Proper Medical Care of theProper Medical Care of the

SickestSickest Patient of All: Patient of All:

J. Deane Waldman, MD MBA University of New Mexico:

• Health Sciences Center &• Anderson Graduate Schools of Mgmt

University ofNew Mexico

HealthcareHealthcare

University ofNew Mexico

Principles of Good Medical Practice

Healthcare Dx &Healthcare Dx & R Rxx

JD Waldman, MD MBAJD Waldman, MD MBA

1. Gather data: Obj. & Subj; Present (pt) & past (lit.)

2. Make etiologic diagnosis

3. Evidence-based decision making (logic ≠ sufficient)

4. Treat causes, not symptoms

5. Measures all outcomes, esp. desired & unintended

6. Partner with patient

7. Adjust treatment plan PRN

University ofNew Mexico

Diagnostic ToolsDiagnostic Tools

• History• Physical exam• X-rays• Lab studies• Review of lit

• Rx partnership

• Provocative tests• Therapeutic trials

For Sick Person For Sick System

• Value Chains• C. A. P. A.• Queueing theory• Systems thinking • Learning curves• Constraints analysis• Cultural survey• 5 Forces analysis• Managerial acc’ting• Lean management

Healthcare Dx &Healthcare Dx & R Rxx

JD Waldman, MD MBAJD Waldman, MD MBA

• BCG Matrix• Checklists• Compet Profiles• CGE / CQI / TQM• Grainger causality• Heijunka• Markov model• Network analysis• Simone’s maxims• Venn diagrams

IllustrationsIllustrationsHealthcare Dx &Healthcare Dx & R Rxx

JD Waldman, MD MBAJD Waldman, MD MBA

Etiologic Diagnosis:Disconnection

Healthcare Dx &Healthcare Dx & R Rxx

JD Waldman, MD MBAJD Waldman, MD MBA

What is disconnected from what?We….are disconnected from……our money.

Measured outcomes…disconnected…desired ones.

Decisions….are disconnected from……outcomes.

Behaviors….are disconnected from……incentives.

WE…disconnected…consensus principles.

The cure is therefore…RECONNECTION.

Healthcare Dx &Healthcare Dx & R Rxx

JD Waldman, MD MBAJD Waldman, MD MBADialogue is thefirst step

Leading toReconnection.

‘Enfranchises’Spanish-speaking

Americans.