" dicta appropriate to the Policy sections.

If I had a dollar for every time I've encountered these bloated, incoherent P&Ps, I'd be on permanent vacation in Hawaii, not pecking away at this blog in my PJs at the DFW La Quinta. I guess the good news is that no one ever reads these things anyway. Wait a minute! That's "waste," ja?

But, I digress...

How about some photos from Day Two for now? (There aren't many; the somnolescent Happy Hour Mode stage lighting still sucked.) I'm fixin' to watch Game 1 of the NBA Final shortly, and my brain is tired. I'll be finishing up this post on my way home to The Peoples' Republic tomorrow.

Keynoter Doug McKeever, CalPERs

The CEO Panel

CEO Panel Moderator Mark Graban

LEI Founder Jim Womack, now of Planet Lean

An inspiring two days. Fun being the dumbest guy in the room.

OFF-TOPIC ERRATUM

My Vegas pals' band and their new high-tech project. Talk about "innovation"!

This promo will run on TV's onboard the new Royal Caribbean Quantum cruise liners. It's a behind the scenes, sneak peek of our new virtual concert. Thanks to The Imagination House for creating it.
Posted by Santa Fe and The Fat City Horns on Friday, June 5, 2015

Honored that they used some of my stills in this video. I blogged them for years when I lived in Las Vegas. If you want to hear some of the best of the best "20 Feet From Stardom" performers comprising what I call the "extended Santa Fe tribe" and that I am blessed to call my friends, check out my Santa Fe and Friends mp3 audio podcasts.
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TOPICAL ERRATUM (PAYMENT POLICY)

Margalit Gur-Arie always rocks!

How to Use CPT 99490 for Healing the Sick
The Medscape Physician Compensation Report puts primary care physicians at the bottom of the heap, with a median earning of less than $200,000 per year in 2014. What if the largest insurer of older Americans took those numbers to heart and decided to give primary care a pay raise of 25%, in recognition of and better support for the hard work involved in caring for the very old and the very sick? This is the general idea behind the brand new Chronic Care Management (CCM) fee introduced by Medicare on January 1st 2015. Three cheers for Medicare!...

Unfortunately, Medicare structured its fees based on the now prevailing assumption that all doctors are charlatans, and hence every penny paid to them must be justified by at least one thousand pages of legal size, single spaced, dated and notarized documentation, or the electronic equivalent thereof. Furthermore, as is customary in our nation’s capital, every law or regulation that may be beneficial to the public, comes adorned with a wealth of gifts for special interests, which often render the original intent null and void for all practical purposes. The CCM is no different.

Medicare could have settled on a simple capitation fee for chronic care to provide payment for currently uncompensated care management and to expand such services to patients who can benefit from additional attention. By piling on reams of preconditions and micro-specifications, Medicare all but ensured that none of the money it plans to spend on CCM will actually benefit chronically ill patients...

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More to come...

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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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Thursday, June 4, 2015

"Standard work establishes a baseline for innovation." #HCsummit15 day two

How to Use CPT 99490 for Healing the Sick

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