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).

Introduction: An understanding of the level of activation for self-management, defined as patients’ knowledge, skills and self-efficacy regarding self-management is important. It gives clues how self-management may be improved in the individual patient. In this study, the level of activation for self-management was assessed in patients with asthma or COPD at the time of referral by their General Practitioner to a pulmonologist. Method: Between September 2014-December 2016, the integrated health status was determined in patients with asthma or COPD referred to a pulmonologist using a specifically developed diagnostic pathway. Part of this diagnostic pathway is to examine the level of activation for self-management using the 13-item Patient Activation Measurement (PAM-13). The PAM-13 measures patients’ activation for self-management. Four different levels of activation can be distinguished, from very low (PAM-1) to high (PAM-4). Results: 112 valid PAMs were obtained in patients with asthma and 90 in patients with COPD. The distribution of PAM scores in asthma patients was: 35% of the PAM-1, 21% PAM-2, 38% PAM-3 and 5% PAM-4. In COPD patients the distribution was: 30% PAM-1, 28% PAM-2, 36% PAM-3 and 7% PAM-4. Conclusion: In 56% of the asthma patients and in 58% of the COPD patients there is little or no degree of activation for self-management (PAM-1 and PAM-2) at the time of referral from primary to secondary care.

Activation for self-management in asthma or COPD patients referred to a pulmonologist

International Profiles of Health Care Systems, 2014: Australia, Canada, Denmark, England, France, Germany, Italy, Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States

Objective: To examine the regional variation in hospital care utilization in the last 6 months of life of Dutch patients with lung cancer and to test whether higher degrees of hospital utilization coincide with less general practitioner (GP) and long-term care use. Design: Cross-sectional claims data study. Setting: The Netherlands. Participants: Patients deceased in 2013-2015 with lung cancer (N = 25 553). Main Outcome Measures: We calculated regional medical practice variation scores, adjusted for age, gender and socioeconomic status, for radiotherapy, chemotherapy, CT-scans, emergency room contacts and hospital admission days during the last 6 months of life; Spearman Rank correlation coefficients measured the association between the adjusted regional medical practice variation scores for hospital admissions and ER contacts and GP and long-term care utilization. Results: The utilization of hospital services in high-using regions is 2.3-3.6 times higher than in low-using regions. The variation was highest in 2015 and lowest in 2013. For all 3 years, hospital care was not significantly correlated with out-of-hospital care at a regional level. Conclusions: Hospital care utilization during the last 6 months of life of patients with lung cancer shows regional medical practice variation over the course of multiple years and seems to increase. Higher healthcare utilization in hospitals does not seem to be associated with less intensive GP and long-term care. In-depth research is needed to explore the causes of the variation and its relation to quality of care provided at the level of daily practice.

/pdf/regional-variation-in-hospital-care-at-the-end-of-life-of-14dnrxd4da.pdf

Regional variation in hospital care at the end-of-life of Dutch patients with lung cancer exists and is not correlated with primary and long-term care

In deze studie is een set van 35 kwaliteitsindicatoren
 ontwikkeld voor de verloskundige zorg in het ziekenhuis. Deze indicatoren
 zijn gedurende zes maanden getest op bruikbaarheid in dertien ziekenhuizen. Uit de evaluatie blijkt dat de registratie haalbaar is en dat verdere
 implementatie van de indicatoren ondersteund wordt door de betrokken
 zorgverleners in het ziekenhuis. In de komende jaren wordt door de
 Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) gewerkt aan de
 implementatie van de set indicatoren om de kwaliteit van de obstetrische
 zorg in het ziekenhuis te stimuleren.
 Het doel van deze indicatoren is om gynaecologen een hulpmiddel te geven om
 de kwaliteit van de door hen verleende obstetrische zorg te monitoren en te
 bewaken. Bij het ontwikkelen van de kwaliteitsindicatoren zijn de
 richtlijnen van de NVOG als uitgangspunt genomen. Er is rekening gehouden
 met de mate waarin de indicatoren eenvoudig meetbaar en snel beschikbaar
 zijn en in hoeverre zij een bijdrage kunnen leveren aan verbeteringen in de
 zorg. De Landelijke Verloskunde Registratie (LVR) is de belangrijkste
 informatiebron voor de indicatoren. Na drie beoordelingsrondes door experts
 is een set van 35 kwaliteitsindicatoren tot stand gekomen, waarvan negentien
 structuur-, dertien proces- en drie uitkomstindicatoren. Structuurindicatoren hebben betrekking op de organisatie van de zorg, zoals
 een structurele complicatiebespreking. Voorbeelden van geselecteerde
 procesindicatoren zijn het percentage inleidingen en het percentage
 kunstverlossingen. Als uitkomstindicator is onder meer geselecteerd het
 percentage levendgeboren kinderen met een Apgarscore lager dan vijf, na vijf
 minuten.

Kwaliteitsindicatoren voor de obstetrie: ontwikkeling en gebruik in Nederland

Braspenning JCC, Van Doorn-Klomberg AL, Bouma M, Westert GP. Tijdsbesteding in de huisartspraktijk. Huisarts Wet 2012;55(12):542-7. Er is weinig bekend over het aantal uren dat de medewerkers van huisartsenpraktijken wekelijks werken, en hoeveel daarvan daadwerkelijk besteed worden aan directe patientenzorg. Wij hebben een secundaire analyse uitgevoerd op 867 vragenlijsten van de NHG-Praktijkaccreditering® (NPA) uit de periode 2009-2011 en 890 vragenlijsten uit 2007-2008. Bij wijze van kruisvalidatie vergeleken wij deze gegevens met de patientendossiers van 53-123 praktijken uit het Landelijk InformatieNetwerk Huisartsenzorg (LINH) over 2006-2010. Gemiddeld werkten de werknemers van een huisartsenpraktijk in 2010 47,7 uur per 1000 patienten per week (NPA 2009-2011, 328 praktijken), waarbij het aantal uren van huisarts, assistent en praktijkondersteuner (POH) zich verhoudt als 4 : 3 : 1. In 2007-2008 besteedde de huisarts 14,9 uur aan directe patientenzorg, ongeveer tweederde van de gemiddelde werkweek (NPA 2007-2008; 714 huisartsen). In 2010 was dat 16,4 uur, een stijging van 10,1%. Huisarts en POH samen besteedden in 2010 naar schatting 20,1 uur per 1000 patienten per week aan directe patientenzorg. Blijkens de LINH-gegevens lag het aantal contacturen in 2010 op 16,1 per 1000 patienten per week. Onze schatting van de tijdsbesteding in de huisartsenpraktijk is omgeven met onzekerheden, maar het is aannemelijk dat huisarts, assistent en POH in een normpraktijk met 2350 patienten samen gemiddeld 112,1 uur per week werken, exclusief diensten. Huisarts en POH besteden ongeveer tweederde van hun tijd aan directe patientenzorg.

Gert P. Westert

Papers

Activation for self-management in asthma or COPD patients referred to a pulmonologist

International Profiles of Health Care Systems, 2014: Australia, Canada, Denmark, England, France, Germany, Italy, Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States

Regional variation in hospital care at the end-of-life of Dutch patients with lung cancer exists and is not correlated with primary and long-term care

Kwaliteitsindicatoren voor de obstetrie: ontwikkeling en gebruik in Nederland

Tijdsbesteding in de huisartsenpraktijk