Is Every Defect Really a Treasure?
Authors: Frank Davidoff
Journal: Annals of Internal Medicine (2012)

Editorials1 May 2012Is Every Defect Really a Treasure?Frank Davidoff, MDFrank Davidoff, MDFrom Institute for Healthcare Improvement, Wethersfield, CT 06109.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-9-201205010-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail We certainly can learn from our mistakes. However, most of us learn this way only in fits and starts, and with wildly varying degrees of success—hardly surprising when you consider the many counterforces arrayed against this backdoor approach to improvement. Start with the ubiquitous personal factors of inertia and path preference (“The devil you know …”). Add to this our intuitive sense (plus pragmatic experience) that the fallout from confronting our failures is so often messy: ingrained habits uprooted, cherished values challenged, complex systems dismantled and rebuilt, even jobs eliminated and unanticipated costs incurred.Moreover, if you are a physician, ...References1. Davidoff F. Shame: the elephant in the room [Editorial]. BMJ. 2002;324:623-4. [PMID: 11895807] CrossrefMedlineGoogle Scholar2. Gawande A. Personal best. The New Yorker. 3 October 2011;53. Google Scholar3. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989;320:53-6. [PMID: 2909878] CrossrefMedlineGoogle Scholar4. Bradley EH, Curry LA, Spatz ES, Herrin J, Cherlin EJ, Curtis JP, et al. Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann Intern Med. 2012;156:618-26. LinkGoogle Scholar5. Curry LA, Spatz E, Cherlin E, Thompson JW, Berg D, Ting HH, et al. What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study. Ann Intern Med. 2011;154:384-90. [PMID: 21403074] LinkGoogle Scholar6. Davidoff F. Heterogeneity is not always noise: lessons from improvement. JAMA. 2009;302:2580-6. [PMID: 20009058] CrossrefMedlineGoogle Scholar7. Kent DM, Rothwell PM, Ioannidis JP, Altman DG, Hayward RA. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials. 2010;11:85. [PMID: 20704705] CrossrefMedlineGoogle Scholar8. Bate P, Mendel P, Robert G. Organizing for Quality. New York: Radcliffe Publishing; 2008. Google Scholar9. Kaplan HC, Provost LP, Froehle CM, Margolis PA. The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement. BMJ Qual Saf. 2012;21:13-20. [PMID: 21835762] CrossrefMedlineGoogle Scholar10. Dixon-Woods M, Bosk CL, Aveling EL, Goeschel CA, Pronovost PJ. Explaining Michigan: developing an ex post theory of a quality improvement program. Milbank Q. 2011;89:167-205. [PMID: 21676020] CrossrefMedlineGoogle Scholar11. Batalden P. Lessons Learned in Changing Healthcare … and How We Learned Them. Toronto: Longwood Publishing; 2010. Google Scholar12. Greenhalgh T, Stones R. Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory. Soc Sci Med. 2010;70:1285-94. [PMID: 20185218] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Frank Davidoff, MDAffiliations: From Institute for Healthcare Improvement, Wethersfield, CT 06109.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0681.Corresponding Author: Frank Davidoff, MD, Institute for Healthcare Improvement, 143 Garden Street, Wethersfield, CT 06109; e-mail, [email protected]net. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction Elizabeth H. Bradley , Leslie A. Curry , Erica S. Spatz , Jeph Herrin , Emily J. Cherlin , Jeptha P. Curtis , Jennifer W. Thompson , Henry H. Ting , Yongfei Wang , and Harlan M. Krumholz Metrics Cited byDeliberate Learning in Health CareAchieving Integration in Mixed Methods Designs-Principles and Practices 1 May 2012Volume 156, Issue 9Page: 664-665KeywordsAcute myocardial infarctionDeath ratesHabitsHealth careMortalityProblem solvingReperfusionResearch quality assessmentSafetySurgeons ePublished: 1 May 2012 Issue Published: 1 May 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...