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For the Health Of It™©, Volume 2 #13: VA Deaths Represent the Tip of the Iceberg at US Hospitals

Have you seen these recent headlines in the New York Times?

Army Ousts Commander of Hospital After Deaths

Here is the link to the article.

Two good soldiers were lost … one a young mother.  This is a very sad and scary commentary on The Business of Medicine in the US today … not just the VA.  Be sure to read it.

Here are my Top Ten Reasons Why it will not help to get rid of the “Commander” and why these deaths display and exemplify a minute fraction of the many problems found in US Hospitals today, the “tip of the iceberg”.  And, my Top Ten Fixes for the VA system are listed as well.

Problems run rampant in Hospitals and the Business of Medicine in general, because they reflect the flaws and failures that result from the fabric of the Business of Medicine as it is structured in the US today: Money.  In other words, bad care benefits hospitals and many third parties despite the detriment to quality of care and bad Patient outcomes.  The focus on profit, money, saving money and other financial matters reduces quality and increases cost.  The money goes away from Patients, Physicians and Nurses and toward profit or into the pockets of folks who do not care and/or do not provide care.  Simply said, the VA System can set an example for US hospitals by fixing their problems.  And, while you are at it, put the fixes on public display.

By fixing the flaws and failures inherent in the VA Health Care system and by doing so in a transparent manner, the VA can serve as a “template” that shows others “How To Fix Problems That Run Rampant in US Hospitals and the Business of Medicine”.  The VA System can set an example for Health Care by following through with the fixes outlined below.

A. Problems

1.  Mission Confusion: Loosing sight of the mission to care for the sick.

2.  Mission Shift: Move from the focus on the primary mission (care of the sick) to money.

3.  Mission Abandonment: Disregard of the primary mission, care of the sick.

4.  Leadership at every level that does not have the willingness or capacity to care for or about the sick.

5.  Massive and Very Expensive Upper and Mid Level Management Systems that include people who never provide front line patient care

6.  Disregard of Fundamental Rules of Clinical Engagement that are based on long standing Quality and performance standards

7.  Replacement of Experienced Physicians and Nurses with Inexperienced Generic Equivalents who do not have the capacity to provide proper levels of care

8.  Reluctance to Slow the Line, or Stop the Line to preserve Quality Of Care

9.  Failure to Implement Internal and Customized Quality and Performance Improvement Systems

10. Failure to build administrative systems that are composed of and designed by Front Line Providers and Patients

B.  Solutions:

1. Build a new Quality and Performance Improvement (Radar) Systems the give reliable real time front line QUALITY DATA (see our B2 System)

2. Turn the Radar away from the front lines and toward mid level and top leadership.  Build proper performance metrics based on “flow” of quality not money.

3.   For EVERY NON CLINICAL PENNY SPENT Follow the money … every penny … including salary, benefits and bonus money in for profit and non profit VA and contract providers.  Put the spending on public display.

4.  Revamp Electronic Medical Records: Build New and balanced EMR systems that focus on Building Better Health Care turn away from the Business of Medicine

5.  Promote Mission Adhesion: Foster Best Care at every level, Make the Mission visible at every level, and get rid of employees who are not willing to train up, or who do not have the capacity to promote or adhere to the mission.

6.  Stop wasting valuable Physician and Nurse time on secretarial and “Scribe” duties and TRAIN SCRIBES to help with these duties

7.  Make CARE personal at EVERY LEVEL.

8.  Show the names and faces of every employee: Show every provider and decision maker and show every penny each takes out of the patient care pool. Put this on public display.

9. Humane Care, Quality, Transparency, Honesty and Integrity: All systems should put these characteristics at the top of the target list and put measures toward these targets on display.

10. Reallocate resources: Move your money and your care to the front lines and put the money to work where it makes a difference.  Help Physicians and Nurses take care of the Patients who need the care.  Remove all NON CLINICAL DUTIES from Physicians and Nurses.  Train the VA bureaucrats AT ALL LEVELS to give patient care and insist that they give care at least 20% of the time.  If they refuse to train up, kick them out.

The VA system can serve as an example of how to give the best care to those in their charge.  Teach the VA to teach Veterans to Take the Best Care™© of Themselves and those in their charge.  It can be done.

Have a great day.

Dr. Mike

Michael F. Mascia, MD, MPH

Help Build Better Health Care Through Patient-Physician Cooperation

Veritas Health Care

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  1. Dr. Mike on May 31, 2014 at 10:45 am

    Here we go again.

    V.A. Chief Resigns in Face of Furor on Delayed Care

    Blame the guy at the top for a problem in middle management. Shinseki is a kind man who alluded to the real problem. The Times quoted him saying “he was “too trusting” of some people working for him.” Allow me to translate and generalize. The VA Health System and most US hospitals have massive mid sections that have been infiltrated by people who do not care either because they do not have the capacity to care, or they have been blinded by profit over people. In The Business of Medicine, this criminal activity causes bad patient outcomes and sometimes patient deaths.
    We can fix it with the B2 system. Turn the radar onto the midsection of the VA, identify the crooks and replace them with care givers.
    Dr. Mike

  2. Dr. Mike on June 1, 2014 at 11:08 am

    The VA Saga Continues …

    The Headlines:

    Many Veterans Praise Care, but All Hate the Wait

    The link to NY Times article Veterans Praise Care, but All Hate the Wait – NYTimes.comait.html?emc=edit_th_20140601&nl=todaysheadlines&nlid=65359995&_r=0

    The solution: Forget Business as Usual

    A. EMERGENCY Phase 1 First Week

    1. Apologize for delays
    2. Stop all elective surgery
    3. Stop bonuses and raises
    4. STAT Train all employees to be providers (Strategic Targeted Aggressive Training) 24 hours
    5. Move all providers to the front lines
    6. Take care of the emergencies first
    7. Sustain optimal care for emergencies
    8. Address all backlogs with phone triage
    9. Move high priority patients in STAT
    10. Create Real List of Needs and Backlog

    B. Emergency Phase 2: Address Backlog of NON EMERGENCY CASES and System Flaws (To run simultaneously with phase 1 but to be continued into Phase 3: Sustainable Long Term Solutions)

    1. Define the needs in real terms.
    2. Tell people exactly what to expect in realistic terms
    3. Provide the necessary services
    4. Continue to beef up the front lines
    5. Design long term sustainable solutions
    6. Build the infrastructure to meet the needs determined
    7. Engage Veterans in the Health Care Community
    8. Engage Veterans as Patients and Providers
    9. Engage Veterans as an Integral Part of the Care Team
    10. Engage Veterans as an Integral Part of the Quality and Performance Improvement Team

    We will be happy to help Veterans take charge of their Health and Health Care.

    Dr. Mike
    Michael F. Mascia, MD, MPH

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