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

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3. Are We Good Enough? What Are the Odds?: Of a coin landing on heads?0.5 Of a coin landing on heads twice?0.5 x 0.5=0.25 Landing on heads 4 times?(0.5) 4 = 0.625 0.90 x 0.95 x 0.92 x 0.91 = 0.7158 or 72% 3

4. 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 hospitals SCIP measures were reliable 72% of the time? If < 1 out of every 4 patients never got basic care? 4

5. But why? …..because every system is perfectly designed to achieve exactly the results it gets We dont have bad people….we have a bad system. 5

6. 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 6

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