Tuesday, August 31, 2004

The Al Qaeda Obsession

If you read the following posting through to the end, you will see that it relates to the health care theme of this blog. Well, sort of anyway.

As spectacular theater, the destruction of the World Trade Center in New York on September 11, 2001 surpassed by a wide margin anything the world had ever seen. That a small band of men, driven by demons we cannot comprehend, would have both the imagination and the audacity to do what they did truly boggles the mind. And that they should do it in full sight of millions of people all across the world, thanks to the marvels of modern television, made it all the more gripping.

But as a human calamity, it was relatively small beer. Measured on any international or historical scale, floods, volcanic eruptions, earthquakes, epidemics, genocidal conflicts, and other catastrophes regularly wipe out multiples of the nearly 3,000 victims who perished on that fateful day. As a taker of human life, it is even dwarfed by routine daily events like medical errors, automobile accidents, and urban violence.

Yet it has so mesmerized our collective consciousness as to dominate the political life of our country, both domestically and internationally, during what will soon be three years since the historic tragedy that goes by the simple sobriquet 9/11. In fact, it may well turn out to be the defining issue of our upcoming presidential election.

9/11 has been given the status of continuing threat by a terrorist entity known as Al Qaeda. The fact that nobody quite knows what Al Qaeda is, who is in it, how it works, what it is up to, or the whereabouts of its self-proclaimed leader Osama bin Ladin, seems only to add to its fear-inducing mystique.

My ten years of living and working in the Arab Middle East causes me to view all of this with considerable skepticism. For example, anyone with managerial experience will know that running an organization is not easy in the best of circumstances. People are prone to jealousy, backbiting, insubordination, overweening ambition, treachery and other behaviors that detract from organizational effectiveness. Imagine, then, trying to run an organization of fanatical individuals of different nationalities who are scattered across the globe and who are from cultures in which, based on my observations, such values as discipline, trust, diligence, and loyalty – all critical to organizational success - are notoriously weak. Imagine further having to do so secretly and against the active opposition of almost every government in the world.

It may be that an attack involving sophisticated means like nerve gas, deadly bacteria, or nuclear weapons will arise out of the confusion, disorganization, and general amorphousness inherent in such a situation. But it seems highly improbable. More credence can be given to the possibility of truck bombs (potentially devastating enough as we learned in Oklahoma City and the first attack on the World Trade Center) and efforts like that of the Richard Reid, the hapless and unsuccessful shoe bomber.

Given the obsession about all of this that has consumed the American people, it is to be expected that politicians and the media will milk it for all it is worth.

Ordinary folks, on the other hand, would be well advised to put some proportion to it. When somebody threatens violence against us, it is only prudent to take measures to protect ourselves. But it ought to be possible to leave that to agencies like the FBI, the CIA, and the National Security Agency, which probably now have more agents on the case than Al Qaeda has active members.

In the meantime, the rest of us should be worrying about our automobiles, our doctors, and our inner city hoodlums, which are sure to kill more Americans than Al Qaeda terrorists could even dream of.

An Upcoming Book

The following was received as part of a longer message from Paul Hoffman just as I was departing for the August trip abroad. The “two days ago” that he refers to would have been August 5.

Lets all pitch in and help prevent the thud he is anticipating.

Two days ago, Dick Davidson submitted a splendid foreword for the book on mistakes in healthcare management that I have co-edited with Frankie Perry. I have also been gratified by testimonials provided on the draft manuscript by Duane Dauner, Tom Dolan, Leo Greenawalt, Pat Hays, Gary Mecklenburg, Dennis O'Leary, and Gail Warden. Despite their appraisals, I am still anticipating that the book, now scheduled for publication by Cambridge University Press in November or December, will land with a resounding thud.

More on Fee-for-Service

The following comes in from Mitch Rabkin in response to my posting on the flaws inherent in fee-for-service. Mitch, as most of you know, was long-time CEO at Beth Israel in Boston and mastermind of the important Beth Israel/Deaconess merger a number of years ago.

Re fee-for-service, Jack Cook and I published an article in the November 2002 issue of AAMC's journal, Academic Medicine, proposing a methodology of capitation that has incentives directed toward prudent performance on the part of all players. It is fairly dense a read, yet one might expect that health policy wonks could slog through it -- thus far, it has met with a great yawn. Interesting!

Friday, August 06, 2004

More on Medical Errors

The medical errors saga gets no better.

The Business section of the August 3, 2004 issue of The Boston Globe carried a story under the byline of Liz Kowalczyk reporting on a survey of ENT surgeons. Of the 466 who responded to a survey (out of 2,500 who received the questionnaire), 45 per cent reported that a medical error had occurred in their practice in the previous six months. Seventy-eight of the errors seriously harmed patients and nine were fatal. Two were blinded.

The study was published in the journal Laryngoscope. In an accompanying editorial, Lucian Leape of the Harvard School of Public Health said that while anesthesia, emergency medicine, and intensive care physicians have made some progress in this area, most surgeons have not been involved in these activities, regarding “safety and quality improvement as the province of others.”

Reporter Kowalczyk interviewed Dr. David Roberson of Boston Children’s Hospital, one of the study’s authors, and Dr. Michael Zinner, head of Surgery at Brigham and Women’s Hospital. They suggested that more and better information would be helpful and that patients might be more involved in helping prevent errors.

In any other line of work, process improvement, discipline, and accountability would be called for. But not in health care. At least not yet.

This page is powered by Blogger. Isn't yours?

FREE counter and Web statistics from sitetracker.com