Since my last posting on this subject, with a family member having been admitted into care in a hospital I was able to talk to other health professionals who particpated in the care giving. For the past two weeks, I had the impression of smooth flow and wait free attendance of the care and auxiliary staff who needed to attend to the care and recovery of one particular patient at hand. I had sampled the Nursing staff who were explicitly assigned on the ward when sharing what I had observed.

However, its quite possible I have conveyed skewed perspective given that my daily visits were around the same time window between 12:00 – 2:30 pm. I managed to discuss my observation of what appeared to be smooth flow in providing the patient with the daily need in care (medicine, meals, clean up, exercise etc.) with couple of the aides who came in to give a breathing treatment, this usually lasting no more then 15 minutes. It works out that not every task, even the medical treatment task, appears on the ward Scrum board that I had previously mentioned. In fact he pointed out that his daily orders of which patients to attend to for this particular type of treatment appeared from the Pharmacy. He pointed out, more often than appearances had so far led me to believe, there would be a bottle neck in the patients room with number of care personal trying to serve one need or another. This resulted in waiting and lining up similar to the lines we see at a grocery check out – his exact statement. Fortunately they have some slack and really freedom to coordinate their time, so often they’d go to a nearest patient needing service and return there after. No doubt there are others who may not be permanent fixtures to the ward but do provide service to it that have similar experience, and waiting may not be the only waste that they see or experience.

Clearly, there is room for improvement that can lead to better coordination and collaboration amongst all the care providers. In the ideal case having a shared and common information system, Scrum or Kanban board at the ward level would be of great value. In general I would say at the strategic level there is an opportunity to work at the ward level with all the care staff to Train, Map and Check on Lean principles, in particular their role in helping identify and eliminate waste. I say do this at the ward level, as in my mind this is the effort of a team. Though I consider Lean thinking to take place a many levels, including individual, role as well as team based. I like the following example 8 Wastes with Healthcare examples (ref: Lean Healthcare Exchange).

I also realize that the Paul Levy’s recent blog Kaizen Corner – standardized work was in part addressing this and the opportunity of better coordination in order to deliver value to the customer. His blog is aptly called Running a Hospital.

ASF Communications Specialist Patrice Taddonio, BIDMC CEO and ASF Board Member Paul Levy, ASF Boston Program Director Devon Reber

The history of Beth Israel Deaconess Medical Center (BIDMC) began a century ago with the founding of Deaconess Hospital in 1896 and then Beth Israel Hospital in 1916 — each institution dedicated largely to meeting the health needs of vulnerable and underserved individuals in the Boston area.

During this same period, Dr. Albert Schweitzer and his wife Helene Bresslau were on a parallel journey: they dedicated their lives to meeting the health needs of underserved individuals in Gabon, Africa. The Albert Schweitzer Hospital at Lambaréné (which they founded in 1913) now has the lowest documented mortality rate in all of Africa for children hospitalized with severe malaria, and The Albert Schweitzer Fellowship (ASF) sends senior medical students there to provide skilled medical care each year.

Today, BIDMC serves as the official U.S. Sister Hospital for the Schweitzer Hospital in Africa — and also provides ASF with crucial, invaluable support in our quest to eliminate health inequalities across the U.S. and in Africa. ASF’s hub — our central office — is housed at BIDMC; in short, the hospital provides us with everything from office space and computers to the support of a community of medical professionals as committed to their patients as they are to training the next generation of compassionate, conscientious physicians.

ASF couldn’t do what we do — develop “leaders in service” committed to meeting the health needs of the underserved — without BIDMC’s support.

In addition to serving as the Albert Schweitzer Hospital’s Official U.S. Sister Hospital, BIDMC is the official hospital of another iconic institution: the Boston Red Sox. And yesterday, two lucky ASF staffers had the chance to participate in BIDMC’s annual Fenway Fantasy — a game of softball on the field at Fenway Park, with BIDMC CEO and President Paul Levy (and ASF board member) playing the role of Josh Beckett. (Check out Levy’s Fenway Fantasy photo album here.)

It was a lighthearted afternoon. But at the same time, it was a reminder of just how lucky we are to be a part of the BIDMC community — a community that is truly on our team.

The local – and extremely pesky to Beth Israel Deaconess Medical Center – Service Employees Industrial Union (SEIU) is at it again, with an EyeOnBI ad in the Wednesday Boston Globe char-broiling BIDMC for raising fees on late-night Emergency Room visits.

[I]t’s outrageous that Beth Israel Deaconess’ physician group would charge patients – including seniors on Medicare – for arriving ‘late’  at the Emergency Room when we have no other choice.

In turn, here’s BIDMC CEO Paul Levy’s blog post ridiculing the SEIU ad.

Once again: Leave it to a CEO to bring a knife to a gunfight.

Let me start off by saying that I love Beth Isreal Deaconess Medical Center, especially the excellent Emergency Room staff.  I’ve been a reluctant but frequent customer of Emergency Rooms  all over town, and I can say with authority that they are the best.  Every time I end up in BI, I receive impeccable treatment at top speed, and I can’t thank the good people who work there enough for all their help.

But that treatment comes at a cost.  And, if you get there after 10 PM, it costs more. 

In a country where so many are forced to use the ER for their primary medical care, allowing hospitals to charge extra fees for late service is, at best, tacky and, at worst, discouraging to those who should seek immediate attention. 

Eye on BI, a watchdog group started by the SEIU and the Area Trades Council to put pressure on the current BI administration, has taken up the cause of exposing the hospital’s practice of issuing “Late Night” ER fees and demanding that the hospital refund those they had already collected.  They protested outside the Four Seasons in downtown Boston, which hosted a BI board meeting this afternoon.

This sort of informational campaign is central to the group’s mission:

“By revealing ongoing systemic problems at BIDMC…, we will spur a return to the principles that defined the Beth Israel and the Deaconess at their founding: The ideals of ’service to community,’ ‘mutual respect and collaboration’ in the workplace, and treating ‘patients compassionately.’”

They do all that too, but the Eye on BI group’s  main focus is on fighting Paul Levy, the CEO of BI and author of the well-read blog, Running A Hospital.  Levy is famous for his liberal, collaborative approach to management, but he is also a vocal opponent of organized labor. 

In the interest of full disclosure, I should say that I’ve had my own smaller conflicts with Mr. Levy over the issue of the public option, and they didn’t bring out the best in me.  After I began frequenting his hospital and reading his blog, I friended him on Facebook and kept up with his status updates.  Then, over the summer, the health care debate started heating up, and he started posting about competition in the health care industry, and I started responding to his status messages, and as I did that more often, my tone started to get less and less productive. I still believe that it’s way nastier to deny people a public option than to make nasty comments about it, but it wasn’t very nice.  Basically, it ended with him calling me “cruel” and me making an internal vow to leave Paul Levy alone.   

But when Eye on BI called Levy out on ER fees, the issue hit too close to home for me to not stop by the Four Seasons to show my solidarity.  When I arrived, I found a number of patient advocates and medical workers spread out around the building, engaging with pedestrians around the building and distributing fliers.

The protesters expressed a uniform concern for the overall damage these fees do to patients’ rights.  Those people who depend on the emergency room most are those who can least afford the already-high cost of emergency care, and additional charges can be crippling.

The protest reached those behind the wheel through this large mobile billboard parked on the Public Garden that stated “Baggage Fees? Irritating.  Late-Night ER Fees? Outrageous.” 

Altogether, the event was understated, but the protesters managed to make their point in a way that brought the problem to the public eye and encouraged further discussion without stooping to undignified attacks.  I am taking notes.

ASF Board Member Paul Levy is the CEO of Beth Israel Deaconess Medical Center (and a blogger extraordinaire). Last night, he spoke about health care reform on NECN — click here to watch.

We’ve transcribed some provocative segments from Levy’s interview below. Do you agree? Disagree? Let us know in the comments.

On public vs. private: “There’s an approach that’s used in the Netherlands, which has universal health care access, where they use private insurance companies, strongly regulated, that have to provide insurance to all under very clear conditions. Everyone has to get insurance. Those companies compete and the public benefits from that. The problem with a public option — which is to say, a government plan so-called ‘competing’ with private insurance companies — is there’s no way you can have real competion there. The government plan will have access to tax-free money, they won’t be subject to regulation by all 50 states . . . what I think we’ll see, if we have a public option, is a gradual movement to, in fact, a single-payer plan, and I’m not sure that’s the best way to go.” 

On the things everyone is concerned about when it comes to health care: ”1. Everybody wants to have insurance — obviously, that’s important. 2. They want to be protected from egregious or nasty practices of insurance companies — preexisting conditions, losing your insurance because you get sick, those kinds of things. You can do both of those very effectively without a public plan.”

On why higher taxes might not be the end of the world: “My view is, if we want a national plan that gives everybody insurance and we know we need to subsidize low-income people,  if it’s a national priority to do that, the way to pay for it is by tax increases. Now nobody in Washington wants to talk about that, but we raise taxes when we do other things that are a national priority. And here I think the admin and some members of congress are trying to give the impression that you can give access and control costs and give everybody choice. You can’t do all three.”

On the U.S.’s primary care system: “We don’t have the best healthcare in the world. What we have is superb secondary and tertiary care, which is to say hospitals. But we’ve neglected the primary care system, and if you look at Europe and other parts of the world, what they’re really done is build up a superb primary care system — which does save money for society, because it means that patients are cared for in their doctors offices more often, and referred less often to specialists who do expensive tests and expensive procedures. If we made a change along that way, that would go a long way . . . that would truly save money, and would also give people, I think, a better sense of security that someone had  time to spend with them in the office, instead of 18 minutes before you’re shunted off to a specialist.”

The New Cambridge Observer is pleased to join Beth Israel Hospital’s Paul Levy et all in the rally to help the Boston Globe. Here’s the post, followed by a partial list of participating bloggers. I believe the idea is to leave comments on Paul Levy’s blog at runningahospital.blogspot.com, but if you leave them here, I’ll link or forward.  AMH
Here’s the post:

Posted by Paul Levy at 4/06/2009 10:00:00 PM.

New Cambridge Observer is a publication of the Harris Communications Group of Cambridge, MA.

Partial list of participating bloggers:

http://runningahospital.blogspot.com/

http://www.bluemassgroup.com/

http://www.letstalkhealthcare.org/

http://healthblawg.typepad.com/

http://geekdoctor.blogspot.com/

http://patientdave.blogspot.com/

http://endlessknots.netage.com

http://billives.typepad.com/

http://cseries.typepad.com/celebrityseries/

http://amatterofdegree.typepad.com/a_matter_of_degree/

http://venturecyclist.blogspot.com/

http://www.insideoutchina.com

http://www.negotiationguru.blogspot.com/

http://baystateliberal.blogspot.com

http://hilforum.com/

http://www.byeday.net/weblog/networkblog.html

http://www.healthbusinessblog.com/?p=2137

http://mikegil.typepad.com/

April 07, 2009 5:26 AM

Paul Levy said…

And two more:

http://achronicdose.blogspot.com/2009/04/blog-rally-to-help-boston-globe.html

http://www.healthcontentadvisors.com/2009/04/06/blog-rally-to-save-the-boston-globe/

I never thought that the Boston Globe would be seriously facing the prospect of shutting down. This is THE Boston Globe we’re talking about. This is BOSTON we’re talking about, a major intellectual center of the North East. I myself have been a critic of the paper, mainly because its coverage of local news has been diminishing. I don’t believe they have ended the City Weekly section: it was what I liked about the Sunday Globe the most, offering coverage of Boston neighborhoods, Brookline, Somerville and Cambridge.

The Globe’s major contribution though, has been the investigating reporting. Yes, we do need checks and balances for the executive power. The Globe’s journalists with long running connections and sharp eye were able to uncover the corrupt and the illegal. These are the stories that matter, cause we DO want to keep checks on the executive power. Yes, I want to know about Governor Partick’s new misstep, I want to know about the abuse of power from the Legislature, the Catholic church, the police, the Mayors etc etc

So we DO need this newspaper, and Boston bloggers have been rallying for ideas to save the paper. This is from the common statement:

 We view the Globe as an important community resource, and we think that lots of people in the region agree and might have creative ideas that might help in this situation. So, here’s your chance. Please don’t write with nasty comments and sarcasm: Use this forum for thoughtful and interesting steps you would recommend to the management that would improve readership, enhance the Globe’s community presence, and make money. Who knows, someone here might come up with an idea that will work, or at least help. Thank you.

(P.S. If you have a blog, please feel free to reprint this item and post it. Likewise, if you have a Twitter or Facebook account, please add this url as an update or to your status bar to help us reach more people.)

If you would like to comment with a new idea or thought on how to help save the paper, you can do that at Blue Mass Group here or at Paul Levy’s Blog “Running a hospital” here.

UPDATE: The Globe itself invites readers to propose ideas for survival. You can comment here.

Last month Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, found his organization facing a $20 million budget shortfall caused by the economic crisis.  Instead of ordering the layoffs of the 600 workers necessary to cover the $20 million deficit, Levy decided to discuss this problem with his employees and to solicit their feedback on how the medical center should respond. 

Levy said the following at a meeting with employees of the medical center:  “I want to run an idea by you that I think is important, and I’d like to get your reaction to it,” Levy began. “I’d like to do what we can to protect the lower-wage earners – the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don’t want to put an additional burden on them.  Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice.  It means that others will have to give up more of their salary or benefits.”

What followed was an enormous amount of applause by the medical center employees, the vast majority of whom expressed their willingness to take pay cuts so that none of their coworkers would have to be laid off.  Over the next several days, Levy received over 600 emails from employees suggesting various ideas for reducing expenses.  These ideas enabled the medical center to find creative ways to trim $16 million in expenses, which saved 450 of the 600 positions that had been originally slated for layoffs.  (They are still looking for ways to keep the remaining 150 people in their jobs.)

Two of the pillars of workplace democracy are sharing information among employees and involving them in the decision-making process.  Paul Levy’s experiment with these innovative management practices will undoubtedly have a huge impact on the workers’ motivation and loyalty towards the organization.  Instead of facing sudden traumatic layoffs, the employees of Beth Israel Deaconess Medical Center were given a unique opportunity to participate in the decision-making process, and the center followed through and implemented the ideas that were generated.  The results have proven to be a huge success.

I wonder how many additional layoffs could have been prevented during the past year if executive managers had been more willing to seek out and act on the knowledge of their team members….

Source: Boston Globe

——————————-

Join the LinkedIn Workplace Democracy Network and follow us on Twitter!

I like articles like this one. Too often all I see in the world around me is greed and selfishness and while I try not to pay too close attention, it’s difficult and it sometimes becomes oppressive. I see it everywhere, not just on the news, but in my own life when people I know, people I work with and people I respect, choose to fulfill their own desires, wants, what have you, over the needs of others. I’m not saying that doing things and getting things for ourselves is bad or that we need to stop doing for ourselves for some greater good, just that we share our lives and our spot in this world with a lot of different people and I think we have an obligation to help others around us when we can and to the best of our abilities. Not to the extent that we have to deny ourselves, but just to the extent that we comfortably can.

I don’t know much about doctors or hospital administration, but I think Paul Levy and the staff of Beth Israel are people who are on the right track. By working to make bad things better by looking out for others in need, they make things better for everyone. They don’t do it because they were asked or because they were forced, but because they felt it was the right thing to do and because it was something within their means to do.

The threat of layoffs is a very real fear today and I’ve talked with people who, despite facing that threat, refuse to agree to concessions and I don’t understand this. The staff of Beth Israel is willing to act selflessly and make concessions so others can keep their jobs, but what about people who refuse to make concessions to save their own job? Can you make sense of that for me.

Just yesterday I was talking with someone who told me he might be faced with the possibility of losing two hours per week and he thought that was unacceptable because his employer couldn’t guarantee his health insurance wouldn’t rise and he was concered that while he was losing two hours of pay per week, prices on everything around him would continue to rise. Certainly valid concerns, but I don’t understand why a concession to get paid for 38 hours of work per week, when it means saving your job,  is worse than working zero hours per week. Is it arrogance or something else I’m missing?

I read an interesting blog tonight from the Boston Globe about a CEO of a large hospital, Boston’s Beth Israel Deaconess Medical Center and how he has chosen to handle the need to trim and save and still keep employees. It’s a marvelous read and he seems to have an innovative way of thinking. Thank you Paul Levy for using your brain and awesome common sense.

He actually has taken time to know his staff of 8,000. Observed the “peons” at work and learned from them and believe it or not, has asked them for input in preserving the hospital. Imagine.

What if the government officials and other highly paid and compensated CEO’s began to see the “gift” they could give, the legacy they could leave long after they leave this planet earth, by taking pay cuts, giving up some of their benefits and actually walking in a brand new pair of “corporate shoes”?

How many would benefit from the sacrifices made at the top? There would be a drop in unemployment because people could keep their jobs. Prices of goods might even decline because of the “supply and demand” principle and people wouldn’t be losing their homes, they would have a roof over their heads. Now that would be actual proof of living a “Wonderful Life”….putting the needs of others ahead of your own.

After all people, it’s “just stuff”.…you can’t take it with you…..Ever seen a hearse pulling a U-Haul into a cemetery? NOT!!!!! Why not all unite like we did after 9/11 and help where we can. It all begins with strong and determined leadership. Cuts in spending, being cost effective in choosing bids for government work and products, sharing what we do have with our neighbors…..”Paying it Forward”. And perhaps little by little the Ordinary People will show how extraordinary our thinking really is……Let’s show ‘em guys….God has opened a window in Boston it’s time we open others out there wherever we live, just waiting for us to begin anew.

Let’s hear it for a creative spirit and unselfish leadership, the fundamentals the people of the world have admired….now, GM, Chrysler, AIG, Walmart, Senators, Representatives, Mayors, Governors, Presidents of CitiBank, Bank of America, all lenders , CEO’s etc etc, step up to the plate and join the game. What do you say?

Wouldn’t it be ultimately more profitable, more resourceful and less stressful for all of us if we could have more CEO’s who have empathy to lead the team to the winning inning before the game is called for lack of participation?

Think about it “peons”…..write a blog….write a letter….call your congress people, bank presidents, send emails….it’s our opportunity to unite and join forces for the good of our fellow brothers and sisters in America.…Are you with me? Then let’s just do something…..start tomorrow….be active with your thoughts and ideas and lets show the world how extraordinary we each are, let us all shine. As we round the bases, one at a time to win the game of survival of a great America. While doing so, we will lift the buschel from our own lights and one never knows when an idea born from despair and frustration might be one of many that save this nation. We can and we will, do it together as our forefathers did in their beginning….It’s a new beginning and I for one want to play a role, do you?

Paul Levy is CEO of Beth Israel Deaconess Hospital in Massachusetts. What sets him apart from other CEOs blogging today is that he has thoroughly embraced the ideas of transparency and authenticity. He writes a blog called, Running a Hospital and does so with great skill.

Shel Holtz’s article, “A Clear Case For Transparency,” describes one example of his frankness. In one post Levy asks the one question you would never expect to hear from a CEO, “Do I get paid too much?”. He actually outlined on the blog how much he was making and a how the board of directors had come to this sum. While his salary is a matter of public record, it is refreshing to see a CEO who is willing to raise the topic himself and offer it up for discussion. While there were a wide range of comments to this post, most people were just impressed that he was willing to talk about it.

Which brings me to the point that candidness is an important part of transparency. Levy’s salary was already public knowledge. But the way in which he handled the topic himself, was impressive. It is not enough for companies to put important information out there to their stakeholders, the delivery is just as important. You could put up salary information, but if it is confusingly organized, or poorly explained, how is this helpful to stakeholders?

By explaining how the decision was made for his salary, Levy gave stakeholders a clear understanding of where the money was going and why. By opening this up as a topic of discussion on his blog, he is truly transparent. Looking at his blog as a whole, the sheer magnitude of posts he writes a month and the candid way he writes is very impressive. CEOs should use his blog as an example to look at, if they are thinking about blogging, or taking their blog to the next level.

Re–blog from the ArtsJournal Blog Plain English.

Paul Levy on the economical side effects for art and culture when London is hosting the Olympic Games in 2012. Not a big surprise but still sad to read.

New Here & Now Redesign, originally uploaded by WBUR.

For eons now I have been tempting listeners with promises of a shiny and improved Here & Now website. My initial post bemoaned the show logo itself, a flawed, convex monstrosity, sprinkled with what for all the world looked liked expletives plucked from cartoon bubbles (an unfortunate resemblance not unnoticed by a certain public radio host who shall remain nameless).

It really had to go. And with it the rest of the facade itself, and of course the entire arthritic scotch tape and paper clip scaffolding holding up the entire thing.

The folks at Here & Now, a dedicated nose-to-the-grindstone bunch of public radio servants, deserve far better.

And they are getting it. Oh so very shortly.

As an exclusive to those few who read this blog, I present the new site. And like On Point before it, the bones are WordPress. Don’t let the gaping content holes panic you. We aren’t yet finished. The official launch isn’t likely until the other side of the new year.

Whaddaya think?

Also, I was naturally delighted to see that Paul Levy, Beth Israel’s CEO and recent Here & Now guest, took me up on my challenge to embed 90.9 audio in his blog. Still looking for more trailblazers like Paul or Michael Goldberg.

Don’t hesitate to contact me if you require my help.

Paul Levy’s Blog "Running a Hospital", originally uploaded by WBUR

Fire sale here at the station: All audio most go and at unbelievably low prices! In fact, no price at all: Nada. Zilch. Zero.

Wait a minute, let’s amend that, shall we? The great giveaway is limited to 90.9-produced and -owned audio. And Car Talk, popular belief notwithstanding, doesn’t fall under that heading. Sorry y’all.

For months now, as part of my ongoing manic romp through the social media space, I’ve been tooling around with Utterli—the erstwhile “Utterz”—a Maynard-based audio blogging service.

Given audio is our stock and trade, the natural affinity should be quite obvious.

I have been uploading segments originally aired on Here & Now and our local version of Morning Edition. Moreover, from time to time you will hear my dulcet tones responding to users’ comments or reminding folks of upcoming station events or, say, fund drives.

One very wickedly cool feature of Utterli is those sleek embeddable widgets. In layperson’s terms this means you can copy and paste an audio player into your blog. To see this in action visit Michael Goldberg’s post here in his “Autism Bulletin” blog. Notice the player? Click and you’ll hear Bob Oakes’s interview with Deval Patrick.

Please feel free to sprinkle your blog with our stuff. All I ask in return is you let us know when you do. I get a real charge out of seeing WBUR stuff distributed across the World Wide Interwebs. Oh, and before I forget, you are heartily encouraged to “Utter” back.

Post away!

Not so long ago, an error in a Boston hospital led to a patient undergoing ‘wrong-side’ surgery, and the procedure was done on the wrong body part. The hospital and its CEO, Paul Levy, was admirably transparent about the whole situation, letting staff and the wider public know what had happened. As well as an investigation they also set up a “Safety Culture Operational Task Force co-chaired by a nurse, a surgeon, and an anesthesiologist, and engaging almost two dozen other people from a variety of disciplines and positions in the hospital.”

What they came up with was a checklist that all surgical teams have to go through before each surgery: “Responsibilities and the order of events is clearly laid out, even to the point of requiring that any radio in the OR is shut off during the time-out so as to avoid aural distraction. Note the forcing function at the very top of the form: No blades, needles, specula or bronchoscopes can be within reach of the surgeon until the full time-out is completed” (they have an online version to fill out too). A bunch of “secret shoppers” has also been set up to audit compliance. While I know nothing about surgery, I am a big fan of the simple process of checklists and how they can help improve even the most difficult of procedures…

Surgery checklist

… such as systematic searches. Go on, introduce one into your own working day!

A few good and/or interesting posts to draw to your attention:

• C.J. Mahaney writes here about the difference between being busy and being diligent, faithful and fruitful.  There is a promise of more to come dealing with various aspects of laziness.
• The Art of Manliness tells us how to give and take criticism like a man (HT: Reformissionary).  A lot of it is common sense, and some of it ought to be sanctified with a dip in the bath of Scripture principle, but it is worth reading and following.
• Carl Trueman writes about being trapped in Neverland at Reformation 21.  While I come from a different place and time (at least relatively) and therefore find his chip-on-the-shoulder angst a bit odd, I agree with the problem that he identifies.  I should point out that I have reasonable credentials with which to make a critique: my mother’s father – who worked, I think, with livestock (as an ostler) in Wales – was killed when she was young, and her mother – a wise, witty, independent woman of steel – knew poverty.  My father’s father worked in a London market.  Does that give me enough credibility?  Perhaps not.  Still, the problem of a perpetual adolescence is one that needs to be hit head on.  Increasingly, pastors are called to be parents also to a generation of spoiled and incompetent Peter Pans.
• Rich Barcellos gives some simple and practical thoughts on prayer meetings.
• My friend Paul Levy has some pointed comments on virtual church that are worth considering.

I read an article in the HSJ the other day about mortality rates during NHS operations being made available to the general public. It is, apparently, possible to find mortality rates for certain procedures on the NHS Choices website, but it certainly ain’t easy. I’ve just been pottering around for a while and, finally, for example looking at coronary bypass surgery at some London trusts, I got to this page (I hope the link works for you – if not, start on the homepage and click ‘compare hospitals’ and then ‘compare hospitals for treatments’ and, well, carry on from there). Some data is given to compare hospitals, though not explicit mortality rates – rather, they all have the same statement that with regards to mortality it is “As expected compared to the UK average”, which is not particularly helpful, especially given that the HSJ article implied that such a statement would be found for all NHS Trusts. I suppose that’s a good thing, i.e. that there’s no great disparity in care between Trusts, though it would be nice to see a few above average Trusts breaking from the pack (though of course that would then doom some to be below average…).

Other questions for which there is data for some of the Trusts are “does the surgical department have a lot of experience in this operation?”, “how long am I likely to spend in hospital?”, “how long will I wait from referral to treatment?”, and “how well does this organisation control MRSA blood infections for elective patients” (although for these last two questions the site does warn that different NHS trusts collect data in different ways, and hence the data are not comparable between trusts. Ho hum). The statistics are rather crude, and collected at the Trust level, so in real terms for the patient having to decide where to go for his/her coronary bypass operation they are pretty much useless. However, there are two things to say. One is that I expect (hope) that the data being collected will become more helpful, comparable and granular as time goes on. Secondly, even given their crude, unhelpful state at the moment, I’m delighted the data are out there.

I like being open and publishing outcome data because the act of transparency helps ensure that everyone “ups their game” as Paul Levy, a big fan of transparency (whatever the costs) might put it. It makes us all uncomfortable, as we all make mistakes and probably the natural reaction is to try and hush them up and save face, but really the improvement of a system requires that mistakes and errors are recognised and logged. Some will be human error of course, and that’s all fine and good and to be expected, but some of them are likely to be the result of systemic error – i.e. error that occurs because of a fault of the system. And while you cannot do much about human error, you can do a great deal about systemic error.

Now, while the NHS for the most part probably hates having their data out there, the reality is that it is unlikely to be used by patients during their decision making process. It probably will be used from time to time by jounalists, but journalists will just make up stats if they don’t have them to hand, so it doesn’t really make much of a difference. However, just the knowledge and discomfort of having the outcome data out there means that transparency and the acknowledgement of error is hopefully going to become more common in the NHS and, as a result, systems will be improved, to the ultimate benefit of the patient. Maybe I’m just being hopelessly optimistic, but I’m delighted to see NHS data being released to the prying eyes of all, and I hope that it’s a trend that continues even if, from time to time, it’s used against them.

WRITTEN BY PAUL LEVY

LOW DOWN

An Eastenders star and Australian actor, and a young director Chris Hislop come together in a creative collaboration which results in a one act play which is a darkly comic exploration of a man in fear of losing his touch as a writer, as well as his touch with reality.

REVIEW