NEJM Audio Summary - Dec 1, 2011

Excerpted Script

15'41" | "The Four Habits of High-Value Health Care Organizations", a prospective article by Richard Bohmer, from Harvard Business School, Boston. Health care organizations considered among the nation's highest performers often have unique personalities, structures, resources, and local environments. Yet they often have remarkably similar approaches to care management, common habits that may be transferrable. The first common habit is specification and planning. To an unusual extent, these organizations specify decisions and activities in advance. Specification also applies to separating heterogeneous patient populations into clinically meaningful subgroups. A second common habit is infrastructure design. High-value health care organizations deliberately design microsystems — including staff, information and clinical technology, physical space, business processes, and policies and procedures that support patient care — to match their defined subpopulations and pathways. The third habit is measurement and oversight. High-value organizations primarily use measurement for internal process control and performance management. The fourth and final habit is self-study. Beyond ensuring that their clinical practices are consistent with the most recent science, these organizations also examine positive and negative deviance in their own care and outcomes, seeking new insights and better outcomes for their patients.

191 words / 96 sec = 119 wpm

スティーブン・R・コヴィーによる自己啓発本「７つの習慣」("The 7 Habits of Highly Effective People")をパロったと思われる俯瞰記事です。寄稿者、リチャード ボーマー医師は、ハーバード ビジネス スクールの教授であり、"Designing Care: Aligning The Nature and Management of Health Care"という本を著し、ウォール ストリート ジャーナル紙に応えて、医療が単独の開業医モデルから「チームベースのスポーツ」に進化した主張しています。以前にもNEJMに、"The Shifting Mission of Health Care Delivery Organizations"という記事を寄せております。単純化すると、病院は一層他業界の如く企業化を推し進めるべきという意見のようですが、正直、時代の流れからは、ワンテンポ遅れており、一橋大学の猪飼周平の「病院の世紀の理論」のほうが、的を得ているように思います。

蛇足ながら、本家の７つの習慣は、下記の通り。

1. Be Proactive
2. Begin with the End in Mind
3. Put First Things First
4. Think Win/Win
5. Seek First to Understand, Then to Be Understood
6. Synergize
7. Sharpen the Saw