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Thomas H. Lee

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How to develop healthcare teams with grit

In an NEJM Catalyst video and text piece, Thomas H. Lee discusses the need for health-care teams with “grit” in today’s every more complex healthcare environment.

Lee describes four key elements of what it means for a group or an organization to behave like a gritty individual. The text below is from NEJM:

Have a goal hierarchy:

“In a goal hierarchy, the lowest-level tasks are akin to daily to-do lists, with things like going through one’s inbox on the electronic medical record, answering pages, and sending in prescriptions. ‘Those are tasks that if that was the only thing I focused, on I’d have a burnout issue,’ says Lee.”

“Middle-level goal tasks are designed to help clinicians accomplish things like coordinated care and preventing complications for patients by addressing their current symptoms.”

A Growth Mindset

“‘A growth mindset is the idea that you can get better and change — even if you are already the best. ‘That drive for improvement, that restlessness with the status quo, that is part of grit,’ says Lee.”

Two Types of Resilience

“One type of resilience is the willingness and the ability to bounce back from setbacks, acknowledging that things didn’t go right and trying to learn from the experience and be better as a result.”

“A second type of resilience is the flexibility to deal with the unexpected. When taking care of patients, the unexpected happens all the time — unexpected medical conditions or other circumstances. ”

Identification with Growth

“Individuals must feel pride in being part of the Parkinson’s team or the cancer team, and pride in being part of their institution. ‘That has to be something that motivates them, gives them pride, makes them feel better about themselves,” Lee says, ‘so that when the inevitable stresses of the unpredictable come along, they’re ready to shoulder them and not fall apart.”’

“‘These elements of a gritty team are essential competitive differentiators for health care organizations that are going to thrive in the marketplace that lies ahead,’ he adds. Grit is strategic and will help organizations thrive in the face of competition.”

To access the piece, please hit this link.


The great potential of improving nonvisit care

They write in NEJM Catalyst that “Face-to-face interactions will certainly always have a central role in healthcare, and many patients prefer to see their physician in person. But a system focused on high-quality nonvisit care would work better for many others — and quite possibly for physicians as well. Virtually all physicians already use nonvisit interactions to some extent, but their improvised approaches could be vastly improved if health systems were designed with such care as the explicit goal.”

To read their essay, please hit this link.



The perils of picking the wrong hospital


The New York Times summarized the findings of an important and alarming new comprehensive study:

“Researchers have found that patients at the worst American hospitals were three times more likely to die and 13 times more likely to have medical complications than if they visited one of the best hospitals.”

The study,  in the academic journal PLOS One, shows “there is considerable variation in outcomes that really matter to patients, from hospital to hospital, as well as region to region,” Dr. Thomas H. Lee, M.D., a longtime healthcare executive not involved in the research, told The Times.

The Times reported that “The study’s authors looked at 22 million hospital admissions, including information from both the federal Medicare program and private insurance companies, and analyzed them using two dozen measures of medical outcomes. Adjusting the results for how sick the patients were and other factors, like age and income, the researchers discovered widespread differences among hospitals. Even a hospital that had excellent outcomes for heart care might have poor outcomes in treating diabetes.”

To read the study, please hit this link.

To read The New York Time’s article on it, please this link.

Trying to identify a ‘good’ hospital merger isn’t easy


Leemore S. Dafny, Ph.D., and Thomas H. Lee, M.D., writing for the New England Journal of Medicine, look at the difference between good and bad hospital mergers.

“A ‘good’ merger or affiliation is one that increases the value of healthcare by reducing costs, improving outcomes, or both, thereby enabling providers to generate and respond to competition. The all-too-common alternative is a merger intended to reduce competition — to ensure referral streams (which would otherwise be earned through superior offerings) or to help providers negotiate higher prices and thereby avoid the difficult work of improving outcomes and efficiency.”

“Although regulators can sometimes stop a ‘bad’ merger, they cannot create a good one,” they note.

“The harsh reality is that it’s difficult to find well-documented examples of mergers that have generated measurably better outcomes or lower overall costs — the greater value that is publicly touted as the motivation underlying these combinations. The most consistently documented result of provider mergers is higher prices, particularly when the merging hospitals are in close proximity. Providers’ hopes for improving value by consolidating and then integrating care within merged entities remain objectives rather than accomplishments in most organizations.”




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