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Monday, February 8, 2010

ideas for quality improvement that could be done at a community hospital

1. The return of the Morbidity and Mortality conference, but with a twist--When I was in medical school and residency, if any hospital admission went spectacularly wrong, we had an M and M conference.  The major players had to research the medical record, draw a timeline of what happened, and discuss their reasoning and actions with regard to the case.  Everyone came. It was like a gladiator show. There was blood. There were tears. And everybody at the conference thought about what they would have done differently to make the whole thing come out better.  There is nothing wrong with a traditional M and M conference, other than the fact that should there be a malpractice case it would potentially lead to embarrassment or successful prosecution. What I would propose would be C and Q conference which would explore the cost and quality of any spectacularly complex case. The bill would be projected on the wall, and the various actions would be evaluated and discussed in terms of their adherence to known effective practice, and their eventual contribution to the health or disease of the patient. We would all get to see exactly how much all of the things we ordered and did cost.

2. Suggestion boxes, possibly online, with rewards: This was effective in reducing costs in airlines, and might be helpful in hospitals. Airlines got rid of mandatory bags of peanuts and various other silliness that I don't remember. The scale of these companies made peanuts a big deal. Still. Community hospitals don't have the scale issue, but an individual aliquot of money in medicine is usually huge. Perhaps just the activity of thinking about cost savings would help focus us appropriately.

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