Re: “Gawande’s Appeal for Better Systems of Care” by Matthew Weinstock in H&HN Daily, Aug. 11


For the many brilliant and effective recommendations that Dr. Atul Gawande has made to improve health care in the United States, we are forever grateful.


But one, which he has yet to acknowledge or advance, is supporting a patient's "informed decision" — and increasing the legal right — to seek compassionate medical aid in dying

for unremitting pain at the end of life that cannot be relieved by palliative care, hospice, the (re)education of physicians, psychiatric consultations or other conventional medical approaches.

Physicians have long assumed, or been taught, that a patient's death represents a professional failure. The system of health care payment in the United States encourages that, so physicians and hospitals provide as many treatments as third-party insurance covers or an individual can afford.

Our Canadian friends and many of their counterparts in Europe, find this … commitment to "end-of-life care at any cost," difficult to understand.

When Canadian (and maybe American) patients have an option closer than Switzerland after the first of next year, perhaps patients will die the way many American physicians choose to die themselves — with the knowledge that many current American end-of-life care "treatments" neither extend lives nor alleviate pain and suffering.

— Ron Hammerle, chairman

Health Resources Ltd.

Tampa, Fla.

The Burning Platform

Re: “What's Missing from Your Patient Experience Strategy?” by Marty Stempniak in H&HN Daily, Aug. 24

There is so much about the patient experience that HCAHPS barely touches the surface. Trust is crucial and it can be eroded at any moment of truth in the patient experience pathway.

We find that sharing the consumers' emotional responses to the experience provides stories that create the burning platform. That builds senior leader buy-in very quickly.

— Kristin Baird

Getting Docs to Say 'Yes' to CDI

Re: "Getting Physicians Behind a Clinical Documentation Initiative" by Todd J. Kislak in H&HN Daily, Aug. 13

You speak as if engagement is the first step and the key to further collaboration. There is a step before engagement. You don't see it because health care administrators routinely leave this step out. Enrollment precedes engagement.

Enrollment is the process that leads to the doctors' saying, "Yes, we want this clinical documentation improvement" in the first place. This involves understanding and explaining the benefits of adopting this CDI to the physicians so that they clearly see the benefits to their patients and staff, and the personal benefit the doctors would derive when this program is implemented … in a way that results in their saying … "OK, I am in … what do we do to make this happen?"

I have never seen an administration do an adequate job of enrollment. That is why implementation and engagement are so difficult.

— Dike Drummond, M.D.

Integrated IT Key for Triple Aim

Re: "A Truly Integrated Health Care System," by Laura Jacobs in H&HN Daily, July 2

Thank you for a great summary. I believe that health information technology development, including exchange, will be needed to maximize the benefits of organized systems of care. Over time, all providers, including affiliated and nonaffiliated, will need to participate with integrated network activities if we are going to achieve the Triple Aim within communities.

— Ed Gamache

Here's to Jenny

Re:"NICU Nurse Helps Parents to Cope" by Lauren Arcuri in August H&HN

Beautiful. We need more nurses like this to help make the NICU more bearable. Thanks for sharing Jenny's story; it's inspiring. Thanks, Jenny, for being one of the good guys!