According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61729-2.pdf

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

https://flore.unifi.it/bitstream/2158/1072092/1/GBD%20Lancet%202015.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

As GDP is a measure of market capacity and not economic well-being, this report has been commissioned to more accurately understand the social progress indicators of any given state. Gross domestic product (GDP) is the most widely used measure of economic activity. There are international standards for its calculation, and much thought has gone into its statistical and conceptual bases. But GDP mainly measures market production, though it has often been treated as if it were a measure of economic well-being. Conflating the two can lead to misleading indications about how well-off people are and entail the wrong policy decisions. One reason why money measures of economic performance and living standards have come to play such an important role in our societies is that the monetary valuation of goods and services makes it easy to add up quantities of a very different nature. When we know the prices of apple juice and DVD players, we can add up their values and make statements about production and consumption in a single figure. But market prices are more than an accounting device. Economic theory tells us that when markets are functioning properly, the ratio of one market price to another is reflective of the relative appreciation of the two products by those who purchase them. Moreover, GDP captures all final goods in the economy, whether they are consumed by households, firms or government. Valuing them with their prices would thus seem to be a good way of capturing, in a single number, how well-off society is at a particular moment. Furthermore, keeping prices unchanged while observing how quantities of goods and services that enter GDP move over time would seem like a reasonable way of making a statement about how society’s living standards are evolving in real terms. As it turns out, things are more complicated. First, prices may not exist for some goods and services (if for instance government provides free health insurance or if households are engaged in child care), raising the question of how these services should be valued. Second, even where there are market prices, they may deviate from society’s underlying valuation. In particular, when the consumption or production of particular products affects society as a whole, the price that individuals pay for those products will differ from their value to society at large. Environmental damage caused by production or consumption activities that is not reflected in market prices is a well-known example.

https://andrewoswald.com/docs/stiglitz20report_commission20final20200920sept.pdf

Report by the commission on the measurement of economic performance and social progress

Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read "60 mg"instead of "60 mg (use with caution in 'supranormal' renal function)."In the above-indicated cell, a footnote has also been added to state: "Edoxaban should be used in patients with high creatinine clearance only after a careful evaluation of the individual thromboembolic and bleeding risk."Supplementary Table 9, column 'Edoxaban', row 'Dose reduction in selected patients' (page 16). The cell should read "Edoxaban 60 mg reduced to 30 mg once daily if any of the following: creatinine clearance 15-50 mL/min, body weight <60 kg, concomitant use of dronedarone, erythromycin, ciclosporine or ketokonazole"instead of "Edoxaban 60 mg reduced to 30 mg once daily, and edoxaban 30 mg reduced to 15mg once daily, if any of the following: creatinine clearance of 30-50 mL/min, body weight <60 kg, concomitant us of verapamil or quinidine or dronedarone."

/pdf/2020-esc-guidelines-for-the-diagnosis-and-management-of-38dpic1xu8.pdf

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).

To improve perioperative patient safety, guidelines for the preoperative, peroperative, and postoperative phase were introduced in the Netherlands between 2010 and 2013. To help the implementation of these guidelines, we aimed to get a better understanding of the barriers and drivers of perioperative guideline adherence and to explore what can be learned for future implementation projects in complex organizations. We developed a questionnaire survey based on the theoretical framework of Van Sluisveld et al. for classifying barriers and facilitators. The questionnaire contained 57 statements derived from (a) an instrument for measuring determinants of innovations by the Dutch Organization for Applied Scientific Research, (b) interviews with quality and safety policy officers and perioperative professionals, and (c) a publication of Cabana et al. The target group consisted of 232 perioperative professionals in nine hospitals. In addition to rating the statements on a five-point Likert scale (which were classified into the seven categories of the framework: factors relating to the intervention, society, implementation, organization, professional, patients, and social factors), respondents were invited to rank their three most important barriers in a separate, extra open-ended question. Ninety-five professionals (41%) completed the questionnaire. Fifteen statements (26%) were considered to be barriers, relating to social factors (N = 5), the organization (N = 4), the professional (N = 4), the patient (N = 1), and the intervention (N = 1). An integrated information system was considered an important facilitator (70.4%) as well as audit and feedback (41.8%). The Barriers Top-3 question resulted in 75 different barriers in nearly all categories. The most frequently reported barriers were as follows: time pressure (16% of the total number of barriers), emergency patients (8%), inefficient IT structure (4%), and workload (3%). We identified a wide range of barriers that are believed to hinder the use of the perioperative safety guidelines, while an integrated information system and local data collection and feedback will also be necessary to engage perioperative teams. These barriers need to be locally prioritized and addressed by tailored implementation strategies. These results may also be of relevance for guideline implementation in general in complex organizations. Dutch Trial Registry: NTR3568
 .

/pdf/reducing-work-pressure-and-it-problems-and-facilitating-it-xu6xqlrwna.pdf

Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals

OBJECTIVE To analyse the variation in the registration of hospital admissions across Dutch hospitals and determine how this variation affects the Hospital Standardised Mortality Rate (HSMR). DESIGN Retrospective, descriptive. METHOD We used data from the National Medical Registration (LMR), covering the records of all hospital admissions in 2005 in Dutch hospitals, to analyse the variation between hospitals in 3 variables: the number of secondary diagnoses, the percentage of unplanned admissions, and the percentage of non-specified diagnoses ('other diagnoses'). The impact of this variation on the HSMR was analysed by calculating the correlation between the HSMR and each of the variables. The correlation between the original HSMR and the HSMR without adjustment for these variables was also calculated. RESULTS The variation in the percentages of unplanned admissions and admissions with a non-specified diagnosis was low. The variation in these two variables had a small or no effect on the HSMR. There was a considerable variation in the mean number of secondary diagnoses per hospital. This variation had a limited but statistically significant effect on the HSMR. The HSMR calculated without adjustments for secondary diagnoses correlated strongly with the original HSMR. CONCLUSION This analysis does not support the view that the HSMR is strongly affected by variation in the registration of hospital admissions and is therefore not reliable. Therefore, there is no need for restraint with regard to publication of the Dutch HSMR.

Variations in Dutch National Medical Registration hardly affect the hospital standardised mortality rate (HSMR)

Van latere zorg : Toekomstverkenning naar de aansluiting tussen zorgvraag en zorgaanbod in Noord-Brabant tot 2025

IntroductionA well-organized, accessible, and patient-centered primary care capacity is crucial to achieve a high- performing health care system (1). Health systems with strong primary care infrastructure have a track record of better health outcomes, better patient satisfaction and lower costs (2, 3). The growing numbers of frail elderly and people requiring longterm care increase the need for an integrated primary care system or 'medical home' (4) that emphasizes accessibility, continuity, and coordination of care.Many countries aim to strengthen primary care but struggle on their way to achieve this. Coverage and organisational reform will be necessary but is not sufficient; fixing the inadequate primary care capacity will be essential too (5).In Australia and United States, longstanding calls for fundamental payment reform to encourage comprehensive primary care appear finally to be coming to fruition through governmental legislation supporting a comprehensive suite of reforms to primary care (6-8).The health system in The Netherlands is increasingly recognized as a best practice model of primary care after the comprehensive health reforms of 2006 (9-11).Several comparative studies provide evidence of the high performance of the Dutch health care system. For instance, the Commonwealth Fund International Health Policy (IHP) Surveys of 2006-2010 showed that three groups of respondents in the Netherlands - citizens, chronically ill patients, and primary care physicians - all report positive views of the system in general, compared with other countries (12-16).In this paper we focus on the most relevant elements of Dutch of the primary care system, and discuss implications for other healthcare systems.As a frame of reference, we will elaborate on the following elements of a high performing primary care service: 24 hour access to general practice, comprehensive person oriented care, reliable methods for the coordinaton of care, optimal information exchange, a system for ensuring accountability and improving quality, and a motivated workforce. For understanding how these elements work, we first provide some contextual information on the Dutch primary care system.The Dutch primary care systemThe Netherlands, a country with 16.5 million inhabitants, has 4,235 general (family) practices including 8,783 trained general practitioners (GPs) (17). General practice is well organized and its development as a specialism goes back to the 1950's. In the 1970's the one-year graduate training program was established, which was expanded in 1990 to the current 3-year training program in 8 university medical centres. Most GPs work in small practices (no more than 3 practitioners) located close to the community, build on personal relationships between practitioners and families, and most of them are owned by the physicians themselves. GPs play a key role in the primary care system as payment of healthcare delivered by other disciplines in primary care need approval from the patient's GP. Last decade, collaboration among practices has increased, moving to larger teams and organizational networks, including other primary care disciplines, such as physical therapists, psychologists, and community nurses.Healthcare reform in 2006In 2006, a reform of the Dutch healthcare system was introduced (Table 1), including the obligation of every citizen to register with one general practice. Patients can change practices, but most have a longstanding relationship with their practice and personal GP. In the 2008 Commonwealth Fund IHP Survey of chronically ill patients, 79 percent of the Dutch respondents reported that they had been in the same practice for over five years (14).All patient medical records are (electronically) stored in the general practice, so that patients can be easily followed over time. In the healthcare system, GPs act as a guide and gatekeeper for patients, with referrals needed for visits to hospitals and medical specialists initiated and coordinated by the GP. …

Gert P. Westert

Papers

Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals

Variations in Dutch National Medical Registration hardly affect the hospital standardised mortality rate (HSMR)

Van latere zorg : Toekomstverkenning naar de aansluiting tussen zorgvraag en zorgaanbod in Noord-Brabant tot 2025

Achieving high performance quality in primary healthcare: The Dutch example.

Public needs for information disclosure on healthcare performance: Different determinants between Japan and the Netherlands