The Coronavirus Threat: A view from East Asia.

Regular readers of Nones Notes Blog know that my brother, Nelson Nones, has lived and worked outside the United States for nearly 25 years – much of that time in East Asia. So naturally I was curious about his perspectives on the spread of the Coronavirus from its epicenter in Wuhan, China, what precautions he is taking in the face of the threat, and his perspectives on how the actions of Asian countries affected by the outbreak may be mitigating the potential effects of the virus.

Here is what Nelson wrote to me in response to my query:

The Coronavirus has not affected my business here in Bangkok to date. I did make a trip to Singapore during the last week of January and to Taiwan during the first week of February, after arriving back in Thailand from the U.S. on January 12th.  I haven’t been sick at all – before or since.

However, in an abundance of caution I am keeping myself at home as much as possible, and I have decided not to travel anywhere until the current hullabaloo dies down.

As for the situation here in Thailand, this country is actually the location of the first COVID-19 (Coronavirus) case ever recorded outside Mainland China. This was back on January 13th, just two weeks after China first notified the World Health Organization (WHO) of the new disease, and only two days after China recorded its first COVID-19 death.  

The patient here in Thailand was a Chinese woman who had traveled from Wuhan, the epicenter of the pandemic.

Since then, Thailand has recorded 42 additional cases for a total of 43 patients, of whom only one died (on Sunday March 1st), and 31 have recovered.  This leaves 11 active cases – all considered mild.

The first case of human-to-human virus transmission within Thailand was recorded on January 16th, affecting a taxi driver. Of the 43 cases confirmed so far, 25 affected Chinese citizens; seven affected Thai citizens with travel histories to China, Japan or South Korea; seven affected Thai citizens who work in the tourism or healthcare industries; and the remaining four were other domestic cases (of which only two potentially represent “community spread”).  Thailand’s infection growth factor peaked on January 26th.

Being one of the world’s most popular tourist destinations (especially from China), Thailand has never imposed any travel restrictions, even from China (nor has the U.S. ever imposed any COVID-19 travel restrictions on Thailand), but all arriving international passengers are screened by an initial body temperature check. Those who fail the initial screening are required to disclose their travel histories within the past 14 days, in detail.  If they have travelled to or from any affected areas, and exhibit any COVID-19 symptoms, they are immediately quarantined at a specially-designated hospital for isolation and treatment.

Under the circumstances, and considering its geographic proximity to China as well as the normal volume of Chinese tourist travel, I think Thailand’s containment efforts so far have been successful and offer some lessons for the United States. Containment in India, Indonesia and Bangladesh so far is even more impressive (Indonesia reported its first two cases only on March 2nd).

Displayed below is a listing of South, Southeast and East Asian countries, ranked by population (together with the U.S. for comparison purposes), showing the number of cases and deaths reported so far:

* Excludes Diamond Princess cruise liner cases.

Sources:

Case data are from https://www.worldometers.info/coronavirus/#countries

Populations are from https://en.wikipedia.org/wiki/List_of_countries_by_population_(United_Nations)

The countries shaded in green, above, are those which did not require advance visas for Chinese citizens holding ordinary passports, prior to the imposition of temporary COVID-19 travel restrictions. These countries were either visa-free or allowed “visa on arrival.”

The countries in red typeface, above, are those which had imposed temporary COVID-19 travel restrictions as of early February 2020. These include “entry bans on Chinese citizens or recent visitors to China, ceased issuing of visas to Chinese citizens and re-imposed visa requirements on Chinese citizens or countries that have responded with border closures with China.” (See https://en.wikipedia.org/wiki/Visa_requirements_for_Chinese_citizens for source data.)

It’s quite clear from the data above that, excluding Mainland China itself, there is little or no correlation between the incidence of COVID-19 cases or deaths and the leniency of a country’s previous or current travel restrictions in so far as Mainland Chinese are concerned.

Indeed, all of the four countries having a higher number of cases than Thailand (Japan, South Korea, Hong Kong and Singapore) required advance visas before the COVID-19 outbreak, and all but one (Hong Kong) had imposed COVID-19 entry bans as of February 2nd

Conversely, apart from Thailand, the countries which did not require advance visas before the COVID-19 outbreak have averaged fewer than one case per country (although all of them except Cambodia and East Timor had imposed temporary COVID-19 travel bans by February 2nd).

The countries shown in bold typeface above are those which are geographically closest to the COVID-19 epicenter. An average of 570 COVID-19 cases have been reported within each of these 10 countries; only Laos has been immune so far. Conversely, an average of 6 COVID-19 cases have been reported within each of the remaining 26 countries (excluding China itself).

From these data, I’ve drawn the following four generalizations:

  • Outside of Mainland China, international travel bans and visa restrictions are not effective tools for controlling the spread of COVID-19 disease within a country.
  • Geographic proximity to Mainland China is well-correlated to the historical spread of COVID-19 disease in South, Southeast and East Asia.
  • Vigilant screening and disposition of suspected cases is vital to containing the spread of COVID-19 disease, as Thailand’s experience demonstrates.
  • Allowing high concentrations of suspected cases to form without treatment, such as Wuhan (China), the Diamond Princess docked at Yokohama (Japan) and Shincheonji church at Daegu (South Korea), is a recipe for disaster.  

Of course, the virus and its spread is an evolving narrative, and Nelson’s observations may soon be overwhelmed by new developments. Still, I was somewhat surprised to read that the situation is not quite as dire as the news reporting here in the U.S. would seem to indicate.

Have you heard from overseas friends or colleagues about how they are responding to the Coronavirus outbreak? Please share their perspectives with other readers here.

The promise — and peril? — of microchip implants for people.

In 2017, when employee volunteers at Three Square Market, a Wisconsin-based technology company, agreed to have microchips implanted in their wrists so that they could access the company’s lunchroom vending machines without exchanging money, some people tittered.

At best, it was viewed as a publicity effort to draw attention to the firm and its work in the microchip industry.

So where are we with human microchip implants two years later? Well … not so far along in some ways, and yet things may be poised for a sea change in the not-too-distant future.

And actually, it has less to do with human microchip implants as a convenience as it does with their potential to revolutionize health monitoring and medical diagnoses.

Biohax International, a Swedish-based company founded more than five years ago, is further along on the development curve than most other developers in the field. According to a report from Thomas Industry Insights, thousands of Swedes now have microchip implants, and the number is expected to continue growing at a robust pace.

At present, Biohax chip implants can house anything from emergency contact information to FOB and other access capabilities for cars, homes and even public transportation.

But the next frontier looks to be in healthcare. At present, prototype microchips are being developed that will enable continual monitoring of a person’s vital signs – things like glucose monitoring and blood pressure monitoring.

It isn’t difficult to imagine a day when certain patients are prescribed potentially lifesaving microchip implants that will serve as “early warnings” to nascent health emergencies.

Is this the future?

There could be a downside, of course – there nearly always is with these sorts of things, it seems. What does a world look like where physicians, insurance companies, employers or credit card companies make implants a mandatory condition for service or employment?

How far of a line is it to go from that to being part of a “surveillance state”?

And even if the situation never came to that, would people who demur from participating voluntarily in the “microchip revolution” be somehow walled off from the benefits microchips could deliver – thereby becoming “second-class citizens”?

The ethical questions about human microchip implants are likely to be with us for some time to come — and it’s certainly going to be interesting to see how it all plays out.

Do you have particular opinions about the “promise and peril” of microchip implants? Please share your thoughts with other readers here.

Fitbit aims to become the “check engine” light for the body.

… But first it needs to convince consumers that wearables are a “need-to-have” versus a “nice-to-have” product.

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Between Fitbits, Apple Watches and other “wearables,” I suspect the holiday season this year will be full of gift-giving of these and other types of interactive gadgetry.

The question is – how many of these items will still be being used by the end of the next year?

According to a recent online survey of ~9,600 consumers in the United States, the United Kingdom and Australia conducted by market research firm Gartner, many of these wearable devices will be destined for the dresser drawer.

The abandonment rate for smartwatches is expected to be ~29%, while for fitness trackers, it’s forecast to be nearly the same at ~30%.

Part of the problem is that while most people typically purchase these products for themselves, more than one-third of fitness trackers and more than a quarter of smartwatches are given as gifts.

When gadgets like these are gifted, often it’s “easy-come, easy-go.”

The Fitbit company knows about these dynamics all-too well. According to an article earlier this month in The Wall Street Journal, the company is struggling to develop its next generation of products and to attract new users.

While that’s going on, for this holiday season, Fitbit’s sales are forecast to grow only in the 2% to 5% range, as compared to double-digit increases in prior quarters.

Essentially, what Fitbit and other brands need to do is to move consumers to start considering wearables as “need-to-have” rather than “nice to have” products — and to avoid the dreaded “fad” moniker (as in “for-a-day”).

This imperative helps explain Fitbit’s attempts to position its products as ones that measure long-term health conditions rather than being simply fitness trackers.

The notion is that physicians could start prescribing Fitbit devices to track patients’ vital signs in heart health, or physical therapists doing the same to help monitor their patients’ at-home exercise routines.

Fitbit is also working on developing trackers that can detect and diagnose long-term health conditions. To that end, what’s critical is to come up with defining functions that other gadgets can’t perform.

Otherwise, consumers are less likely to be interested — figuring that they can get the same kind of functionality out of other devices they already own.

In the meantime, look for wearables to be under the tree this holiday season … and then for many of them to be stuffed in a drawer someplace by next summer.

For physicians on the front lines, burnout is a real concern.

bdoIf you’re like many people, you may have begun to notice some telling changes in the “atmospherics” you encounter in your visits to the doctor’s office.

Perhaps the signs are just subtle, but things seem to be a little more stressed in the office – and a little less comforting for patients.

With the big changes happening in how healthcare services are delivered and how care providers are compensated, perhaps those changes are to be expected.

But a new survey of more than 500 physicians by InCrowd, a Boston-based market intelligence company focusing on the healthcare, pharmaceutical and life sciences fields, points to some unwelcome “collateral damage” that has to be concerning to everyone.

According to the InCrowd research results, three-fourths of the physicians surveyed do not feel that their healthcare facility or practice is doing enough to address the issue of physician burnout.

For the purposes of the research, burnout was defined as “decreased enthusiasm for work, depersonalization, emotional exhaustion, and a low sense of personal accomplishment.”

If three-quarters of the physicians think that too little attention is being paid to burnout issues, that may be one explanation for the changes in the “dynamics” many patients sense when they pay a visit to their doctor.

This doesn’t mean that the majority of physicians feel that they themselves have experienced burnout. But in two particular physician categories – emergency care and primary care – nearly 60% of the physicians surveyed reported that they had personally experienced burnout.

And most of the remaining respondents know other physicians who have experienced the same.

While burnout may be a more extreme condition, for many physicians the average day presents any number of challenges and frustrations. Nearly four in ten respondents reported that they “feel frustrated” by their work at least a few times weekly — or even every day.

dtThe two biggest contributors to this frustration? Time pressures, and working with electronic medical records.

Perhaps the most startling finding from the InCrowd survey is that ~58% of the physician respondents say that they’re either unsure or wouldn’t recommend a career in medicine to a family member or child.

To me, that finding says volumes. When a profession goes from being the object of aspiration to something to be avoided … we really do have a problem.

What’s been your experience at your doctor’s office on recent visits?  Do you sense a degree of tension or stress that’s more than before?  Please share your thoughts with other readers.

The Affordable Care Act: Still unpopular with physicians after all these years.

ACAOne of the predictions we’ve heard about the admittedly controversial Affordable Care Act is that acceptance of it will grow over time, as people become more familiar and comfortable with its provisions.

So far at least, we haven’t seen this happening in the public polling about the law.

And now we’re seeing similar dynamics playing out in the all-important physician community.

In fact, the latest findings are that the ACA is more unpopular than ever, if the results of a new survey of physicians are to be believed.

The survey was conducted in January 2015 by LocumTenens, a physician staffing firm and online job board.

The headline finding must be this:  While ~44% of the survey respondents reported that they had been opposed to the Affordable Care Act legislation prior to its implementation, now ~58% are opposed to it after a year of working under the confines of the law.

R. Shane Jackson, president of LocumTenens, had this to say about the key finding:

“After a year in the trenches trying to help patients understand this legislation, physicians by and large feel the law hasn’t done a lot to help improve healthcare.”

More specifically, Jackson noted,

“Physicians feel the ACA has made serving patients and running their businesses much harder.  A year after implantation – and years after the political debate started – doctors are still passionate about how this law should have been designed, and would still like to see changes made that will make it simpler for their staffs and patients to understand.”

Among the negatives physicians see with the current ACA law are these aspects:

  • Lower reimbursement rates to hospitals and physicians
  • Increased compliance burdens for physician practices
  • Higher patient debt due to high-deductible plans

ACA healcare premium changesAlso faulted are the insurance companies for not doing more to inform newly insured patients about their premiums, deductibles and coverage limits.

It isn’t all poor marks for the ACA, however.  Physicians in the LocumTenens survey do credit the legislation for a number of positive outcomes including:

  • Helping more people gain access to healthcare
  • Expanding coverage to more children and young adults
  • Eliminating coverage denials due to pre-existing health conditions
  • Placing more focus on preventive healthcare measures
  • Decreasing the costs of end-of-life care

So what is the “net-net” on all of this?

Two-thirds of the physician respondents want the ACA law repealed (and three-fourths think it will be, incidentally).  But physicians want it replaced by something else that retains the positive aspects of the ACA while doing away with the negatives.

That’s the same message we’ve been hearing from politicians, too.  So the bigger question is how to unscramble the ACA egg … and whether anything actually better can come out of the effort.

Would anyone care to weigh in with their thoughts and ideas in this never-ending debate?

The Continuing Evolution of Consumer Healthcare Information-Gathering Practices

health informationWith the interminable discussion and disagreement about the (so-called) Affordable Care Act we’ve been having lately, it’s easy to lose sight of some of the other important developments in health care and related behavioral trends.

One of them is how people are evolving in the way they obtain their health information.  A new consumer survey helps provide insights.

The survey, conducted among nearly 1,100 Americans age 18 or older by healthcare communications consulting firms Makovsky Health and Kelton Global, shows that U.S. adults visit a physician three times per year, on average.  That’s not much different from what previous research shows.

At the same time, however, American consumers now spend an average of over 50 hours per year researching health information on the Internet.  And they’re accessing such information all over the place – from health-oriented websites to social media. 

WebMD continues to have pride of place among healthcare online resources:

  • WebMD:  ~53% of adults access during the year
  • Wikipedia:  ~22%
  • Health magazine websites:  ~19%
  • Advocacy group websites:  ~16%
  • YouTube videos:  ~10%
  • Facebook:  ~10%
  • Blogs:  ~10%
  • Pharmaceutical company websites:  ~9%

Because health subject matters can be rather complicated or detailed, one would suspect that most people might do their research using a PC rather than devices with less screen-viewing or printing capabilities.  And this research bears that out:

  • ~83% use PCs the most to find health information online
  • ~11% use tablets the most
  • ~6% use smartphones the most

[However, tablet usage has grown from just 4% in the 2012 survey, while PCs have declined by a similar margin.]

The influence of consumers’ own doctors remains as strong as ever.  When asked what would motivate consumers to visit a pharmaceutical company’s website for information, the survey respondents cited physicians over any other motivational influence:

  • Physicians:  ~42% of respondents would be motivated by this source
  • News articles:  ~33% would be motivated
  • TV advertising:  ~25%
  • Drug discount card:  ~14%
  • Magazine advertising:  ~13%
  • Web/online advertising:  ~11%
  • Newspaper advertising:  ~9%
  • Radio advertising:  ~9%

… All of which leads one to wonder if most of the dollars being spent by pharma companies on radio, TV, magazine and web advertising are simply wasted. 

Really, this type of pharmaceutical advertising would appear to be “spray and pray” … on steroids.

Here’s a final piece of information from the Makovsky/Kelton survey that was quite revealing — perhaps even startling:  With all of the talk about the Affordable Care Act, as of the time of this survey a few months back, one-third of respondents reported that they had never spent any time researching the reforms and how they might affect them. 

… And another third indicated that they had spent less than one hour total researching the topic.

What’s wrong with that picture?

Power to the people: Online medical diagnosis is here to stay.

Online medical adviceWith the plethora of medical information websites now available, the results of the Pew Research Center’s recent survey on online medical diagnosis behaviors by “Jane and John Q. Public” comes as little surprise.

The research, part of Pew’s Internet & American Life Project, found that ~35% of U.S. adults surveyed reported that they’ve used the web to try to figure out what medical condition they may have … or have done so for a friend or family member.

Pew calls these people “online diagnosers.” Of these, a plurality (~46%) reported that their online research led them to conclude that they needed the attention of a medical professional.

And what about the accuracy of their initial diagnoses? Here’s what the Pew survey revealed:

  • A medical professional confirmed their diagnosis: ~48%
  • A medical professional did not agree … or offered a different opinion about the condition: ~18%
  • The medical professional’s view was inconclusive: ~1%
  • A medical professional or clinician wasn’t visited to get a professional opinion: ~35%

The Pew survey also found that certain sectors of the public more inclined tap online resources for diagnosing a medical condition. These segments include:

  • Women
  • Younger age groups (35 or lower)
  • Those with college or advanced degrees
  • Those part of households earning $75,000+ in annual income

Lest you think that the explosion of websites specializing in health information — including the ever-growing array of hospital websites – are the ones spurring the online activity, the Pew survey clearly finds that the standard search engines are where most of the action is happening:

  • Google, Bing or Yahoo-type search engine sites: ~77%
  • WebMD or other health information-type sites: ~13%
  • Wikipedia: ~2%
  • Facebook or other social-type sites: ~1%

Some hospitals are near-obsessive about their patient satisfaction ratings and achieving high quality scores from third-party ratings firms like Press-Ganey. But the Pew survey finds that a distinct minority of health consumers takes the time and trouble to consult such reporting: Only about one in five survey respondents reported consulting online reviews of pharmaceuticals, medical treatments, physicians, or hospitals.

And practically no one posts online reviews of their own about healthcare services or health providers.

Here’s one final piece of information from the Pew survey: Despite the fact that people who search for health information often do so out of a concern for their own health or the health of a family member, that doesn’t mean that they’re willing to pay for the privilege of accessing the information.

To begin with, only around one-quarter of the Pew respondents reported that they had been asked to pay to access the health-related information they wished to see online.

Their reaction when confronted with such a pay wall? Do everything possible to avoid shelling out any money:

  • ~83% attempted to find the information somewhere else without having to pay
  • ~13% gave up searching entirely
  • Just 2% decided to pay for the information

So even in circumstances as fundamental as those involving health, it would seem that information in cyberspace “wants to be free.”

The Business World: Hazardous to your Health?

Overweight Business TravelersWord of two recent medical studies should give pause to those of us in the professional world who do our share of traveling on the job.

First up, researchers at the Mailman School of Public Health at Columbia University are reporting that businesspeople who travel two weeks or more during an average month are significantly more likely to have a higher body mass index and to be obese.

The conclusions were drawn from reviewing data from medical records of ~13,000 participants in a corporate wellness program, as provided by preventive health services firm EHE International.

In comparing frequent business travelers (those who typically travel 20 or more days per month) against light travelers (only 1-6 days per month), not only did the evaluation discover poorer health results for the first group, it also found that those individuals were 260% more likely to rate their own health as “fair” or “poor” compared to the less frequent travelers.

The Columbia University study notes that since ~80% of business travel is carried out using personal automotive transport, often this means long hours of sitting.

Poor food choices on the road are no help, either. Of course, this is a challenge for all business travelers no matter what mode of transport they choose to take, what with the high sodium and fat content of restaurant fare – and oh, would you like sour cream and butter on your baked potato?

Not surprisingly, the Columbia study concludes that those who travel extensively for work “are at increased levels of risk and should be encouraged to monitor their health.”

But if that news isn’t enough, along comes another study that links middle age obesity to mental degradation in later life. As reported in the most recent issue of Neurology, the medical journal of the American Academy of Neurology, researchers in a study conducted at the Karolinska Institutet in Stockholm, Sweden conclude that controlling body weight during the middle years can significantly reduce the risk of developing dementia in later years.

This study analyzed time-lapse information from ~8,500 twins aged 65 or older, and within that sample, evaluated the results from the ~475 individuals diagnosed with dementia or possible dementia against factors such as height, weight and BMI measures that had been recorded 30 years earlier.

The Swedish study found that those who were overweight or obese during midlife were at 80% greater risk of developing dementia or Alzheimer’s disease in later life.

Connecting the dots between these two studies makes things quite clear: If you want to lessen you chances of Alzheimer’s or dementia in old age, keep your weight under control today. And to keep your weight under control today, beware of the traveler’s lifestyle and get off your duff in the office.

Now if you’ll excuse me, I need to go exercise.

Online healthcare and virtual doctor visits: Are we there yet?

Online Physician ConsultationsThe harsh realities of cost are driving healthcare providers, insurance carriers and government agencies to implement policies designed to encourage consumers to take better control over their own health.

More healthcare plans and programs than ever before are including incentives for making lifestyle changes, undergoing preventive care routines, “do-it-yourself” testing as well as online consultations with physicians.

In this regard, it seems everyone is completely on the bandwagon … except perhaps the consumer.

Why is that the case? One reason might be because of what we’ve trained people to expect in the delivery of healthcare services.

For decades, American consumers weren’t given any meaningful incentives for engaging in preventive care or in making lifestyle adjustments. Several generations of Americans were acclimatized to seek out healthcare services when they needed it – and that was when something was wrong. And the billing for those services was sent directly to the insurance company for payment.

In such an environment, preventive health or cost control was the last thing on people’s minds.

I recall being hospitalized for six days back in the early 1980s, along with being given a battery of medical tests conducted by health specialists of every stripe. I’m sure the invoicing associated with my hospitalization and treatment was astronomical … but I never saw a copy of the bill to really know.

My only out-of-pocket expense for the entire week? Thirty dollars for using the television set in the hospital room.

What was surprising to me, even at the time, was that I was kept in hospitalization far longer than I felt I needed to be – my symptoms of infection were gone after just a day or two. If I had been responsible for paying for even a portion of my hospitalization, I’m sure I would have been talking with anyone I could find about how quickly I could be discharged!

Today of course, people are far more aware of skyrocketing healthcare costs – not to mention their concerns about ever-rising health insurance premiums, higher deductibles, and bigger co-pays. Still, when asked about adopting new ways of interfacing with healthcare providers, American consumers seem somewhat ambivalent about them.

A recent online survey of ~1,000 Americans age 18 and over conducted by marketing and research firm Euro RSCG Worldwide found that only ~42% of respondents are comfortable with the idea of having online consultations in lieu of personal visits with their doctors.

[Men are more receptive to this idea (~58%) than women are (~37%) … but women are the ones more apt to make healthcare decisions for their families.]

On the other hand, here’s an interesting additional insight from the survey: When told that having an online consultation with their physician might result in lower expenses, ~77% of those same respondents reported that they’d be open to trying it.

What about the concept of “do-it-yourself” testing? Close to half of the respondents in the survey (~48%) reported that they’re receptive to the idea of using mobile apps to run their own tests and checkups at home. Checking blood pressure was the most popular DIY test, along with tracking and reporting on symptoms.

Of course, as time moves forward, technology is no longer the big obstacle it once was for turning “virtual visits” and “remote care” into a reality. Instead, it’s consumer attitudes and a willingness to adapt. And to accomplish that, the purveyors of modern healthcare must try to undo several generations of “learned” behavior that’s nearly the polar opposite.

Denise Murtagh, a planning director at Euro RSCG, mentions another factor as well: the doctors themselves. “A lot will depend on how facile physicians are with the technology, and how comfortable they are with it.”

And let’s not forget age demographics, too. The survey underscores that Gen-X and Gen-Y consumers are far more comfortable with the idea of physician remote care (47% – 52% positive) than Baby Boomers and those born earlier are (only 33% – 39% positive).

It looks like we’ll need to give this trend a bit more time to come into full flower.

Improving the Prognosis for Patient Safety in Hospitals

"Josie's Story" Book"Safe Patients, Smart Hospitals" BookThere’s a newly published book just out on the issue of patient safety in U.S. hospitals that’s quite an interesting read. The book is titled Safe Patients, Smart Hospitals (Hudson Street Press, ISBN-13: 978-1594630644), written by Peter Pronovost, Ph.D, M.D., a professor at Johns Hopkins University School of Medicine, and Eric Vohr, former assistant director of media relations at Johns Hopkins University School of Medicine and an instructor of technical writing at the school. Dr. Pronovost is also Medicaid director for the Johns Hopkins Center for Innovation in Quality Patient Care. (The book is also available in a Kindle edition.)

Instead of presenting us with a dry tome like so many other books on healthcare issues, this volume starts out with a true-life medical case where procedures and protocol at a top-notch healthcare institution were not enough to save the life of a patient.

The example the authors use to introduce us to the issue of patient safety is Josie King, an 18-month old girl who was the victim of accidental scalding by hot water and who was admitted to Johns Hopkins Hospital with second-degree burns. Unfortunately, the little developed a bacterial infection from a central line catheter while in the hospital, which was then improperly treated, leading to her death.

Living not far from Baltimore area, I recall this story as being big news in the local media market back in 2001 when the case occurred. Numerous stories were broadcast along with concerns raised as to how such events could have happened at one of America’s most prestigious healthcare institutions. (The child’s mother, Sorrel King, also wrote a book about the incident – Josie’s Story – published last year.)

Both Dr. Pronovost and Mr. Vohr are intimately familiar with the Josie King tragedy because of their first-hand knowledge of the events at the time. In fact, Dr. Pronovost used the experience to develop a simple set of usage guidelines for central line catheters – reducing a ~120-page thicket of inconsistent, confusing procedures and guidelines down to a five-step checklist. When a test program across 50 intensive-care units in Michigan hospitals used the five-step checklist in lieu of the traditional guidelines, there was a dramatic reduction in the incidence of catheter line infections to near zero, along with saving an estimated 2,000 lives.

In their book, Messrs. Pronovost and Vohr are basically issuing a “call to action” for taking a similar approach to a myriad of other surgical and related procedures at hospitals. But the book also pinpoints significant hurdles the authors believe are standing in the way of action. These range from having a lack of uniform standards from one hospital to another … a propensity for doctors and other medical staff to stick to existing behaviors and protocols even if they have shortcomings … the sometimes insufficient lines of communications between physicians and nurses … and, not least, the unwillingness of some surgeons, as the prima donnas of their hospitals, to taking direction, advice or orders from other medical staff members.

In my line of work, I have the opportunity to interact with healthcare organizations ranging from smaller community hospitals to large regional “destination” health centers. From my experience, I tend to agree with the authors that different hospitals have different protocols, different priorities, and different cultures, which could certainly lead to different patient outcomes in some cases.

Nevertheless, I have never seen a case of wanton disregard for patient safety. From what I’ve observed, I think any problems that might arise would more likely come from the large volume of patients being cared for, along with the constantly evolving technologies and procedures. It’s really too bad that medical staff members aren’t blessed with a 36-hour day, because so many seem to put forth a 36-hour effort within a 24-hour day … day in and day out.

Perhaps for this reason as much as any other, it is interesting – and welcome – to read of practicals way to improve patient safety through using steps such as ones outlined by Dr. Pronovost and Mr. Vohr in their book. For anyone interested or involved in the healthcare industry, it’s a volume definitely a worth reading.