The goal of this open access book is to develop an approach to clinical health care ethics that is more accessible to, and usable by, health professionals than the now-dominant approaches that focus, for example, on the application of ethical principles. The book elaborates the view that health professionals have the emotional and intellectual resources to discuss and address ethical issues in clinical health care without needing to rely on the expertise of bioethicists. The early chapters review the history of bioethics and explain how academics from outside health care came to dominate the field of health care ethics, both in professional schools and in clinical health care. The middle chapters elaborate a series of concepts, drawn from philosophy and the social sciences, that set the stage for developing a framework that builds upon the individual moral experience of health professionals, that explains the discontinuities between the demands of bioethics and the experience and perceptions of health professionals, and that enables the articulation of a full theory of clinical ethics with clinicians themselves as the foundation. Against that background, the first of three chapters on professional education presents a general framework for teaching clinical ethics; the second discusses how to integrate ethics into formal health care curricula; and the third addresses the opportunities for teaching available in clinical settings. The final chapter, "Empowering Clinicians", brings together the various dimensions of the argument and anticipates potential questions about the framework developed in earlier chapters.
"""Reengineering Health Care" gets to the core of transforming our current system by advocating the widespread use of IT, eliminating inefficient practices, and keeping the system focused on a healthy individual and not on a broken process.""--Newt Gingrich, Founder of the Center for Health Transformation, and former Speaker of the U.S. House of Representatives ""This book is a prescription for streamlining health care. Using the techniques that have successfully transformed business into customer-focused and efficient organizations, the authors provide a step-by-step approach to improving health care processes, guiding health care into the next generation of Lean delivery systems.""--Dr. John Halamka, Chief Information Officer, Beth Israel Deaconess Medical Center ""In health care, we tend to inundate our people with information, rather than enabling them to have insights. This concise guide will resonate with both senior and front-line managers who know they're engaged in unproductive work. They will see that reengineering is not overly difficult and can enable them to improve patient care and efficiency.""--Trevor Fetter, President and CEO, Tenet Health Corporation, and Trustee, Federation of American Hospitals ""It isn't reform that will fix our ailing health care system, its reengineering. Champy and Greenspun highlight organizations that have transformed, and reinvented, themselves by reengineering care delivery-they've lowered costs, improved care quality and patient safety, and increased the satisfaction of those giving and receiving care. Every clinician, hospital executive, and politician should read this book.""--Bill Crounse, M.D., Senior Director, Worldwide Health, Microsoft Corporation ""Implement health care technology, and you have better health care tools; reengineer with a focus on technology, process, and people, and you have a better health care system. This straightforward guide shows how to transform health care to maximize quality, safety, convenience, and impact the cost of delivery. No one can read this book and not feel a profound call to action.""--H. Stephen Lieber, CAE, President & CEO, HIMSS In their legendary book, "Reengineering the Corporation", Jim Champy and Michael Hammer introduced businesspeople to the enormous power of a revolutionary methodology called "reengineering". Using reengineering, businesses around the world have systematically retooled their processes--achieving dramatic cost savings, greater customer satisfaction, and more value. Now, Jim Champy and Dr. Harry Greenspun show how to apply the proven reengineering methodology in health care: throughout physician practices, hospitals, and even entire health systems. You'll meet innovative and visionary leaders who've been successfully reengineering organizations across the entire delivery spectrum and learn powerful lessons for improving quality, reducing costs, and expanding access. This book doesn't just demonstrate the immense potential of health care reengineering to revolutionize health care delivery: "it offers a clear roadmap for realizing that potential in your own organization""." Deliver Better Care to More People, at Lower Cost How reengineering can lead to more efficient, safer delivery--and sharply reduced costs How to focus on prevention and wellness, as well as chronic disease and hospital care How to earn the trust, contributions, and passion of skeptical physicians and health care professionals How to harness technology to create more seamless, accessible, valued, and sustainable health care systems--and avoid technology's pitfalls How Zeev Neuwirth transformed the Lenox Hill Hospital ER and the 700-doctor Harvard Vanguard Medical Associates practice How Tom Knight is revolutionizing patient safety at Methodist Hospital System, one of America's largest private, nonprofit medical complexes How to start today in your own organization!
America's health care troubles largely stem from a great success: modern medicine can do much more today than in the past. So what's the trouble? How to pay for it. In easily comprehensible prose, MIT-trained economist Arnold Kling explains better ways of financing health care for the poor, workers, the disabled, and the elderly. Kling predicts relying less on government and more on private savings would improve health outcomes. A must-read for health care reformers.
States are increasingly important players in the current efforts to reform U.S. health care, as the federal government withdraws from this responsibility. Robert B. Hackey analyzes the varied routes states have taken in reformulating health care policy and provides a road map of what specific strategies work and why. In this comparative case study, Hackey focuses on four states--Massachusetts, New Hampshire, New York and Rhode Island--that have had markedly different experiences with regulating health care over the past two decades. Hackey's detailed comparisons show how the states' policies changed over time, moving from regulatory to market-oriented solutions, and examines which policy programs appear best poised to meet the future. Hackey uses regime theory to explain how the states' policy choices concerning cost control and entry regulation were shaped by the prevailing political culture and institution of each state. He concludes that the autonomy of state government form special interests is vital to the successful adoption, implementation and outcome of state initiatives. Rethinking Health Care Policy offers policymakers, planners and specialists useful insights into the politics of state regulation and into future directions for health care reform.
For those fortunate enough to reside in the developed world, death before reaching a ripe old age is a tragedy, not a fact of life. Although aging and dying are not diseases, older Americans are subject to the most egregious marketing in the name of "successful aging" and "long life," as if both are commodities. In Rethinking Aging, Nortin M. Hadler examines health-care choices offered to aging Americans and argues that too often the choices serve to profit the provider rather than benefit the recipient, leading to the medicalization of everyday ailments and blatant overtreatment. Rethinking Aging forewarns and arms readers with evidence-based insights that facilitate health-promoting decision making. Over the past decades, Hadler has established himself as a leading voice among those who approach the menu of health-care choices with informed skepticism. Only the rigorous demonstration of efficacy is adequate reassurance of a treatment's value, he argues; if it cannot be shown that a particular treatment will benefit the patient, one should proceed with caution. In Rethinking Aging, Hadler offers a doctor's perspective on the medical literature as well as his long clinical experience to help readers assess their health-care options and make informed medical choices in the last decades of life. The challenges of aging and dying, he eloquently assures us, can be faced with sophistication, confidence, and grace.
Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.
Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
Medical Entanglements uses intersectional feminist, queer, and crip theory to move beyond “for or against” approaches to medical intervention. Using a series of case studies – sex-confirmation surgery, pharmaceutical treatments for sexual dissatisfaction, and weight loss interventions – the book argues that, because of systemic inequality, most mainstream medical interventions will simultaneously reinforce social inequality and alleviate some individual suffering. The book demonstrates that there is no way to think ourselves out of this conundrum as the contradictions are a product of unjust systems. Thus, Gupta argues that feminist activists and theorists should allow individuals to choose whether to use a particular intervention, while directing their social justice efforts at dismantling systems of oppression and at ensuring that all people, regardless of race, gender, sexuality, class, or ability, have access to the basic resources required to flourish.
The United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Groups commonly referred to as minorities-including Asian Americans, Pacific Islanders, African Americans, Hispanics, American Indians, and Alaska Natives-are the fastest growing segments of the population and emerging as the nation's majority. Despite the rapid growth of racial and ethnic minority groups, their representation among the nation's health professionals has grown only modestly in the past 25 years. This alarming disparity has prompted the recent creation of initiatives to increase diversity in health professions. In the Nation's Compelling Interest considers the benefits of greater racial and ethnic diversity, and identifies institutional and policy-level mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies. Assessing the potential benefits of greater racial and ethnic diversity among health professionals will improve the access to and quality of healthcare for all Americans.
