1. I know of no more encouraging fact than the unquestionable ability of man to elevate his life by a conscious endeavor Henry David Thoreau

5. Tension Between the Public and Health Care Providers
Society’s growing request for quality control and transparency within evidence-based healthcare
Conservative, authoritative, rigid, too often arrogant, expert-based medical professionalism
Increasing mistrust and tension.
We cannot stop this social trend. Perhaps it’s time to redesign medical training and practice.

7. Crossing the Quality Chasm. IOM, 2001

12. In many hospitals in Israel (including Hadassah)
Local performance is almost never routinely measured, because traditional medical training assumes that doctors naturally aim for excellence.
Only a few hospitals have successfully started a systematic approach to quality improvement, while others have failed – trying outsourcing.
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

13. Plan of Action
Promote departmental initiatives of performance monitoring, using 1 or 2, self-chosen, indices of quality.
After individual meetings with 24 Department Heads, 14 have already defined tentative projects, such as outcomes of procedures, or patient’s understanding of informed consent.
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

16. Plan of Action
Promote departmental initiatives of performance monitoring, using 1 or 2, self-chosen, indices of quality.
After individual meetings with 24 Department Heads, 14 have already defined tentative projects, such as outcomes of procedures, or patient’s understanding of informed consent.
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

17. Plan of Action
Promote departmental initiatives of performance monitoring, using 1 or 2, self-chosen, indices of quality.
After individual meetings with 24 Department Heads, 14 have already defined tentative projects, such as outcomes of procedures, or patient’s understanding of informed consent.
Collaboration with nursing staff & medical school.
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

18. Plan of Action
Promote departmental initiatives of performance monitoring, using 1 or 2, self-chosen, indices of quality.
After individual meetings with 24 Department Heads, 14 have already defined tentative projects, such as outcomes of procedures, or patient’s understanding of informed consent.
Collaboration with nursing staff & medical school.
Various educational activities.
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

19. Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

20. Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

21. Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

22. Justification for Cost ($250,000/year)
Salaries for clinical leaders, data typist, coordinator, secretarial work.
Academic detailing costly but most effective to change physician’s behavior.
Experience from industry outside medicine: cost of quality/prevention far lower than cost of failures.
A safety culture requires willingness to direct resources.
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

23. Alternatives poor +++ Incremental Cost Implement -ation Effectiveness
Criteria
Options
poor
+++
Outsourcing
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

24. Dept of Social Medicine
Alternatives
Implement -ation
Effectiveness
Incremental Cost
Criteria
Options
poor
+++
Outsourcing ?
Dept of Social Medicine
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

25. Dept of Social Medicine
Alternatives
Implement -ation
Effectiveness
Incremental Cost
Criteria
Options
poor
+++
Outsourcing ?
Dept of Social Medicine
Clinical Dept Heads
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

26. Dept of Social Medicine Center for Evidence based Practice
Alternatives
Implement -ation
Effectiveness
Incremental Cost
Criteria
Options
poor
+++
Outsourcing ?
Dept of Social Medicine
Clinical Dept Heads
feasible
possible +
Center for Evidence based Practice
Last time the rate of postoperative infections was measured at Hadassah, this was more than two years ago and in only one department.

27. Joint Commission on the Accreditation of Healthcare Organizations - Revised Standards Effective: July 1, 2001
The leaders ensure implementation of an integrated patient safety program throughout the organization, including at least:
Designation of one or more qualified individuals or an interdisciplinary group to manage the organization-wide patient safety program
Increasing mistrust and tension.
We cannot stop this social trend. Perhaps it’s time to redesign medical training and practice.

29. When God created the universe, it did not stand up.
God tried again and again but it kept falling apart.
Until God created the “Tschuva” (Response/Responsibility).
According to our tradition, corrective measures and continuous improvement are the basic keys to successful existence.
If G-d makes mistakes, perhaps so do physicians. The key is in the design of correction.
I believe our healthcare system now demands it and Hadassah can lead the way.
Talmud (Rabbi Eliezer’s chapter III)