Thomas W. Nolan

Bio: Thomas W. Nolan is an academic researcher from Silver Spring Networks. The author has contributed to research in topics: Health care & Quality (business). The author has an hindex of 12, co-authored 19 publications receiving 5805 citations. Previous affiliations of Thomas W. Nolan include IHI Corporation.

The Triple Aim: Care, Health, And Cost

Abstract: Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health car...

All-or-None Measurement Raises the Bar on Performance

Abstract: Often,severalindividualperformancemeasuresareusedto assess care of the same condition. For example, a recentsummary of data on the Joint Commission on Accredita-tion of Healthcare Organizations’ standardized perfor-mancemeasuresincluded9measuresforacutemyocardialinfarction,4measuresforcongestiveheartfailure,and5mea-suresforpneumonia.TheJointCommissiononAccredita-tionofHealthcareOrganizations’standardsetforpneumo-nia measures performance with respect to oxygenationassessment, pneumococcal vaccination, blood cultures,smoking cessation counseling, and mean time to initiationofantibiotics.Thefirst4ofthesearediscretemeasuresthatindicate the presence or absence of the item in the medicalrecord.Thetimetoinitiationofantibioticsisacontinuousvariablemeasuredinminutes.Thereareatleast3differentoptions for calculating performance on multiple, discretemeasures for the same condition.Option 1: Item-by-Item MeasurementPerformance on the provision of each element of care is re-portedseparatelyasapercentage,inwhichthedenominatoristhetotalnumberofpatientsinthesampleandthenumera-toristhetotalnumberofpatientsforwhomtheitemwaspres-entinthemedicalrecord.The2004NationalHealthCareQual-ityReport,

System changes to improve patient safety

Abstract: The automated teller machine that dispenses cash and other banking transactions has become ubiquitous in many parts of the world. Most machines follow one of two sequences to complete a transaction. Some dispense the money first and then return the card. Others reverse these two steps. Since the aim of the transaction is to obtain the money, common sense and research in human factors predict that the person using the machine is more likely to forget the card if it is returned after the money is dispensed.1 The order is designed into the system and produces a predictable risk of error. Researchers have documented the extent of errors and their effect on patient safety. 2 3 Like the card forgotten at the automated teller machine, many of the adverse events resulted from an error made by a person who was capable of performing the task safely, had done so many times in the past, and faced significant personal consequences for the error. Although we cannot change the aspects of human cognition that cause us to err, we can design systems that reduce error and make them safer for patients.4 My aim here is to outline an approach to designing safe systems of care based on the work of human factors experts and reliability engineers. #### Summary points Many errors are attributable to characteristics of human cognition, and their risk is predictable Systems can be designed to help prevent errors, to make them detectable so they can be intercepted, and to provide means of mitigation if they are not intercepted Tactics to reduce errors and mitigate their adverse effects include reducing complexity, optimising information processing, using automation and constraints, and mitigating unwanted effects of change Designers of systems of care can make them safer by attending to three tasks: designing the system …

The Business Case For Quality: Case Studies And An Analysis

Abstract: The financial implications of implementing quality improvements are often poorly understood. Simply put, does improving quality yield a return on investment? We examine four cases—management of high-cost pharmaceuticals, diabetes management, smoking cessation, and wellness programs in the workplace—to understand the financial and clinical implications of improving care. We explore costs and benefits, in both the short and the long term, to four stakeholders with different and sometimes conflicting interests: providers, purchasers and employers, individual patients, and society. Finally, we recommend policy changes to better align financial incentives for superior quality of care.

Physicians as Leaders in Improving Health Care: A New Series in Annals of Internal Medicine

Abstract: Searching for one word to describe the state of mind of the physician in the United States today, we might choose beleaguered.Threats appear from all sides-from payers, would-be managers of care, t...

Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations

Abstract: This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.

Systematic reviews in health care: Assessing the quality of controlled clinical trials

Abstract: This is the first in a series of four articles The quality of controlled trials is of obvious relevance to systematic reviews. If the “raw material” is flawed then the conclusions of systematic reviews cannot be trusted. Many reviewers formally assess the quality of primary trials by following the recommendations of the Cochrane Collaboration and other experts. 1 2 However, the methodology for both the assessment of quality and its incorporation into systematic reviews and meta-analysis are a matter of ongoing debate.3-5 In this article we discuss the concept of study quality and the methods used to assess quality. #### Components of internal and external validity of controlled clinical trials Internal validity —extent to which systematic error (bias) is minimised in clinical trials Quality is a multidimensional concept, which could relate to the design, conduct, and analysis of a trial, its clinical relevance, or quality of reporting.6 The validity of the findings generated by a study clearly is an important dimension of quality. In the 1950s the social scientist Campbell proposed a useful distinction between internal and external validity (see box below). 7 8 Internal validity implies that the differences observed between groups of patients allocated to different …

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

Abstract: The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system per- formance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs

Abstract: Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation—the skills and confidence that equip patients to become actively engaged in their health care—makes to health outcomes, costs, and patient experience. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual’s level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients’ role in managing their health care can contribute to improved outcomes and that patient activation can—and should—be measur...