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Neuhauser D, Provost L, Bergman B. The meaning of variation to healthcare managers, clinical and health-services researchers, and individual patients. BMJ Quality & Safety. 2011;20(Suppl 1):i36-i40.
Given that the reduction of unjustified variation in clinical outcomes and costs between the best and the worst performances among healthcare services is the 'low hanging frui... more
Given that the reduction of unjustified variation in clinical outcomes and costs between the best and the worst performances among healthcare services is the 'low hanging fruit' of improvement programs, it is important to note the differing interpretations of such measurements among different staff groups demonstrated in this study.
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Meyer GS, Demehin AA, Liu X, Neuhauser D. Two Hundred Years of Hospital Costs and Mortality MGH and Four Eras of Value in Medicine. New England Journal of Medicine. 2012;366(23):2147-2149.
Analysis of a remarkable and probably unique set of records of mortality and costs from the Mass. General Hospital over two centuries. This shows that although there has been ... more
Analysis of a remarkable and probably unique set of records of mortality and costs from the Mass. General Hospital over two centuries. This shows that although there has been steady decline in mortality, costs have recently and disproportionately increased. Of interest to those working to find ways to measure and monitor value as reflected by cost per unit outcome
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McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635-2645.
A random sample of over 7000 patients in the USA with several acute and chronic medical conditions that showed that on average only about 55% were receiving the correct eviden... more
A random sample of over 7000 patients in the USA with several acute and chronic medical conditions that showed that on average only about 55% were receiving the correct evidence based medical care
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May RM. Simple mathematical models with very complicated dynamics. Nature. 1976;261(5560):459-467.
A clear description of the complex chaotic reactions can arise from apparently simple time series equations. Probably not for the mathematically faint hearted but this classic... more
A clear description of the complex chaotic reactions can arise from apparently simple time series equations. Probably not for the mathematically faint hearted but this classic paper provides important foundation knowledge for anyone interested in understanding the often seemingly unpredictable peculiarities of non-linear complex adaptive systems such as healthcare.
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Lillrank P, Liukko M. Standard, routine and non-routine processes in health care. International Journal of Health Care Quality Assurance. 2004;17(1):39-46. doi:10.1108/09526860410515927
Makes important but often overlooked distinctions between variation and variety and between standard, routine and non-routine processes of care. Useful reading for anyone tryi... more
Makes important but often overlooked distinctions between variation and variety and between standard, routine and non-routine processes of care. Useful reading for anyone trying to manage healthcare quality management / improvement programs
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Kern T. Darker Shades of Blue: The Rogue Pilot. McGraw-Hill; 1999.
An account from the US air force of how to diagnose and manage the dangers of sociopathic rogue pilots - a small but dangerous group. Much of the experience and advice is ver... more
An account from the US air force of how to diagnose and manage the dangers of sociopathic rogue pilots - a small but dangerous group. Much of the experience and advice is very relevant to the management of the small but dangerous group of rogue doctors with similar personalities and failings, but who can still attract and impress influential peers and superiors in organisational hierarchies
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Kaplan RS, Norton DP. The Balanced Scorecard : Translating Strategy into Action. Harvard Business School Press; 1996.
An early and simple but still relevant and valuable 4 quadrant schema for measuring key dimensions of performance in an organisation including healthcare services
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Horn SD, Gassaway J. Practice-based evidence study design for comparative effectiveness research. Medical care. 2007;45(10):S50-S57.
A persuasive argument in favour of developing and using structured practice based evidence to analyse and improve patient outcomes in operational healthcare service where form... more
A persuasive argument in favour of developing and using structured practice based evidence to analyse and improve patient outcomes in operational healthcare service where formal randomized controlled trials are either not feasible or not relevant.
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Hodgson CS, Teherani A, Gough HG, Bradley P, Papadakis MA. The relationship between measures of unprofessional behavior during medical school and indices on the California Psychological Inventory. Acad Med. 2007;82(10 Suppl):S4-7.
A USA study showing that unprofessional behaviour as medical students correlated significantly with relevant variables in their prior California Psychological Inventories admi... more
A USA study showing that unprofessional behaviour as medical students correlated significantly with relevant variables in their prior California Psychological Inventories administered on admission to medical school
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Granovetter MS. The strength of weak ties. The American journal of sociology. 1973;78(6):1360-1380.
A classic paper in sociology showing that in the spread of ideas and opportunities such as finding a job or looking for innovative solutions to problems, weak social connectio... more
A classic paper in sociology showing that in the spread of ideas and opportunities such as finding a job or looking for innovative solutions to problems, weak social connections are often more productive than strong ones. This is relevant to the development of cross - disciplinary scientific research and clinical service development.
A persuasive argument with examples of how Bayseian probabilistic conceptual models are used, often unconsciously in clinical decision making. This adds further to the case f... more
A persuasive argument with examples of how Bayseian probabilistic conceptual models are used, often unconsciously in clinical decision making. This adds further to the case for greater use of analytical methods such as statistical process control in monitoring progress and comparing outcomes
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Gabbay J, Le May A. Practice-Based Evidence for Healthcare: Clinical Mindlines. Routledge; 2011.
Detailed account of an ethnographic study of how general practitioners make decisions - mostly through the 'mindlines'of practice based evidence more often the more rigorous... more
Detailed account of an ethnographic study of how general practitioners make decisions - mostly through the 'mindlines'of practice based evidence more often the more rigorous but often inapplicable methods and requirements of evidence based practice
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Fowler FJ, Gallagher PM, Anthony DL, Larsen K, Skinner JS. Relationship between regional per capita Medicare expenditures and patient perceptions of quality of care. Jama. 2008;299(20):2406-2412.
No positive relationship was found between costs of care and patients perceptions of quality of care (USA Medicare) in fact for some variables there was an inverse relationshi... more
No positive relationship was found between costs of care and patients perceptions of quality of care (USA Medicare) in fact for some variables there was an inverse relationship
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Fortin M, Dionne J, Pinho G, Gignac J, Almirall J, Lapointe L. Randomized controlled trials: do they have external validity for patients with multiple comorbidities? The Annals of Family Medicine. 2006;4(2):104.
Study showing that the results of carefully controlled randomized trials do not easily translate in implementation in general practice because of frequent comorbidities that w... more
Study showing that the results of carefully controlled randomized trials do not easily translate in implementation in general practice because of frequent comorbidities that would have caused them to be excluded from the relevant trials
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Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Annals of internal medicine. 2003;138(4):288-298.
High spending (USA Medicare) regions had greater utilization of physician services but no better outcomes and no more patient satisfaction with the care provided.
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Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Annals of internal medicine. 2003;138(4):273-287.
High spending (USA Medicare) regions had greater utilization of physician services but no better quality of care
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Edmondson AC. Learning from failure in health care: frequent opportunities, pervasive barriers. Quality and Safety in Health Care. 2004;13(suppl 2):ii3.
An exploration through comparison of different organizational cultures and (nursing) management practices of which systemic issues promote or inhibit learning from mistakes. Q... more
An exploration through comparison of different organizational cultures and (nursing) management practices of which systemic issues promote or inhibit learning from mistakes. Quote " ...This article describes two powerful organisational factors that inhibit collective, shared, systematic learning from failure in health care. Organisational cultures lacking psychological safety for speaking up about ambiguous, small issues of potential concern (as opposed to large issues of obvious concern) and an overarching work design that emphasises production pressure and worker independence inhibit organisational learning from failure...." . An important paper for nursing management
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Dekker S. Drift into Failure: From Hunting Broken Components to Understanding Complex Systems. Ashgate Pub.; 2011.
A comprehensive and instructive tour of the causes of failures in a wide range of industries including healthcare with a focus upon the multiplicity of interactive factors the... more
A comprehensive and instructive tour of the causes of failures in a wide range of industries including healthcare with a focus upon the multiplicity of interactive factors the contribute as part of the complex adaptive systems that need to be better understood and managed
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Cohen WM, Levinthal DA. Absorptive capacity: A new perspective on learning and innovation. Administrative science quarterly. 1990;35(1):128-152.
The usually and much cited origin of the processes whereby individuals ans organizations do or don't succeed in importing and using new information
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Carrre S, Gottman JM. Predicting divorce among newlyweds from the first three minutes of a marital conflict discussion. Family Process. 1999;38(3):293-301.
A study of conversations between couples, a few minutes of which predicted the future course of their marriages.This form of analysis has been used to a limited extent to asse... more
A study of conversations between couples, a few minutes of which predicted the future course of their marriages.This form of analysis has been used to a limited extent to assess communications between doctors and patients but deserves wider application.