Commonwealth FundWhy Not the Best

William R. Scharf, M.D.September 24, 2013

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Are We Good Enough?

What Are the Odds?:

Of a coin landing on heads? 0.5Of a coin landing on heads twice? 0.5 x 0.5=0.25Landing on heads 4 times? (0.5)4 = 0.625

0.90 x 0.95 x 0.92 x 0.91 = 0.7158 or 72%

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What Are the Odds

• You would mail a letter if it only reached the sender 72% of the time?

• You would use an ATM if it only returned money 72% of the time?

• Have surgery if the hospital’s SCIP measures were reliable 72% of the time? If < 1 out of every 4 patients never got basic care?

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But why?

…..because every system is perfectly designed to achieve exactly the results it gets

We don’t have bad people….we have a bad system.

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What About Our System?

Examples:•Leadership issues•Teamwork issues•Ownership•Results are collected long after the operation•Results may not be shared for everyone to see•Problems with documentation•Poor accountability and poor rewards

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