Leo: We spent millions of dollars developing a pen for the astronauts that would work in zero gravity. Know what the Russians did?
Toby: Used a pencil?
Well it was not exactly true but it illustrated a very important point: solutions could sometimes be very simple and cheap.
Now most readers know that I love snorkeling and when I started my wife on it she, being a scientist, wanted to know the names of things she saw whilst snorkeling. The West Wing came to mind.
We used a polypropylene chopping board (the smaller one), drill a hole in the corner to tie a strap so that the hand could sometimes be free to operate the camera. We then use a golf pencil tied to the board with a fishing line to write.
Blue Brittle Star ©Am Ang Zhang 2010
So what about The NHS(England): Use The Mayo Pencil!
The main features:
The needs of the patient come first.
An Egalitarian Culture
Healthcare is not a commodity.
Private or Charity Patients are Equal.
No over treating at Mayo.
Competition does not serve patients’ interests.
Disincentive system that works.
What Makes the Mayo Clinic Different?
by Maggie Mahar
October 21, 2008
The needs of the patient come first.
“At Mayo the focus is on the patient. The needs of the patient come first. I think one of the Mayo brothers originally said it—and here, that really is the case,” says Patterson. “We also do high quality research at Mayo, and we have a graduate school of medicine. But research is not the primary focus.
At Mayo, on the other hand, stardom is frowned up. “Mayo has been, from the beginning, a group practice,” says Patterson. “You really have to be a team player. People in administrative positions understand that everyone is an important member of the team.”
An Egalitarian Culture
You may have heard that at Mayo, doctors collaborate. But did you know that after their first five years all physicians within a single department are paid the same salary? During those first years, physicians receive "step raises" each year. After that, they top out ,and "he or she is paid just the same as someone who is internationally known and has been there for thirty years," says Patterson. ("Most could earn substantially more in private fee-for-service practice." he adds.)
“It doesn’t matter how much revenue you bring in,” Patterson explains, “or how many procedures you do. We’re all salaried staff—paid equally.
“Turnover is very low. It’s unusual for people to leave here, and when they do, many like me, wind up coming back. You would be surprised—we celebrate many 35 and 40 year anniversaries. That fact that people stay so long is important to the success of the organization.”
Patterson does not sound as if he’s boasting. He didn’t found Mayo. He didn’t create the culture. He merely works there—and he is telling me why he likes it.
Yet I believe that there is much that health care reformers can learn by studying how Mayo operates.
There is, after all, a difference between healthcare and hamburgers. Healthcare is not a commodity.
Healthcare is not a commodity.
Yet—and this is key—although Mayo’s doctors are not worrying about the dollar value of what they do, they are not more extravagant than other doctors in dispensing care. Quite the opposite: Extensive analysis of Medicare records done by researchers at Dartmouth University reveals that treatment at the Mayo Clinic in Rochester Minnesota
Yet no one would suggest that Mayo scrimps when treating patients. The Clinic received stellar marks on established measures of the quality of care, and both patient satisfaction and doctor satisfaction were higher than at UCLA.
…………when it comes to healthcare, lower costs and higher quality often go hand in hand. Mayo’s patients are not hospitalized as long as patients at other medical centers—and don’t see as many specialists—because resources are used efficiently, and diagnoses are made quickly.
A Fully Integrated System
“Here at Mayo, we can do things in a week that take several weeks to organize in New York
For example, “In New York, each division has its own staff to make appointments. If I wanted several specialists to see a patient, I had to go through each of those divisions. At Mayo, we have a pediatric appointment office that makes all of the appointments for pediatric patients.”
Meanwhile, at Mayo, “We have a unitary medical record and a very effective IT department,” says Patterson. “We developed our own software, and we can we dictate notes—we don’t have to type.” (This is a boon because, believe it or not, many doctors don’t know how to type.)
“In the hospital, what we dictate can be transcribed within about an hour.” Patterson adds. “In the clinic, it’s done by the next half-day. In the meantime, if someone needs to access your notes, they can dial in and listen to the dictation.”
Private or Charity Patients are Equal
The Mayo Clinic in Minnesota New York
Like most academic medical centers, Mayo treats a fair number of patients who cannot afford to pay their bills. In 2007 it spent $182 million providing charity care and covering the unpaid portion of Medicaid bills—plus another $352 million on “quantifiable benefits to the larger community” which included “non-billed services, in-kind donations and education.”
That year, 100,000 benefactors gave the Clinic a record $373 million—enough to pay for the benefits the Clinic provided for the community, but far from the amount that would be needed cover the charity care Mayo provided.
When it comes to serving Medicaid patients, Mayo is generous with its time and talent. “Here, there is no distinction between Medicaid patients and other patients,” says Patterson. “I wouldn’t know whether they are on Medicaid, or have insurance from their employer. The business office knows that.”
At many academic medical centers, Medicaid patients are seen mainly by residents in a separate clinic. “At Mayo no one is seen only by residents. And we routinely spend 90 minutes with a new patient —going through X-rays, and a complete examination,” says Patterson.
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No over treating at Mayo.
It also is important to keep in mind that, “contrary to popular assumptions, it’s the volume of services, not the price per service, that accounts for most of the variation in Medicare spending” observes Dr. Jack Wennberg, the founder of what is now known simply as “the Dartmouth research.” And as more than two decades of Dartmouth
“UCLA knows it has a problem,” Wennberg confided in an interview last year. “But what are they going to do—close down beds and fire doctors? They need that stream of revenue that comes from the beds and doctors to service their debt.” So Medicare spends more at UCLA—and some patients are over-treated.
Competition does not serve patients’ interests.
The Mayos also made it clear that patients’ interests were not well served if doctors competed with each other. Late in life William emphasized that in addition to making a commitment to the patient, doctors must make a commitment to each other: “Continuing interest by every member of the staff in the professional progress of every other member,” would be essential to sustaining the organization’s future.
More than one hundred years later, building a health care system that adheres to such a collective vision of its mission may be difficult. Perhaps it can only be done in Minnesota
In the end, Mayo offers proof that when a like-minded group of doctors practice medicine to the very best of their ability—without worrying about the revenues they are bringing in for the hospital, the fees they are accumulating for themselves, or even whether the patient can pay—patients satisfaction is higher, physicians are happier, and the medical bills are lower. Isn’t this what we want?
Disincentive system that works.
Virtually all Mayo employees are salaried with no incentive payments, separating the number of patients seen or procedures performed from personal gain. One surgeon refers to this tradition as a ‘‘disincentive system that works.’’ Adds another surgeon: “By not having our economics tied to our cases, we are free to do what comes naturally, and that is to help one another out. . .. Our system removes a set of perverse incentives and permits us to make all clinical decisions on the basis of what is best for the patient.”
These are values that can be traced directly back to William Mayo and Charles Mayo, who, together with their father, William Worrall Mayo, founded Minnesota United States
Read the full article: What Makes the Mayo Clinic Different?
The Cockroach Catcher surprised even himself that he was still naive about the future of the NHS that he joined over 40 years ago.
Elsewhere, I stated:
Private Health Care providers all knew the value of specialist. These specialists have been known as hospital consultants in England (and the rest of the U.K.
The only reason why they now want to move into GP service is to have control over secondary care. Many Insurers have full control over the consultants and the hospitals they are allowed to operate.
Why are hospitals and the consultants not kicking up a fuss?
Here is a view:
“In the case of the consultants, a show was made of trying to make them accept much closer supervision by hospital managers, and cut back on their private work. But it soon came to seem that the real aim of doing this was to make them feel more disenchanted with working as salaried NHS employees and readier to go into business – to form doctors chambers, on the model of barristers, or other kinds of business, and sell their services to any employer, public or private, that offered them the best terms. A significant number began to plan to do so and some have begun to. And as the cuts begin to bite there will be unemployment among hospital doctors. As you will have read, consultants are among those scheduled to be laid off by St George’s
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