domstat.net

Website loading time

during the test: 2.24 s

cable connection (average): 2.9 s

DSL connection (average): 3.55 s

modem (average): 38.19 s

HTTP headers

HTTP/1.0 200 OK

Content-Type: text/html; charset=UTF-8

Expires: Fri, 14 Oct 2011 20:04:38 GMT

Date: Fri, 14 Oct 2011 20:04:38 GMT

Cache-Control: private, max-age=0

Last-Modified: Fri, 14 Oct 2011 19:12:10 GMT

ETag: "28bc448c-7335-40fb-99c4-8127380abb49"

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Server: GSE

Information about DNS servers

Received from the first DNS server

Request to the server "runningahospital.blogspot.com"
You used the following DNS server:
DNS Name: ns2.otimaideia.com.br
DNS Server Address: 187.61.14.179#53
DNS server aliases:

HEADER opcode: REQUEST, status: NOERROR, id: 35457
flag: qr rd REQUEST: 1, ANSWER: 0, AUTHORITY: 13, ADDITIONAL: 0

REQUEST SECTION:
runningahospital.blogspot.com. IN ANY

AUTHORITY SECTION:
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Received 258 bytes from address 187.61.14.179#53 in 228 ms

Received from the second DNS server

Request to the server "runningahospital.blogspot.com"
You used the following DNS server:
DNS Name: ns1.otimaideia.com.br
DNS Server Address: 187.61.61.241#53
DNS server aliases:

HEADER opcode: REQUEST, status: NOERROR, id: 12015
flag: qr rd REQUEST: 1, ANSWER: 0, AUTHORITY: 13, ADDITIONAL: 0

REQUEST SECTION:
runningahospital.blogspot.com. IN ANY

AUTHORITY SECTION:
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Received 258 bytes from address 187.61.61.241#53 in 231 ms

Subdomains (the first 50)

Typos (misspells)

Location

IP: 209.85.175.132

continent: NA, country: United States (USA), city: Mountain View

Website value

rank in the traffic statistics: 354 069

page wievs - daily average: 139

page views - monthly average: 4 175

visitors - daily average during last 30 days: 83

visitors during last 30 days: 2 485

estimated daily income from ads: 11 USD

estimated monthly income from ads: 335 USD

estimated website value: 15 499 USD

Basic information

website build using CSS

code weight: 251.65 KB

text per all code ratio: 31 %

title: Not Running a Hospital

description:

keywords:

encoding: UTF-8

language: en

Website code analysis

one word phrases repeated minimum three times

two word phrases repeated minimum three times

three word phrases repeated minimum three times

B tags

Appendiceal orifice

Ileocecal valve

U tags

I tags

Modern Healthcare

John: 

Jeff: 

Bill: 

Tom:

My reply: 

New York Times

In a grim sign of the enduring nature of the economic slump, household income declined more in the two years after the recession ended than it did during the recession itself, new research has found.

The finding helps explain why Americans’ attitudes toward the economy, the country’s direction and its political leaders have continued to sour even as the economy has been growing. Unhappiness and anger have come to dominate the political scene, including the early stages of the 2012 presidential campaign.

are

Times

Marketplace

Rabbi Robert Goldstein, of Temple Emanuel in Andover, MA, invited me to deliver a Yom Kippur commentary today on the Jonah story.  I'm not used to combining religion with health care, but thought I'd give it a shot.  Here it is, a bit longer than my usual posts.

It’s A Mad, Mad, Mad, Mad World

Now what kind of an attitude is that, 'these things happen?' They only happen because this whole country is just full of people who, when these things happen, they just say 'these things happen,' and that's why they happen! We gotta have control of what happens to us.

We continue to rely on the "craft of medicine," in which each physician practices as an independent expert -- in the face of huge clinical uncertainty (lack of clinical knowledge; rapidly increasing amount of medical knowledge; continued reliance on subjective judgment; and limitations of the expert mind when making complex decisions.)

I feel inclined to respond to your email with an experience I had today on the floor. At work today I made a mistake, a medication error. My stomach turned, I felt faint . . . however I recalled my focus earlier in the day: on the integrity of the hospital and the type of light that it shined on my paradigm as I entered my day. I felt an immediate sense of freedom and put my attention on what I needed to do to correct the error. Although embarrassment and fear visited me, I wasn't overwhelmed by the emotions. I contacted the right people, and helped maintain the safety of my patient. It was a very challenging day . . . and I grew. I will go to sleep with integrity; knowing I was honest, feeling I had done all I could.

I know healthcare presents these types of moral dilemmas to all of us who choose this challenging field to work in. Beth Israel is a safe place to honestly confront these dilemmas and strive to achieve the excellence that I know can exist.

The success of this work has been broadly recognized and has driven or influenced similar initiatives, including those of the Harvard Risk Management Foundation, the Commonwealth of Massachusetts, the State of Maryland, and the District of Columbia, among others.

We decided to be as open and transparent about the incident as possible and went through a Deep Learning journey involving hundreds of people that examined in detail all the root causes that contributed to the accident to get a clear picture of the system that produced the fatalities. Even though the two men who were killed could have made better decisions, my senior leadership team and I could find places where we “owned” the system that led to the tragedy. 

It was a defining moment for us when we, as senior leaders, were finally able to identify our own decisions and our own part in the system (however well intended) that contributed to the fatalities. That gave license to others deeper in the organization to go through the same reflection and find their own part in the system, even though they weren’t directly involved in the incident.

New England Journal of Medicine

The unchecked market power of some providers promises to become increasingly problematic for private payers. And if market approaches prove insufficient to solve a problem of this magnitude, regulatory intervention becomes more likely.

Look for the following "victory" announcement in the coming months:

Boston Globe

A new pact between the state’s largest health insurer and its biggest hospital and doctors network could boost efforts to contain health care costs, both sides said yesterday.

Under the deal, annual rate increases that were projected at 5 to 6 percent for the next three years will be lowered to between 2 and 3 percent. 

The new contract won’t end payment disparities between top-paid providers and struggling community hospitals, which also are being asked to accept smaller pay increases.

Under the agreement, Partners agreed to participate in Blue Cross’s alternative quality contract, a so-called global payment that gives health care providers a budget for patient care and incentives for healthy outcomes rather than billing for each visit and procedure.

Th[at] new contract . . . covers only about 25 percent of the Partners patients insured by HMO Blue.

The good news, Harris says, is that few respondents reported being too busy to report or that the online tool was too complicated. "Respondents recognized that error events should be reported and that they should claim responsibility for them. The barriers we identified are not insurmountable," she added.

The next speaker I am hearing at the "Made Lean in America" conference is Meryl Runion, author of Speak Strong

The journey from perfectionistic to aspiratory:

The journey from performing to experimenting:

The journey from Disney to reality:

The journey from the problem to the process.

The journey from "looking good and being right" to humility and learning to learn.

The journey from workarounds to trust.

The journey from power to influence.

The journey from single dimensions to multi. 

The journey from static to dynamic.

The next speaker I am hearing at the "Made Lean in America" conference is Sami Bahri, DDS, author of Follow the Learner

The Role of a Leader in Creating a Lean Culture

We'll start, though, with a humorous, light touch.  GBMP's Bruce Hamilton (seen here) is famous for a short video, entitled Toast

Patients aged from 18 to 80 scheduled for elective colonoscopy were prospectively randomized to receive either standard sedation (control group) or patient-controlled-sedation (PCS). In the control group, patients received a continuous infusion of propofol. Patients in the PCS group were connected to an infusion pump containing propofol and self-administered 20-mg boluses as often as they required.

Ileocecal valve

Mean doses of propofol (60 mg vs. 248 mg, depth of sedation and time before discharge (1.75 hours vs. 4.45 hours) were significantly lower for patients in the PCS group; nine of them (25.7%) did not use the pump and had total colonoscopy without sedation.

Two weeks after the procedure, 96.5% of patients in the PCS group were willing to repeat the examination under the same conditions vs. 72.5% of patients in the control group.

The conclusion:  Our results demonstrate that need of sedation is widely overestimated in France.

colonoscopy

kaleidoscope

cloudscape

This week's Grand Rounds is over at Colorado Insurance Insider

A Chicago couple thinks a doctor’s bedside manner is so important, they’re giving the University of Chicago $42 million dollars to teach it. Matthew and Carolyn Bucksbaum are backing the Bucksbaum Institute for Clinical Excellence at the University of Chicago. It will be led by Dr Mark Siegler – who’s been the couple’s physician. They say he’s the kind of doctor students should emulate. Carolyn Bucksbaum said the couple was motivated to make the donation after she once had a bad experience with an arrogant doctor who dismissed her illness.

Medical students spend the first half of their education learning anatomy and physiology, and the second half applying that knowledge in the hospital. But where in that process do they learn the very important skill of listening and talking to their patients?

Teaching bedside manner may not be as straightforward as teaching biology, but creating a system of mentorship can help experienced physicians pass lessons down to young and aspiring doctors.

“The way you learn medicine is by seeing, not by talking. You have to show what good care is about. I learned from studying people like Joe [Kirsner],” [Mark] Siegler said. “Joe told us that everything was important, [including] science and clinical inquiry, but patients came first, patients were the absolute first priority.”

“One of the goals is the institute is to do the kind of translational research and outcomes research that we need to demonstrate the importance and effectiveness of good doctor-patient relationships,” Siegler said. “There’s a human encounter to deliver the scientific advance, and I think all of that is amenable to study.”

Is this something you can teach, or is it an innate quality? Is it possible to you teach compassion? Concern? Good manners? Or are these qualities already present (or absent) by the time you are old enough to apply for med school? And if it's something that can be acquired, how do you teach it? Even more important, how do you measure the results? 

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