ࡱ> N$( '@/ 00DArialBlackmantt9 0DTimes New Romantt9 0 DWingdingsRomantt9 00DArial Blackmantt9 0"@ .  @n?" dd@  @@`` x cr /<JLOPQRSTUVWXYZ[\]^_`a 0AA@87? ʚ;ʚ;g4ededtj 0ppp@ <4dddd@w 0tl9 <4dddd@x 0tg4KdKd l 0p@ pp80___PPT10 O  =$4Improving Criteria for Allocating Capital Resources $53,$O Paul B. Hofmann, DrPH, FACHE Hofmann Healthcare Group Moraga, California, USA.OOC9'Myths and Realities of U.S. Healthcare (((Extraordinary spending on healthcare does not produce uniformly excellent healthcare U.S. will spend 17.6% of GDP this year, twice as much as most so-called developed countries 28th in life expectancy 29th in infant mortality Only moderately effective disease care non-system U.S. learning to do some things better  not perfectly Creating healthier communities Improving disease prevention and clinical outcomes Decreasing medical errors Reducing racial and cultural disparities Delivering patient-centered care (timely, convenient, respectful) Making more judicial use of technologies UZZ8ZZZU^  G8UA+More Capital Resources Not Always a Panacea,,Medical care `" health Ability to develop new technology exceeding wisdom to apply it wisely Can treat too much and care too little Must avoid doing too much to patients and too little for patientsN       3*>Classic Issues Affecting Capital Resource Allocation Decisions??(bRequest and urgency almost always exceed funding and implementation capability Need and justification frequently exaggerated Acquisition obstacles and problems minimized Operating costs often under-estimated Unanticipated and/or unintended consequences of project rarely recognized Audits to assess validity of original assertions infrequently performedcZcB87Financial and Non-Financial Criteria Must be Emphasized88(Financial criteria properly focus on conventional cost-benefit analysis Non-financial criteria include: Relation to organization s mission Implications for meeting needs of community, patients, staff and others Contribution to improved productivity, safety, access, clinical outcomes and health status Compliance with legal, licensing, regulatory and similar requirements*hZ Zh D:PUse of Ethical Principles to Make More Appropriate Resource Allocation DecisionsQQ(Competing and equally compelling projects require additional analytical review Decisions must be not only economically justified but also morally defensible E;$Relevance of Four Ethical Principles%%/Beneficence Nonmaleficence Fidelity Justice /0F< Beneficence  LActing with charity and kindness Promote actions that benefit others Take active advocacy role versus passive position Relevance  be diligent in quantifying valueZG=Nonmaleficence Avoid doing harm Prevent decisions that compromise organization or staff Remain sensitive to actual or potential conflicts of interest and refuse to permit them Relevance  be ethically conscious and courageous in resisting political pressuresZH> Fidelity   (Meet prior obligations and commitments Support allocation decisions most aligned with organization s mission and values Give appropriate consideration to inelegant but worthy capital requests Relevance  meet reasonable expectations for funding and explain disapprovals ZI?JusticeAct with fairness and impartiality Establish open and objective decision-making process with clear criteria Consider legacy of previous inequities Relevance - demonstrate consistency in following rational process PT@Concluding ObservationsCompromises unavoidable Balancing competing priorities rarely easy Executive trust and integrity enhanced or diminished by both process and outcome /JKLMNOPQRS J  0` fff33` 3KI3ff` 33ff` /p` 3%*3|` Jy3fff3f` 3ff3̙` 33ff33` DDyq3f` ̙3n` w3ff` }ff>?" dd@,?nKd@ P nA@F`d n?" dd@   @@``PR"   @ ` `2p>> n f P (    6 #" ``   Z*   6 #" `` `  \* T X  "X  Nd#" `P D0   6Ld#" `U B0   S "UY <   c $"YW <    c $"YU <    c $`" <    S ̹#" `SV B0    S "Y <    c $"X <   <Ó #" `  `  T Click to edit Master title style! !$  0xœ " `p  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  6˓ #" `^ `  X* H  0޽h ? }ff80___PPT10. 07  Pixel  0 }`(  : T   "  T8UXd #"   D0   c $X "9)e  B0 6b e  # "e   S X"ie  B0   S ĉX"9) B0   S  ; 0 n f p(  pX p C    f p S  0    The Use and Misuse of Incentives is another article you should have, so I won t elaborate on these observations except to note that we should be exquisitely sensitive to the possibility that well-intended incentives can produce unexpected and undesirable consequences. I should also note here that disclosure is never easy. Last month, the Minneapolis Star Tribune published an article titled,  Minnesota Hospitals Strive for Safety, But Errors Still Increasing. In spite of efforts to make Minnesota hospitals safer, the reporter wrote, the number of deaths & injuries from errors or accidents rose again last year, according to a report released by the MN Dept. of Health. The Health Commissioner said that changing the attitudes among hospital staff has proved harder than adding new safety procedures. However, hospital officials replied that the rising numbers are likely the result of better reporting and an increasingly open culture about acknowledging mistakes.@X<H p 0޽h ? 3380___PPT10.-PN> < 0   tN (  tX t C      t S  Ї @   P  A couple years ago, I asked a physician if he would co-author an article with me for the Hastings Center Report to be titled,  Physicians Should Not Always Pursue Good  Clinical Outcomes. Cardiologists, pulmonologists, and nephrologists can take legitimate pride in preserving organ function but someone must take responsibility for assessing the whole patient, not just an organ s viability. (Can we afford to provide unlimited care? YES!) When we do too much to patients and too little for patients, when we treat too much and care too little, patients risk becoming the victims rather than the beneficiaries of technology. Quality initiatives related to end-of-life issues can be among most challenging and also most satisfying of all hospital performance improvement programs. This past Wednesday, after making ethics rounds in the ICU of a local hospital, I met with its Bioethics Committee to report on 21 telephone interviews I conducted with the next of kin of patients who had died in the ICU during a four month period after a minimum stay of three days. By asking only five questions of relatives, we obtained very helpful feedback about end of life care & services which are too rarely evaluated as part of quality improvement programs.lH t 0޽h ? 3380___PPT10.-p = 0 . & x (  xX x C    &  x S   0   6The value of practicing evidence-based medicine is indisputable, so why haven t we witnessed the benefits of evidence-based mgt? Is it because we don t have evidence-based mgt? When we delay in learning from each other and promoting best mgt practices that affect the quality of patient care, we are  on a daily basis  implicitly compromising patients, families and staff. Throughout the country, there are institutions achieving success in: Reducing the incidence of  never events, Preventing disruptive behavior among staff members to avoid endangering patients and damaging staff morale, and Achieving progress in other vital areas by implementing innovative programs that should be replicated by other organizations. In a February 6 NYT column, Dr. Pauline Chen wrote a column titled,  When Doctors and Nurses Can t Do the Right Thing. She talked about the cost of  moral distress and a study )published in the July 2008 issue of the Journal of Advance Nursing) that reported moral distress was the reason 15% of nurses left their job.nZKH x 0޽h ? 3380___PPT10.-@> 0 H@|(  |X | C    R@ | S  0  R I suspect most of you are familiar with Trinity Health as the nation s 4th largest Catholic health system led by Joe Swedish. I have highlighted two sentences in this eloquent set of comments by the organization s Chief HR Officer, but knowing Joe, I am confident he say their mission imperative of quality is a work in progress.*KH H | 0޽h ? 3380___PPT10.-T? 0 d(  X  C    R  S  0   f6Although I have not been the CEO of a Catholic hospital or health system, I have had the privilege of working with Catholic facilities. I have also made site visits on behalf of the AHA for the Circle of Life award that recognizes innovative end of life and palliative care programs and the Quest for Quality Prize, so I have first-hand knowledge of the respect and high esteem you have legitimately earned. Other faith-based healthcare institutions, as well as those that are not faith-based, expect Catholic hospitals to create and sustain organizational cultures that are national models for innovation in quality improvement programs Given her background, experience and role, Sister Doris is exceptionally qualified to discuss the mission leader s role in creating a culture of quality.H  0޽h ? 3380___PPT10.-r@V$5oO'D3U@JB@+XQWZ\^`3c_eiit|/Mը[gSU1Oh+'0 hp   Slide 1County of San MateoPixel*68Microsoft Office PowerPoint@QU@0OcD3@kqêGg   1  y--$xx--'---$xx----$xx----$xx----$xx----$xx----$x x ----$ x x ----$ x x ----$ x x ----$ xx ----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$xx----$x x ----$ x!x! ----$!!x"x"!----$""x#x#"----$##x$x$#----$$$x%x%$----$%%x&x&%----$&&x'x'&----$''x(x('----$((x)x)(----$))x*x*)----$**x+x+*----$++x,x,+----$,,x-x-,----$--x.x.-----$..x/x/.----$//x1x1/----$11x2x21----$22x3x32----$33x4x43----$44x7x74----$77x;x;7----$;;x>x>;---'}--$II--'--$ > II> >--'--$((((--'--$''22'--'}--$>II>>--'--$''(2(2'--'--$(33((--'}--$(3 3 ((--'--$(3(3(((--'--$ 3 >>3 3--'--$3>>33--'@Arial-. *2 +6Improving Criteria for  ."SystemX-@Arial-. $2 7?Allocating Capital f.-@Arial-. 2 CO Resources.-@Arial-. 12 V@Paul B. Hofmann, DrPH, FACHE.-@Arial-. -2 ]EHofmann Healthcare Group C.-@Arial-. *2 eIMoraga, California, USA.-՜.+,0    $ ^On-screen ShowSan Mateo Medical Centerc   ArialTimes New Roman Wingdings Arial BlackPixel5Improving Criteria for Allocating Capital Resources (Myths and Realities of U.S. Healthcare ,More Capital Resources Not Always a Panacea?Classic Issues Affecting Capital Resource Allocation Decisions8Financial and Non-Financial Criteria Must be EmphasizedQUse of Ethical Principles to Make More Appropriate Resource Allocation Decisions%Relevance of Four Ethical Principles BeneficenceNonmaleficence Fidelity JusticeConcluding Observations  Fonts UsedDesign Template Slide Titles _?a**  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`bcdefghijklmnpqrstuvxyz{|}~Root EntrydO)Current UserwSummaryInformation(aPowerPoint Document(cDocumentSummaryInformation8o