David R' Hunt, M'D', FACS

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The Case for Leadership Method, Motive, and
Opportunity

• David R. Hunt, M.D., FACS
• Medical Officer
• CMS Quality Improvement Group

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metaphor n. Middle English methaphor a
figure of speech in which a word or phrase
literally denoting one kind of object or idea is
used in place of another to suggest a likeness or
analogy between them

• Websters New World Dictionary of the American
  Language, 2nd Ed.

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Executive Order- August 22, 2006

• By the authority vested in me as Presidentto
  ensure that health care programs administered or
  sponsored by the Federal Government promote
  quality and efficient delivery of health care

George W. Bush
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Deficit Reduction Act

• Secretary shall report quality measures of
  process, structure, outcome, patients'
  perspectives on care, efficiency, and costs of
  care that relate to services furnished in
  inpatient settings ..

January 27, 2006
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American health care"gets it right"54.9of the
time.

• McGlynn EA, Asch SM, Adams J, et al.
• The quality of health care delivered to adults in
  the United States.
• N Engl J Med 2003 348(26)2635-45 (June 26).

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Take Home Messages

• Change is inevitable
• Success is wholly dependent on partnership
• The path forward requires a system, resources,
  and courage

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Motive
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Medicare Population
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Medicare Expenditures
SSA Office of the Actuary March 23, 2005
http//www.ssa.gov/OACT/TRSUM/trsummary.html
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Margaret Thatcher
No one would remember the Good Samaritan if he
only had good intentions. He had money as well.
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Strategic Inflection Point

• is a time in the life of a business when its
  fundamentals are about to change. That change can
  mean an opportunity to rise to new heights. But
  it may just as likely signal the beginning of the
  end.

Only the Paranoid Survive Andy Grove, Chairman
and former CEO Intel Corp.
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Current Statutory Framework
Public Reporting
Quality Improvement
P4R P4P
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Method
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Progress, far from consisting in change, depends
on retentiveness. Those who cannot remember the
past are condemned to repeat it.

• George Santayana (1863 - 1952)
• The Life of Reason Reason in Common Sense

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Lister
Billroth
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The Lister Effect Lower Leg Amputation Mortality
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Theodor Billroth at the Allegemeines Krankenhaus
In Vienna
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Quantitative Demonstration of Leadership
Mortality from leg amputation
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Opportunity
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Evolution of CMS

• QIO 6SOW Developmental work for a national model
• QIO 7SOW National QI agenda
• Public reporting
• Performance based payment
• QIO 8SOW Developmental work on leadership
• Expanded role of public accountability and P4P

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Danger Opportunity
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Not everything that can be counted counts, and
not everything that counts can be counted.

• Albert Einstein

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SSI Individual Opportunity

• Aseptic technique
• Gentle handling of tissues
• Debridement of devitalized tissue
• Meticulous hemostasis
• Limited use of suture material
• Proper tension in approximating tissues

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SCIP SSI Systems Oppotunity

• Antibiotic timing (within 1 hour)
• Antibiotic selection
• Antibiotic discontinuance
• Normothermia in colorectal surgery
• Normoglycemia in cardiac surgery
• Preoperative hair removal
• Number of SSIs before discharge

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Cass Men at some time are masters of their
fates The fault, dear Brutus, is not in our
stars, but in ourselves

• Julius Caesar I. ii

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