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Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

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Page 1: Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

Commonwealth FundWhy Not the Best

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

Page 2: Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

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Page 3: Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

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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Page 4: Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

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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Page 5: Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

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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Page 6: Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

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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Page 7: Commonwealth Fund Why Not the Best William R. Scharf, M.D. September 24, 2013

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