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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
306
2023-12-28
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.
72,033
2023-12-28
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
43
2023-12-28
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.
340
2023-12-28
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
2023-12-28
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
2023-12-28
Lilford R, Mohammed MA, Spiegelhalter D, Thomson R. Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma. The Lancet. 2004;363(9415):1147-1154.
A review of the risks of using crude outcome data to measure institutional performance made more convincing by the fact that the same authors have very effectively used such d... more
A review of the risks of using crude outcome data to measure institutional performance made more convincing by the fact that the same authors have very effectively used such data in other publications
619
2023-12-28
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
139
2023-12-28
March JG. Exploration and exploitation in organizational learning. Organization science. 1991;2(1):71-87.
An important and detailed account of the origins and the management of the conflcts in any organisation in choosing whether to stay in the safety zone of what is familiar and... more
An important and detailed account of the origins and the management of the conflcts in any organisation in choosing whether to stay in the safety zone of what is familiar and acceptable or to explore new options which may or may not represent an improvement. Quote : "Exploration includes things captured by terms such as search, variation, risk taking, experimentation, play, flexibility, discovery, innovation. Exploitation includes such things as refinement, choice, production, efficiency, selection, implementation, execution. Adaptive systems that engage in exploration to the exclusion of exploitation are likely to find that they suffer the costs of experimentation without gaining many of its benefits. They exhibit too many undeveloped new ideas and too little distinctive competence. Conversely, systems that engage in exploitation to the exclusion of exploration are likely to find themselves trapped in suboptimal stable equilibria. As a result, maintaining an appropriate balance between exploration and exploitation is a primary factor in system survival and prosperity".
35,027
2023-12-28
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.
9,387
2023-12-28
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
6,595
2023-12-28
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
24
2023-12-28
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.
82
2023-12-28
Nolte E, McKee M. Variations in amenable mortality Trends in 16 high-income nations. Health Policy. 2011;103(1):47-52.
International comparisons of fatal conditions for which interventions most productively focus on attention on, and direct actions towards, those that are most amenable to know... more
International comparisons of fatal conditions for which interventions most productively focus on attention on, and direct actions towards, those that are most amenable to known methods of prevention or treatment
225
2023-12-28
Papadakis MA, Teherani A, Banach MA, et al. Disciplinary action by medical boards and prior behavior in medical school. New England Journal of Medicine. 2005;353(25):2673-2682.
An interesting overview of quality improvement activities in a pediatric intensive care unit using a philosophical model that views knowledge as straddling the intersection be... more
An interesting overview of quality improvement activities in a pediatric intensive care unit using a philosophical model that views knowledge as straddling the intersection between evidence and beliefs
40
2023-12-28
Pisano GP, Bohmer RM, Edmondson AC. Organizational differences in rates of learning: Evidence from the adoption of minimally invasive cardiac surgery. Management Science. 2001;47(6):752-768.
A 16 hospital comparison in the efficiency and effectiveness of surgical teams in the introduction of a new technique of minimally invasive cardiac surgery. Some services did... more
A 16 hospital comparison in the efficiency and effectiveness of surgical teams in the introduction of a new technique of minimally invasive cardiac surgery. Some services did much better than others and this, probably unsurprisingly, was achieved in those with more active surgical leadership, careful team selection and more rigorous team training.
724
2023-12-28
Priesmeyer HR, Sharp LF. Phase plane analysis: Applying chaos theory in health care. Quality Management in Healthcare. 1995;4(1):62.
A, perhaps the, classic and comprehensive study of how new ideas spread, including medical developments and drugs. Memorable quotations include " 84% of population is unl... more
A, perhaps the, classic and comprehensive study of how new ideas spread, including medical developments and drugs. Memorable quotations include " 84% of population is unlikely to change its behaviour based solely on arguments of merit, scientific proof, great training or jazzy media campaigns. The majority of those who try new behaviours do so because of the influence of respected peers” ,,,, and:
"... opinion leaders (have been described) as “people on the edge”: opinion leaders have a certain degree of cosmopoliteness in that they bring new ideas from outside their social group to its members. They “carry information across the boundaries between groups. They are not people at the top of things so much as people at the edge of things, not leaders within groups so much as brokers between groups” ..." Opinion leaders gain part of their perceived expertise regarding innovations by their greater contact across their system’s boundaries".... Resonates Williams description of 'boundary spanners'
2023-12-28
Roland M, Rao SR, Sibbald B, et al. Professional values and reported behaviours of doctors in the USA and UK: quantitative survey. BMJ Quality & Safety
A comparison between the attitudes of USA and UK doctors to a range of ethical and professional issues including their interactions with colleagues they knew to be impaired or... more
A comparison between the attitudes of USA and UK doctors to a range of ethical and professional issues including their interactions with colleagues they knew to be impaired or incompetent (16-18%) Sheds some light on why doctors don't deal very well with such colleagues including the interesting and (for the UK) odd and disconcerting statistic that while 72.4% of USA doctors report that they would cease referring patients to such colleagues only 17.2 % would be inhibited in the UK