Showing posts with label seattle. Show all posts
Showing posts with label seattle. Show all posts

9/06/2012

The House of Hope and Fear: Life in a Big City Hospital Review

The House of Hope and Fear: Life in a Big City Hospital
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Dr. Young's new book is an engaging account of life at the large mission-driven county hospital in Seattle. I spent most of my 3rd year med school rotations there myself 12 years ago and am now working in a mission-driven community health center 18 miles away. My desire to serve the poor was a direct result of the dedication from the doctors and staff that I witnessed at Harborview. Now, I spend more than half my time educating and mentoring medical students and I plan on incorporating this book into our 2nd year curriculum.
The stories are diverse: some are about incredible patients and their challenging situations - socially, medically, psychologically; some are really more about the ethical dilemmas faced by providers, and faced by patient's families; other stories point out the inequities in healthcare, while demonstrating how this institution has creatively found a way to thrive financially while serving the least able to pay.
Most importantly to me - this book is hugely interesting, well written, easy to read, hard to put down and deserving of high praise. The reason this book is so good and the messages conveyed so well is that Dr. Young has incredible skill at portraying the humanity of her subjects. This is a book of true characters; unforgettable characters. The characters are patients, their loved ones and families, the infamous ER director, a remarkable specialist in nephrology, Dr. Young herself, and the staff of the hospital. I read their stories and can picture them on a gurney, in their offices, on the wards, in the ER; I can smell the smells again; and hear the sounds in the ICU.
This text can easily and effectively (each chapter is pretty well able to stand on its own as a separate reading - though together it reads as a cohesive story) be used regularly with medical students and public health and policy students - the examples in it are perfect for igniting debate about healthcare inequality, social justice, medical ethics, professional development, difficult patients, allocation of resources and care for the underserved.

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Opening with the view of an idealistic, young doctor entering her first post-graduate job at the local county hospital, The House of Hope and Fear explores not only the personal journey of one doctor's life and career, but also examines the health care system as a whole. The county hospital setting provides the author with a second education. With clear, eloquent text, she chronicles attempts made to treat those tossed aside by society along with the personal and ideological shifts that accompany this daunting task. All of the political aspects of the hospital's executive board are detailed in a gripping account of the hospital's inner workings, and a human face is expertly given to the healthcare crisis in America.

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11/07/2011

Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience Review

Transforming Health Care: Virginia Mason Medical Center's Pursuit of the Perfect Patient Experience
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The more you know about lean transformation the more you'll envy the Virginia Mason Medical Center (VMMC) for having the right people in the right places at the right times. At the end of the 1990s VMMC faced a struggle for survival as an in-the-black, separate entity. The CEO, Gary Kaplan, an MD and highly regarded executive saw the need for dramatic action and found it, after energetic searching, in Toyota Way thinking and acting. He created and nurtured the informed consent of the board of directors and, through John Black, engaged the Japanese consulting firm Shingijutsu. The executive team joined in embracing what became known as the Virginia Mason Production System (VMPS) and, with the clinical staff, hammered out the Virgina Mason Medical Center Physician Compact, the basis for concordant action in the VMPS.
What's really to envy is the constancy of purpose that VMMC has maintained: when transformation efforts flagged or failed or worse - and they did, regularly - execs and docs, with board support, doubled-down and solved the problems. Each time that happened momentum increased: physicians saw better outcomes and less wasted effort, patients had better experiences, nurses spent more time actually helping patients, payers got to spend money where it mattered more, medical errors (and malpractice insurance cost) dropped dramatically, the list goes on and on, each recovered success synergizing more successes.
As Donald Berwick points out in his Foreword, VMMC isn't perfect yet but, crucially, improvement continues apace: the board of directors, unified behind the VMPS, is chaired by Carolyn Corvi (the Boeing exec who, with Shingijutsu guidance, made the moving line in 737 final assembly happen), executives have become sophisticated in lean system dynamics, clinical staff are well aligned with the VMPS, and VMMC runs significantly in the black. Now all VMMC needs is a rational system of health care payment in which outcomes are rewarded instead of procedure delivery.
The author, Charles Kenney, has produced a highly readable book with plenty of rich, authentic-seeming detail. I am a fast reader somewhat familiar with the sorts of issues addressed in the book, yet despite this being a relatively short book Kenney presents so much to think about that the pleasure of reading the book lasted much longer than anticipated.

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