“We don’t have the time or money for CQI right now.”
Like Marie Antoinette, Rasputin, Lord Kelvin, Neville Chamberlain, Decca Records*, and notable others through history,…….let’s not be exactly wrong.
In these moments of Sturm and Drang, budget constraints, fatigue, overwork, much of it COVID-related,…….the inherent proficiency of CQI is more apparent than ever.
Wu Wei (Action by Non-action) – a seminal observation from the 2500 year-old Tao Te Ching, is exactly right for modern healthcare. The most effective CQI projects to create are de-implementation, i.e., Choosing Wisely initiatives that reduce or eliminate wasteful, ineffective diagnostic tests and therapies. Every department/unit/clinic should have a consensus-derived list of 5-10 items to reduce, if not eliminate, then track metrics and feed back to staff for input and adjustment.
Attached is a fine Choosing Wisely list from the Hospital for Sick Children in Toronto,……and a concise why and how explanation. De-implementation is both a process and an outcome, it saves your time and others’ money by eliminating non-EBM, anxiety-provoking, expensive procedures,……frees up precious energy for the “vital few”,……and allows you to focus your passion on what your patients and families actually need for well-being. Outpatient pediatrics, hospital pediatrics, obstetrics, perinatology, and most specialties have Choosing Wisely lists online for consideration…….
The second article debates the pro’s and con’s of universal newborn whole genome sequencing. Is WGS necessary on a population basis? Will it be truly valuable (health benefits gained divided by resources consumed) and fair? Should an OB/Newborn unit devote finite resources to universal WGS or universal breast-feeding support? Single family room NICU remodels or free prenatal and well-baby care?
If this, then that. If not this, then not that. The determinism of karma.
* British record company dismisses four lads from Liverpool in January 1962 remarking “Guitar groups are on their way out.”
Joe Kaempf, MD
Oregon Representative
Portland, OR
Volume 13, Number 34