Friday, October 23, 2009

Chaos Theory, Health Reform, and Medical Organizations

The Wall Street Journal today carried a book review on Chaos and Organization in Health Care (MIT Press, $29.95). Its authors are Thomas H. Lee, MD, and James J. Mongan, MD. They arek respectively, the network president and chief executive of Partners Health Care, the Boston-based parent company to Brigham & Women’s Hospital and Massachusetts General Hospital, as well as empire extending to a large number of medical clinics and hospitals in Greater Boston.

Partners Health Care’s mission is to bring chaos out of health care disorder in Boston, as well as greater Massachusetts, which already has a 3 year old universal health plan, also designed to minimize chaos. This is ironic. Boston has always considered itself the Hub of Medical Care – the most organized and progressive cluster of medical centers in the nation.

Drs. Lee and Mongan admit bringing workable harmony among Boston caregivers can be difficult. Medicine, it seems, is riddled with “gray zones,” where there is no perfect therapy, given the variability of disease, patients, and doctors themselves. If this is a problem in a tightly knit organization like Partners Health Care, rampant dysfunction must exist the nation as a whole, where independent physicians in solo practice or groups of less than 5 deliver 87% of the care.

Big groups like Partners Health Care may help bring order but they may also create top-down bureaucracies that squelch innovation and creativity. Ask any doctor what fellow doctor they admire the most, and it is likely to be a creative diagnostician – not a faceless organizational bureaucrat. Lee and Mongan face this dilemma and others like it head on. They say ingrained medical cultures and mindsets resist change and that big organizations are unlikely to bring down costs. In Boston and Massachusetts, Partners Health is the most expensive act around, partly because it monopolizes care and can dictate its price.

The two physician executives say that while big organized integrated groups may be an improvement over independent physicians, they offer no panacea. According to the reviewer, “The future of medicine will continue to be defined by experimentation and a fitful groping towards improvement – a long, slow, grubby process not timed by five-year plans emanating out of Washington.”

The Lee and Mongan book reminds me of another book with “chaos’ in the title, From Chaos to Care; The Promise of Team-Based Medicine “ (Perseus Publishing, 2002@) by David Lawrence, MD, chairman emeritus of Kaiser Permanente. Both books share the same thesis, we would do much better is large systems replaced thousands of small practices. This view mirrors conventional Washington wisdom. If we only had more Mayos, Kaisers, and Partners dotting the landscape, costs would down 20%, salaried doctors wouldn’t have incentives to do more, care could be standardized, and outcomes would improve.

Which brings me to chaos theory. In 2008. Dr. Edward N. Lorenz, a meteorologist who sought to predict the weather with computers but instead ended up fathering chaos theory, died at 90 at his home in Cambridge, Massachusetts. Lorenz was best known for describing the “butterfly effect,” the idea that a small disturbance like a butterfly flapping its wings in Brazil could cause a tornado in Texas. The flapping wings represents a small change in the initial condition of a system. This causes a chain of events leading to large-scale phenomena. Had the butterfly not flapped its wings, the final system might have vastly differed.

Dr. Lorenz realized perfect weather forecasting was a fantasy. Perfect forecasting requires perfect knowledge of wind, temperature, humidity, and other conditions everywhere around the world at one moment of time. Even a small descrepancy could lead to completely different weather.

The butterfly effect applies to all matters initiated by mankind – health systems. financial markets, epidemics, wars, global warming, forest management, mortgage crises, physician shortages, and health system costs and outcomes. Similarly, perfect health reform forecasting requires perfect knowledge of the needs, wants, expectations, and disease, cultural conditions of individual patients and independent doctors in every nook and cranny of the land.

It is a fantasy that one can predict and completely control social consequences and behaviors with organizations or computers. The variables are simply too many. As chaos theorists say, “Small variations of the initial condition of a nonlinear dynamical system may produce large variations in the long term behavior of the system.

I believe health care reforms – the tweaks, tucks, rules, regulations, programs, accountable health organizations, protocols, algorithms, taxes, and other solutions will bring adverse and unpredictable consequences.

Reverse chaos theory may be at work here. Instead of the Washington tornado clipping the wings of patient and physician butterflies, the reverse may be true. Health care expectations – the wings of individual patients and independent doctors – may continue to cause the tornado in Washington.

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform (IUniverse.com) is available at amazon.com, barnesandnoble.com, and booksamillion.com for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.

26 comments:

Anonymous said...

I enjoy flick as well as the earrings! Please store them coming.

I love to see how some others create what they have to do.
..very inspiring!

Here is my website: pasociallife.com

Anonymous said...

Your post, Teknogeekz; High Innovation Solutions, Puerto Vallarta and the world & raquo; Blog site
Store & raquo; Xerox Phaser 6125N Cross Platform Color Laser Printer,
is truly well written and insightful. Glad I located
your web site, cozy pertains to!

My homepage - xerox phaser 8560mfp

Anonymous said...

It's an amazing piece of writing for all the web people; they will take advantage from it I am sure.

Feel free to surf to my web site: as explained here

Anonymous said...

Hi there, just become aware of your weblog via Google, and found that it's really informative. I am going to be careful for brussels. I'll be grateful for
those who proceed this in future. Lots of folks will probably be benefited
from your writing. Cheers!

Look at my website :: property

Anonymous said...

In fact when someone doesn't understand after that its up to other visitors that they will help, so here it happens.

my webpage ... Magellansportswear.Com

Anonymous said...

Wow, awesome weblog layout! How long have you ever been blogging for?
you make running a blog look easy. The whole look of your web site
is excellent, let alone the content!

Here is my weblog; Private Cloud Computing

Anonymous said...

Appreciate the recommendation. Will try it out.


Check out my web blog xerox 8560 maintenance kit

Anonymous said...

hp laserjet 1020 drivers supports Windows 2000, Windows XP, Vista and windows7(House & Specialist).

The HP 1020 LaserJet is an excellent.

Feel free to surf to my website: xerox phaser 8560n

Anonymous said...

Thank you a bunch for sharing this with all of us you really know what you are talking about!
Bookmarked. Please additionally consult with my web site =).
We can have a link alternate agreement between us

Also visit my site xerox 8560 toner

Anonymous said...

really fascinating, many thanks a lot!

Feel free to visit my website xerox phaser 8560 ram error

Anonymous said...

Truly no matter if someone doesn't understand after that its up to other viewers that they will help, so here it happens.

my web page; xerox 8560 error codes

Anonymous said...

Very nice article. I absolutely love this website.
Thanks!

Feel free to visit my webpage ... xerox 8560 manual

Anonymous said...

I think the admin of this web site is genuinely working hard in support of his website, since here every
data is quality based information.

My blog hultquist-copenhagen.Com

Anonymous said...

Hi there, just became aware of your blog through Google, and found that it is really informative.

I am going to watch out for brussels. I will be grateful if you continue this in future.
Many people will be benefited from your writing.
Cheers!

Here is my blog; xerox 8560 maintenance kit

Unknown said...
This comment has been removed by the author.
Anonymous said...

His backseat indiscretion was a setup, he claimed, and the young lady
with whom the attorney was caught with his
pants down proved her adulthood with a valid North Carolina driver's license.
Because switches commit and dedicate connections between computers, packets might not be found.

More ever, you are able to skip who you're not
interested in.

Here is my site ... comment pirater un Compte Facebook

Anonymous said...

Bursting Badis an American tv drama series created and produced by Vince Gilligan. I just got a brand new
Macbook and I want to place anything on my iPad into it.
Have you been experiencing divorce at present?

Here is my website ... movie2k, ,

Anonymous said...

You owe it to your health and to yourself to check out this life changing healthy diet.
Close to all processed meals bought from supermarkets have items which outcome in excess unwanted fat.
Grapefruit is number one fruit that speeds up your metabolism.


Feel free to surf to my blog post: recetas para adelgazar - -

Anonymous said...

Asigurați-vă că numele site-ului dvs. le spune oamenilor ceea ce vor găsi pe
site-ul tău .
Cineva caută pe internet pentru moduri de a pieței pentru gratuit .


Take a look at my webpage :: cele mai bune servicii seo sydney

Unknown said...

obat kencing nanah alami obat kencing nanah atau gonore obat kutil di area vagina

Unknown said...

gejala penyakit herpes kelamin ciri ciri herpes kelamin obat herpes kelamin herpes kelamin herpes kelamin herpes di sekitar kemaluan cara menghilangkan mengobati herpes kelamin cara mengobati herpes kelamin

Unknown said...

gejala penyakit herpes kelamin ciri ciri herpes kelamin obat herpes kelamin herpes kelamin herpes kelamin herpes di sekitar kemaluan cara menghilangkan mengobati herpes kelamin cara mengobati herpes kelamin

Unknown said...

cara mengatasi kutil kelamin secara dan cara menghilangkan kutil di sekitar dan cara menghilangkan kutil kelamin dan cara menghilangkan kutil pada kemaluan dan cara mengobati kutil di kemaluan dan cara mengobati kutil pada kelamin dan cara mengatasi mengobati kemaluan dan mengapa muncul bintik kutil pada kelamin dan mengobati mengatasi kutil pada kemaluan dan merontokkan mengobati kutil kelamin merupakan solusi pengobatan herbal dari denature indonesia

Unknown said...

obat cina ambeien yang ampuh atasi wasir secara alami obat wasir berdarah di apotik obat untuk kemaluan pria keluar nanah di sertai perih saat kencing obat kencing perih dan bernanah kenapa dari kemaluan wanita mengeluarkan nanah obat alat kelamin keluar nanah obat kemaluan keluar nanah obat cairan nanah keluar dari kemaluan mengapa kemaluan keluar nanah cara mengobati kemaluan keluar nanah obat kemaluan keluar nanah ujung kemaluan keluar nanah obat penis keluar nanah kelamin pria keluar nanah obat kelamin pria keluar nanah obat kelamin pria keluar cairan nanah mengapa alat kelamin keluar nanah kemaluan laki laki keluar nanah kemaluan keluar nanah kemaluan keluar cairan nanah mengapa kemaluan keluar nanah cairan nanah keluar dari kemaluan kencing perih dan keluar cairan nanah cairan nanah keluar dari kemaluan pria

Unknown said...

obat cina ambeien yang ampuh atasi wasir secara alami obat wasir berdarah di apotik obat untuk kemaluan pria keluar nanah di sertai perih saat kencing obat kencing perih dan bernanah kenapa dari kemaluan wanita mengeluarkan nanah obat alat kelamin keluar nanah obat kemaluan keluar nanah obat cairan nanah keluar dari kemaluan mengapa kemaluan keluar nanah cara mengobati kemaluan keluar nanah obat kemaluan keluar nanah ujung kemaluan keluar nanah obat penis keluar nanah kelamin pria keluar nanah obat kelamin pria keluar nanah obat kelamin pria keluar cairan nanah mengapa alat kelamin keluar nanah kemaluan laki laki keluar nanah kemaluan keluar nanah kemaluan keluar cairan nanah mengapa kemaluan keluar nanah cairan nanah keluar dari kemaluan kencing perih dan keluar cairan nanah cairan nanah keluar dari kemaluan pria

najwa said...

Menghilangkan Kutil Di KelaminJika penyakit ini terus dibiarkan maka gejala juga akan terasa menyakitkan. Mengenai proses munculnya, kutil pada pria ini bisa hadir dalam bentuk datar atau berukuran besar dan berkelompok. Ciri yang paling umum dari kutil kelamin ini adalah bentuknya yang menyerupai kembang kol. untuk cara pemesanana silahkan kunjungsite kami

obat kelamin keluar nanahDan kondisi ini dapat semakin parah dan kemudian menimbulkan berbagai macam komplikasi seperti peradangan sendi dan infeksi jantung. Hal yang seperti ini dapat dicegah dengan mengenali gejala awalnya, sehingga penyakit ini tidak bertambah parah. untuk cara pemesanana silahkan kunjungartikel kami

Mengobati Kutil Pada Kelaminentu saja kita agak seram membayangkan hal ini jika terjadi pada kita, tapi setidaknya cara ini memang terbaik karena dilakuka dengan bersih dan efisien. untuk cara pemesanana silahkan kunjungartikel ini

Obat Kutil Di Kemaluan WanitaHal inilah yang menjadi penyebab kenapa akhirnya banyak penderita yang mencoba berbagai solusi pengobatan herbal dan semacamnya. untuk cara pemesanana silahkan kunjungklik disin

Artikel Lain


http://www.obatherbalkanker.ml/2016/02/obat-alami-kutil-di-kelamin.html