The Best Practice: How the New Quality Movement is Transforming Medicine

by Charles C. Kenney

Americans have always thought their healthcare system was the best in the world. But starting in the late 1990s, shocking reports emerged that showed this was far from the truth. Treatment-related deaths or “complications” were found to be the fifth leading cause of death for Americans, and hundreds of thousands of patients were being harmed by botched medical procedures.

Spurred by the quality crisis, a group of visionary physicians led by Donald Berwick and Paul Batalden embarked on a study of industrial “quality improvement” techniques, daring to apply them to the practice of medicine despite resistance from the medical community. The Best Practice tells the story of this burgeoning movement, and of how the medical landscape is being radically transformed—for the better.
 

Genres: Nonfiction, Business, Medical, Medicine

336 pages, Hardcover

First published January 1, 2008

Reviews

[angeannie · Rating 4 out of 5]

very enlightening advice on the medical profession and how the system sets up many health care professionals to fail+how we can improve

[Rachel · Rating 5 out of 5]

Highly recommend for anyone who works or wants to work in healthcare!

[Jon Silver · Rating 5 out of 5]

This is a great book - a summary of the last 30 years of the patient centered and quality improvement healthcare movement focused on one of its more influential leaders, Don Berwick. Of course, the book focuses on much more than just Berwick - it has chapters chronicling the influential IOM reports from the late 90s about medical errors, To Err is Human and the Chasm Report about poor healthcare quality (ok those were sort of Berwick). The writer has found outstanding examples of quality-centered innovation around the US (+a county in Sweden). It truly is very inspiring for anyone thinking of entering the healthcare field and it is extremely reassuring to learn about dozens of superstars in this burgeoning movement. It should be required reading for any medical student or person entering any health profession. I seriously believe these are very important ideas and this book does a great job capturing its importance and detailing their history. I gave it 5 stars for this reason despite some of the minor flaws I think it has. I had been looking for this book for months and I was not disappointed. It is a quick read.

The main one of these flaws is the folk-hero status it gives to Don Berwick. Personally, I think Dr. Berwick is awesome and he is a hero of mine. However, very frequently the author will be describing some topic, some very interesting work being done in Seattle or Cincinnati or Sweden, and then drop a random line like "And Don Berwick was very impressed" "Don Berwick thought this was a good idea" "Berwick was wowed" "Berwick was skeptical at first, but then he came around" "Berwick went to college with this innovator and always thought deep down that she would go on to do good stuff" Berwick isn't even in the story! He gets mentioned out of nowhere! Its kind of funny. But sometimes annoying, I think leaving out these non sequiturs would convince me more that this book was giving me a straightforward, unbiased chronicle of this movement rather than more of a cheerleading view. Another red flag is the author's place of work - Blue Cross Blue Shield, and the foreword is written by the CEO of Blue Cross Blue Shield. This book DOES basically detail the exciting quality improvement work of some of Blue Cross' most successful competitors, so I guess I am not that worried, but still worth mentioning. Highly recommended

[Amy · Rating 4 out of 5]

This review is more a summary of ideas to revisit later. Although if you are interested in why the American healthcare system performs poorly, how it can be changed, and quality measurement in general this book is worth a read:
...health care performance is rarely measured. Although nearly everything else of significance in the world of the twenty-first century is measured, health care is the surprising exception. (page 10)

Many believe they are among the best; but, in fact, they have little statistical proof. And reputation is not measurement. (page 242)

"One of the enemies of quality improvement is this notion that you've got to get it perfect. What you've go to do is change it and test whether it works. If you wait for perfection, it's never going to happen." - Rick Shannon (page 118)

"People understand if you make a mistake; they don't understand if you cover it up. Our whole journey is driven by two factors- family-centered care and transparency." - Atul Gawande (page 149)

Patients desire three things in the wake of an error: To know the truth about what happened, to receive an apology, and to be assured that steps are being taken to prevent similar mistakes in the future. Lucian Leape (Page 210-11)

Physicians are suspicious of standardization because many doctors share the belief that medicine is an art. The common reaction to standardization of procedures by doctors was to deride it as "cookbook medicine." (page 44)

Reconsider our attitudes towards threshold for action. When do we wait for more knowledge? And when do we go ahead, pull the trigger, act? (pg 283)

"Some is not a number, soon is not a time." Dan Berwick (pg 270)

"People change because of love for something - a deep emotional involvement." Goran Henriks (page 218)

"There are no billing codes for cures. There are no billing codes for outcomes. There are no billing codes for care improvement." George Halvorson (pg 261)

[Nathan · Rating 4 out of 5]

A horrifying yet hopeful book, which I guess is the inevitable pairing of emotions when you deal with insititutional quality. Hospitals are typically doctor-driven power structures focused on optimising doctor time rather than patient experience or quality of medical care. This book details several largely independent efforts in US hospitals (and one from Sweden) to put the patient first and focus on continuous improvement of the quality of care.

The two components of this are: data (typically from IT systems) and the Toyota system for continuous improvement (kaizen). My interest is completely whetted in Deming and his work, and I look forward to reading many more books on the subject. The challenge I particularly foresee is persuading the doctors to change the system--the processes of kaizen are much easier than convincing the members of the organization that it's important and useful. Yet the numbers on hospital-acquired infections are staggering: over 5,000 people each day in the USA! So much can be done, it makes me look around in New Zealand and ask who is doing it here. Sadly, I think the answer is "no-one".

[Alison · Rating 4 out of 5]

good information for anyone working in health care. lots of stats about how many patients/year are injured/killed by medical errors in the US, a few personal patient accounts. the author's voice is clear, organized and makes for an easy read.

after finishing the book though, i was left thinking, "okay so what can i DO with this information?" the book definitely makes you want to act, but doesn't provide specific ways on how to go about doing that. has a lot of examples about how health care systems were able to (owing to their resources-- human, financial and otherwise) and how these genius individuals were able to, but i think Kenney should write another book with suggestions on how to change health care at the grassroots level.

[John · Rating 4 out of 5]

I won this book as a prize and may not have read it otherwise. It gives true stories from both sides of the Atlantic of how health care can be organised to have better outcomes. Whether you are going to vote in England worried about the NHS or wondering when the pursuit of Life, Liberty and Happiness will give you universal health care in the States, you need to borrow and read this book (don't ask me, I've lent mine out already)

[Stephen · Rating 4 out of 5]

Good history of the Quality improvement movement. Starting with people like Don Berwick and how IHI was created, the book progresses through various case reports of hospitals and their turn around while using the Toyota production model, or methodologies like it which adopt small, experimental based changes.

Good for anyone wanting a background on the history of quality improvement and some of the key players who started it all!

[Susan · Rating 4 out of 5]

Worthwhile reading for health care professionals and lay public. Gives an overview of quality efforts, both in the US and internationally.

[Kip · Rating 4 out of 5]

This is a history book. Great reading for those interested in the origins of the Quality Improvement community. Inspiring for those of us who are more recent "converts".

[Fara · Rating 4 out of 5]

I really enjoyed this book. I think even those not involved with quality improvement in healthcare would find it interesting.

[Angi · Rating 3 out of 5]

Wonderful case examples of how a movement for quality health care is possible. Inspiring.

[Ann · Rating 3 out of 5]

Very interesting and well written. Encouraging to know that there are pockets of real change in the health care system.

[Jon Levine · Rating 4 out of 5]

Really good history of the quality improvement movement in medicine. Since the book was written in 08, the work has clearly continued, not least by Obama incentivizing for electronic records.