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- The American College of Radiology invited me to give the annual Moreton Lecture in 2012. In the lecture, which is published in the Journal of the ACR, I addressed the challenges facing our profession in the era of accountable care. I asked physicians of all specialties to act like leaders, not like victims. I strongly urged them to take the lead on improving value themselves, rather than waiting for some external force to do it to them. And when it comes to quality and safety, I asked doctors to aim at what might be possible, rather than settling for what’s "passable." You can get a copy of the lecture at this link.
- Dr. Reinertsen writes a regular column for
Leadership, a publication of the Healthcare Financial Management Association. Here’s a link to a series of his columns on topics such as “How to Go Naked,” “Just Say No,” and “Get Real: Authenticity and Transformation.” http://www.hfma.org/GSASearch.aspx?id=4482&searchterms=reinertsen
And whether you're doctors looking to be employed by a hospital, or hospital execs seeking to create some sort of multispecialty group out of your independent medical staff, you might want to look at our paper on Informed Consent to the Ties That Bind before you sign anything.
- Safety
in Recession?: Hospitals and other health care delivery organizations have come under serious financial pressure during the recent recession, necessitating staff cutbacks and other cost-cutting measures. Can you cut costs and still be safe? Is care going to suffer because of your hospital's efforts to stay profitable? If you have some concerns about this question, you might want to read this short paper on "Safety in Recession."
- Avoiding
Quality Fraud: Just in case boards and
executives need yet another reason to get serious about
improving quality and safety, The Office of the Inspector
General and
other regulators have been taking an increasing interest
in what is being called “quality fraud.” Examples
of quality fraud include making false reports about quality,
knowingly profiting from poor quality, and systemic failure
to oversee quality. Alice Gosfield and I have summarized
the issues for leaders in this recent cover article in Trustee.
- A
Practical Guide for Boards: The
Ontario Hospital Association recently commissioned
a paper designed to provide hospital
Boards with a practical guide to how lay trustees can
oversee clinical quality and safety. The paper describes
best practices
used by the Boards that are getting real results. In
a recent interview with Robert Wachter, MD for the
AHRQ Perspectives on Safety, Dr. Reinertsen explains
the importance of the Board’s leadership in quality
in more
detail.
- Seven
Leadership Leverage Points for Whole System Results: Health
care organizations have become good at doing quality
improvement projects, but those projects rarely spread
and link to other projects at a scale and pace that
moves overall system performance noticeably. In this
2nd edition of a key IHI White Paper, James Reinertsen,
Maureen Bisognano, and Michael Pugh have framed an
updated set of “Seven Leadership Leverage Points” for
leaders to consider, if they truly wish to achieve
system-level results, rather than settle for a few
nice projects. The Leverage Points form the core
framework of the IHI
Executive Quality Academy, an
intense 3-day program for CEO-led senior executive
teams, now in its 4th year.
- Engaging
Physicians in Quality: Hospital executives often ask “But
how can we engage physicians in our quality agenda?” The
answer starts with turning the question around, and asking: “How
can we engage in the physicians’ quality
agenda?” If you think “physicians’ quality
agenda” is an oxymoron, read the IHI white
paper on “Engaging
With Physicians in a Shared Quality Agenda,” written
by Dr. Reinertsen and 3 other IHI faculty. The white
paper was recently revised and adapted for the
National Health Service of
Wales by Worthington and Baboolal in a beautifully written
version entitled “Engaging
Clinicians in a Quality Agenda.” During 2008,
Dr. Reinertsen was interviewed on the subject of physician
engagement in quality for a number of publications. Some
of those interviews can be read at the following links:
- Boards
and the MEC: One
of the most interesting interfaces in hospital leadership
is between the Board and
the Medical Executive Committee, representing the
organized
medical
staff. Alice Gosfield and I wrote this short
paper for Trustee to
give Boards some good ideas about how to engage
together with physician leaders in the quality and
safety agenda.
- Boards
and Dashboards: A
specific question that comes up repeatedly is “what should our
clinical quality dashboard look like?” This
article, written with Michael Pugh as part
of an IHI 5 Million Lives Campaign series,
highlights
some excellent do’s and don’ts
of dashboards.
- Can
you Do Well By Doing Good? The
business case for quality is described as being
weak at best,
and perverse
at worst.
An innovative approach to this problem
can be seen in the paper Doing Well By Doing
Good, developed
jointly with
Alice G. Gosfield, Esq.
- Leadership
Interview Series in Quality and Safety in Health Care:
Jim Reinertsen has
been commissioned by
the Editors
of Quality and Safety in Health Care
to produce a series of interviews with exceptional
leaders of
quality and
safety in health care. The first
two interviews in this series
are completed, and provide fascinating
insights into the leadership
approaches of two health system CEOs
whose organizations are achieving significant results:
Gary
Kaplan at Virginia Mason, and Jim
Anderson at Cincinnati
Children’s.
- 100K
Campaign and Standards of Care: In the November-December
issue of Health Affairs, Alice
Gosfield and I have published a paper describing
a powerful effect
of the 100,000 Lives
Campaign. This extraordinary effort
to improve quality and safety, led by the IHI, has
enrolled
over 2,800
hospitals of every size and shape,
in every state, comprising well
over half the beds in the US. A
number of hospitals have already experienced dramatic
reductions
in mortality by implementing
up to 6 Campaign-recommended practices
such as Rapid Response Teams, the Ventilator Bundle,
and so forth.
We argue that
these six practices have become
the legal standard
of
care for hospitals, overnight,
simply by virtue of the public
commitment of so many hospitals
to implement the practices. As a result, all hospitals
will need
to implement these
practices, or face malpractice
liability risk. You can read the abstract of this paper or see the full
paper here.
- Ten
Powerful Ideas for Improving Patient Care
Health Administration Press
March 2005
Health care executives' jobs have changed.
Instead of being responsible for facilities
and finances,
and delegating
responsibility for clinical quality to physicians,
hospital CEOs and others
are now being held accountable for clinical
quality results. And if they're to get results,
they
will need the strongest
ideas possible, because leadership begins with
ideas. This
compact book, co-authored with Wim Schellekens
M.D., CEO of the Dutch Institute for Quality,
describes and illustrates
ten of the most powerful ideas for clinical
improvement that we know. And how do we know?
They get results.
- MetroDoctors: Journal of the Hennepin and Ramsey Medical
Societies
Health Policy Interview
July/August, 2004
This free-wheeling interview covers a range of topics from ideas for health system
reform to physician report cards to "cookbook medicine." It provides
a quick look at some of the policy positions advocated by The Reinertsen Group,
in an informal format.
- Straight Talk About Clinical
Quality From Health Care CEOs
Ernst and Young White Paper
James L. Reinertsen, M.D., and Mark Finucane
April, 2004
In January 2004, I facilitated a conversation among a highly selected group
of health care CEOs and other national health care leaders, on behalf of Ernst
and Young. This white paper is a report of that conversation, which focused
on three questions:
- Has clinical quality moved from “something that is professionally
good to do, but not strategic,” to “I’d better make
sure I hit my quality targets, or my job is on the line?”
- If quality has moved onto the strategic agenda, what do the new pay-for-performance
models have to do with the shift?
- If quality is now strategic, and if health systems need to hit
tough quality targets as reliably as they hit financial targets,
how are they planning to
succeed?
This white paper provides a fascinating glimpse of how some of
our finest leaders answer these questions.
- Paying
Physicians for High Quality Care
Gosfield, AG, and JL Reinertsen
Letter to the Editor, New England Journal of Medicine 2004; 350: 1910
Arnold Epstein MD and colleagues recently presented a review of the new
physician “pay
for performance” models being implemented in regional trials around the
country. In this publication, you can read the response that Alice Gosfield and
I wrote to Epstein’s paper, along with some other responses, and Epstein’s
reply. Pay-for-performance is getting a lot of attention these days. But these
early versions of “paying for quality” tend to focus on the problem
of under-use, and don’t address the very big quality problems of
overuse and misuse. Furthermore, the revenue incentives tend to be small
in comparison
with the costs of correcting the under-use problems (which by definition
require additional services to be delivered) and so the actual business
case in many
of these new payment systems is rather weak.
- Zen and the Art of Physician Autonomy Maintenance
Annals of Internal Medicine, Vol. 138, 992-995, 17 June 2003
James L. Reinertsen, M.D.
This provocative essay challenges the medical profession to begin a conversation
about one of its most cherished values—individual clinical autonomy. The
essay argues that hanging on to individual clinical autonomy for the practice
of the science of medicine is counterproductive, because it means that we don’t
use all the science we know for the benefit of our patients, and then society
acts to reduce our overall professional autonomy. In a Zen-like paradox, we must
give up autonomy in order to regain it. It would be better for us, and for our
patients, if we practiced the science of medicine as a team activity, and the
art of medicine as individuals.
- It’s About
Time: What CEOs and Boards Can Do For Doctors, Nurses,
and Other Health Care Professionals
Disease Management and Quality Improvement Report, Vol. 2, No. 4, April 2002
James L. Reinertsen, M.D.
What doctors and nurses want most is time—time to spend listening, examining,
explaining, thinking, treating, and comforting. This “touch time” is
precious, and is too often squandered by cumbersome processes of work, clunky
information systems, and overlapping, confusing requirements for documentation,
billing, and other needs. One of the best strategies for building better relationships
with physicians and nurses is to work on a simple agenda: remove everything that
steals “touch time” from them. This article gives some practical
examples of how this work can be done, and of its impact on the quality of care,
as well as the quality of work life for health care professionals.
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