Baseball Forbids Pay for Performance – A Lesson for Healthcare?

Submitted by Steven Lewis on May 10, 2012 - 15:21

Baseball has terrific and comprehensive performance data to which it pays assiduous attention, and an outcomes-based culture. Yet its collective agreement forbids pay-for-performance (P4P) based on players' reaching certain statistical performance targets, like number of home runs or stolen bases. Health care ignores far more data than it pays attention to, yet P4P has been touted in many organizations as the solution to problems of quality and efficiency. This despite the dearth of comprehensive, valid data that relate what a provider does to how well her patients do. This post explains what baseball understands about P4P and why what seems to be a good idea in theory is fraught with unintended consequences in practice.

The Puck Stops Here: Kaizen and the Art of Goaltending

Submitted by Mark Wahba on April 23, 2012 - 18:21

Braden Holtby is the 22-year-old rookie goaltender for the Washington Capitals. He is the sensation of the first round of the 2012 National Hockey League playoffs. Like all goalies, he wears a customized protective mask that marks his identity. But it's what's on the back of Holtby's mask that's truly unique: the symbol of Kaizen, or continuous improvement. Holtby observes, adapts, and implements small changes to his game to improve the odds of stopping the puck. The province of Saskatchewan wants everyone in healthcare to be a Braden Holtby. It has committed to implementing the culture of Lean pioneered by Toyota and adapted to healthcare by organizations such as Virginia Mason Health Systems. Whether in the form of a Stanley Cup or better patient care, Kaizen produces winners.

“Footy's on, Footy's here again”: Why Systems Thinking is good for your health and says that the Cats will take the Flag*

Submitted by Alan Shiell on April 10, 2012 - 11:53

The Geelong Cats regularly sit atop Australian Rules Football. In 2005 the Sydney Swans improbably took their first Grand Final in 72 years. The Cats' domination has survived major turnover in management and on the field. The Swans' miraculous victory applied the principles and culture that define the Cats: specify the outcomes to be achieved, align the incentives, provide information rapidly on the progress being made, support reflective practice and experimentation, and leave operational decisions to front-line agents safe in the knowledge that they will quickly work out how best to get the job done. In public health, We need to see the patterns and the structural forces that cause diseases. And we need to equip frontline practitioners with the information and organizational supports they need to diagnose problems, to take risks and innovate, to act, to reflect, and to re-act accordingly. We need systems thinking.

Patient-Centred Care: Is It In the Cards?

Submitted by Mark Wahba on March 20, 2012 - 18:09

Kids used to collect sports trading cards. These cards had pictures of players on the front, and some data and a few biographical snippets on the back. They made the otherwise remote and unknowable stars a little more accessible and a little more human. Maybe trading cards would be useful a back-to-the-future innovation in health care. At each new patient encounter, the staff member would hand the patient one of their cards. All the doctors, nurses, support staff, everyone. The card would have the staff member’s first name and photo on the front with a little write-up on the back.

Improvement on Ice: Curling and Quality Improvement Science

Submitted by Mary Smillie on February 5, 2012 - 10:15

Curling is a game of strategy, execution, adaptation, and precision. It is a series of discrete decisions and events, all of which are highly visible to both players and fans. It is perfectly designed for deconstruction and analysis. Often called "the roarin' game," at MASH we think of it as a continuous PDSA cycle. High-level curling has a lot to teach high-quality health care.

Feta Compli: In Praise of Dullness

Submitted by Mark Wahba on January 25, 2012 - 10:36

Underdog Greece stunned the soccer world by winning Euro 2004, the sport's second-biggest tournament. How did they do it? With suffocating defence and an arguably tedious style. Purists scorned the approach, but what the Greeks lacked in entertainment value paled beside the stunning victory. Solid, preventive health care that addresses both individual and population needs lacks the glamour of high-tech medicine, but it, too, can be hugely effective. Perhaps health care should take a lesson from Greek soccer: winning beats interesting any day.

Do Clinicians Need Spring Training?

Submitted by Steven Lewis on December 6, 2011 - 18:29

Baseball has spring training and no one is exempt from the drills, the repetitions, the fine tuning, the repetition. It is not just a rite of spring; it is fundamental to the pursuit of excellence. Baseball assumes that skills are impermanent, mastery is fleeting, coaching is essential, and practice never ends. Health care assumes that skills once achieved are permanent, mastery comes with time, coaching is unnecessary, and practice is for students. Baseball has it right.

What Joe Paterno Could Have Learned About Disclosure from Health Care

Submitted by Steven Lewis on November 11, 2011 - 13:44

Penn State University is aflame, its President, two senior officials, and sainted football coach Joe Paterno out the door after 46 years. A former assistant coach, Jerry Sandusky, is under indictment for multiple sexual assaults against young boys over a 15 year period. Health care used to be renowned for its insular culture of secrecy and inability to do right by its victims. It has come a long way. I would like to think that health care CEOs would have responded more honourably and more swiftly than Paterno to a similar crisis.

What Health Care Can Learn from Skating

Submitted by Steven Lewis on November 8, 2011 - 12:07

When performance measurement fails, bad things happen. Figure skating learned that lesson the hard way. Its performance measurement system has evolved from an arbitrary and often corrupt gong show to an increasingly reliable (though still imperfect) science. That it has made progress despite its rigid and hidebound culture is all the more reason for health care to learn from its travails.

You're Either Drafting or Pulling: What Health Care Can Learn From Cycling

Submitted by Alan Cassels on November 1, 2011 - 13:43

Alan Cassels, Drug Policy Researcher and Adjunct Professor, Human and Social Development, University of Victoria,

Most people think cycling, and by that I specifically mean road racing, is an individual sport. They look at the superstars, people like 7-time Tour de France winner Lance Armstrong and think: "that guy is awesome!" Which is true, but only partly.