extent of alcohol abuse and addiction. SAMHSA (Substance Abuse and Mental Health Services) estimates that 5% primary care physicians’ patients are addicted to alcohol. The Columbia report indicated that it believes that the extent of medical problems caused by alcohol dependency and abuse is greatly underestimated and costs much more than reported. Hence many chronic diseases such as depression or heart problems have their root in alcohol consumption or covary with the amount of alcohol consumed. If primary care physicians would screen for this substance as they do for tobacco, much progress could be made in improving the general health of the public. One need only ask along with tobacco questions “How much did you consume the last time you drank alcohol?” and “How many times have you consumed alcohol in tI do not claim that I have already succeeded or have already become perfect! I like that quote from Philippians. It is a very accurate reflection of the principles of quality improvement—always try to provide a better product or a better service. Learn from the data of the past but keep your eye on the better future.

There are so many areas that can be improved in healthcare because it is so complex. Let me illustrate three representative situations, though. Perhaps they will trigger an idea in your mind where you might want to begin a new project or improve on one you have already begun.

--Collaborate more closely with the patient. In the Institute of Medicine’s “Crossing the Quality Chasm” there are several illustrations of this. It suggests that doctors should interact with patients not only in one to one settings but also electronically, as by email or in small group settings. Instructing patients about healthy diets could probably be best accomplished in small group settings with a dietician or other trained staff. Test results could easily be emailed. Another suggestion is to give the patient more information to better let them make choices. For instance, the patient should certainly know the side effects of a drug you as a doctor might suggest as well as available alternative medication. This attention to the customer (patient) is a reflection of the best practices in the competitive retail market. I believe this approach will become more important in healthcare as quality and pricing become more transparent. On August 22 President Bush signed an order instructing all federal agencies that provide health coverage—Medicare, Medicaid and other agencies—to disclose the quality and cost of care provided to beneficiaries.

--Staffs should collaborate more effectively. There should be continuous communication among all staff. I do not only mean that the physicians and nurses should have better communication. Everyone on staff is important, even personnel who provide cleaning services. I recently read that the source of high levels of catheter infections in an ICU was traced to bacteria in a paper towel dispenser in a bathroom at one hospital. This just shows that efforts to contain such infections are important at all levels.

Recently on the iSixSigma website there was an illustration of a project by representatives of staffs from discharge, nursing and physicians to cut down the time of patient discharge. The time was measured from order entry to discharge until the patient left the hospital. The baseline data had a mean of 184.8 minutes. The mean time after process improvement was 47.8 minutes. Everyone benefited from this marked improvement—the hospital, the staff and the patients. The title of the article is “Creating a Lean Six Sigma Hospital Discharge Process.” It is a very good sample of staff collaboration.

--Improve in diagnosis. One of the most commonly missed diseases is alcoholism. In a study done by the Center on Addiction and Substance Abuse done by Columbia University it was reported that 25% of the cost of Medicare is due to abuse of tobacco, alcohol and other substances. While most doctors know their patients’ use of tobacco products very few are aware of the extent of alcohol abuse and addiction. SAMHSA (Substance Abuse and Mental Health Services) estimates that 5% primary care physicians’ patients are addicted to alcohol. The Columbia report indicated that it believes that the extent of medical problems caused by alcohol dependency and abuse is greatly underestimated and costs much more than reported. Hence many chronic diseases such as depression or heart problems have their root in alcohol consumption or covary with the amount of alcohol consumed. If primary care physicians would screen for this substance as they do for tobacco, much progress could be made in improving the general health of the public. One need only ask along with tobacco questions “How much did you consume the last time you drank alcohol?” and “How many times have you consumed alcohol in th

y in one to one settings but also electronically, as by email or in small group settings. Instructing patients about healthy diets could probably be best accomplished in small group settings with a dietician or other trained staff. Test results could easily be emailed. Another suggestion is to give the patient more information to better let them make choices. For instance, the patient should certainly know the side effects of a drug you as a doctor might suggest as well as available alternative medication. This attention to the customer (patient) is a reflection of the best practices in the competitive retail market. I believe this approach will become more important in healthcare as quality and pricing become more transparent. On August 22 President Bush signed an order instructing all federal agencies that provide health coverage—Medicare, Medicaid and other agencies—to disclose the quality and cost of care provided to beneficiaries.

--Staffs should collaborate more effectively. There should be continuous communication among all staff. I do not only mean that the physicians and nurses should have better communication. Everyone on staff is important, even personnel who provide cleaning services. I recently read that the source of high levels of catheter infections in an ICU was traced to bacteria in a paper towel dispenser in a bathroom at one hospital. This just shows that efforts to contain such infections are important at all levels.

Recently on the iSixSigma website there was an illustration of a project by representatives of staffs from discharge, nursing and physicians to cut down the time of patient discharge. The time was measured from order entry to discharge until the patient left the hospital. The baseline data had a mean of 184.8 minutes. The mean time after process improvement was 47.8 minutes. Everyone benefited from this marked improvement—the hospital, the staff and the patients. The title of the article is “Creating a Lean Six Sigma Hospital Discharge Process.” It is a very good sample of staff collaboration.

--Improve in diagnosis. One of the most commonly missed diseases is alcoholism. In a study done by the Center on Addiction and Substance Abuse done by Columbia University it was reported that 25% of the cost of Medicare is due to abuse of tobacco, alcohol and other substances. While most doctors know their patients’ use of tobacco products very few are aware of the extent of alcohol abuse and addiction. SAMHSA (Substance Abuse and Mental Health Services) estimates that 5% primary care physicians’ patients are addicted to alcohol. The Columbia report indicated that it believes that the extent of medical problems caused by alcohol dependency and abuse is greatly underestimated and costs much more than reported. Hence many chronic diseases such as depression or heart problems have their root in alcohol consumption or covary with the amount of alcohol consumed. If primary care physicians would screen for this substance as they do for tobacco, much progress could be made in improving the general health of the public. One need only ask along with tobacco questions “How much did you consume the last time you drank alcohol?” and “How many times have you consumed alcohol in t

hat provide health coverage—Medicare, Medicaid and other agencies—to disclose the quality and cost of care provided to beneficiaries.

--Staffs should collaborate more effectively. There should be continuous communication among all staff. I do not only mean that the physicians and nurses should have better communication. Everyone on staff is important, even personnel who provide cleaning services. I recently read that the source of high levels of catheter infections in an ICU was traced to bacteria in a paper towel dispenser in a bathroom at one hospital. This just shows that efforts to contain such infections are important at all levels.

Recently on the iSixSigma website there was an illustration of a project by representatives of staffs from discharge, nursing and physicians to cut down the time of patient discharge. The time was measured from order entry to discharge until the patient left the hospital. The baseline data had a mean of 184.8 minutes. The mean time after process improvement was 47.8 minutes. Everyone benefited from this marked improvement—the hospital, the staff and the patients. The title of the article is “Creating a Lean Six Sigma Hospital Discharge Process.” It is a very good sample of staff collaboration.

--Improve in diagnosis. One of the most commonly missed diseases is alcoholism. In a study done by the Center on Addiction and Substance Abuse done by Columbia University it was reported that 25% of the cost of Medicare is due to abuse of tobacco, alcohol and other substances. While most doctors know their patients’ use of tobacco products very few are aware of the extent of alcohol abuse and addiction. SAMHSA (Substance Abuse and Mental Health Services) estimates that 5% primary care physicians’ patients are addicted to alcohol. The Columbia report indicated that it believes that the extent of medical problems caused by alcohol dependency and abuse is greatly underestimated and costs much more than reported. Hence many chronic diseases such as depression or heart problems have their root in alcohol consumption or covary with the amount of alcohol consumed. If primary care physicians would screen for this substance as they do for tobacco, much progress could be made in improving the general health of the public. One need only ask along with tobacco questions “How much did you consume the last time you drank alcohol?” and “How many times have you consumed alcohol in t

e of patient discharge. The time was measured from order entry to discharge until the patient left the hospital. The baseline data had a mean of 184.8 minutes. The mean time after process improvement was 47.8 minutes. Everyone benefited from this marked improvement—the hospital, the staff and the patients. The title of the article is “Creating a Lean Six Sigma Hospital Discharge Process.” It is a very good sample of staff collaboration.

--Improve in diagnosis. One of the most commonly missed diseases is alcoholism. In a study done by the Center on Addiction and Substance Abuse done by Columbia University it was reported that 25% of the cost of Medicare is due to abuse of tobacco, alcohol and other substances. While most doctors know their patients’ use of tobacco products very few are aware of the extent of alcohol abuse and addiction. SAMHSA (Substance Abuse and Mental Health Services) estimates that 5% primary care physicians’ patients are addicted to alcohol. The Columbia report indicated that it believes that the extent of medical problems caused by alcohol dependency and abuse is greatly underestimated and costs much more than reported. Hence many chronic diseases such as depression or heart problems have their root in alcohol consumption or covary with the amount of alcohol consumed. If primary care physicians would screen for this substance as they do for tobacco, much progress could be made in improving the general health of the public. One need only ask along with tobacco questions “How much did you consume the last time you drank alcohol?” and “How many times have you consumed alcohol in t

extent of alcohol abuse and addiction. SAMHSA (Substance Abuse and Mental Health Services) estimates that 5% primary care physicians’ patients are addicted to alcohol. The Columbia report indicated that it believes that the extent of medical problems caused by alcohol dependency and abuse is greatly underestimated and costs much more than reported. Hence many chronic diseases such as depression or heart problems have their root in alcohol consumption or covary with the amount of alcohol consumed. If primary care physicians would screen for this substance as they do for tobacco, much progress could be made in improving the general health of the public. One need only ask along with tobacco questions “How much did you consume the last time you drank alcohol?” and “How many times have you consumed alcohol in the past two weeks?” If there is suspicion of alcohol problems, the physician could then give one of several easily administered screening questionnaires, as the CAGE test.

I hope that these short illustrations have stimulated you to think about possible improvements at your healthcare site. The task of improvement will never be done but it is ever so rewarding in both money saved and earned, time saved, satisfaction of the staff, and benefit to the patient.