Closing the Perception Gap

PowerPoint Presentation

Closing the Perception Gap: Learning from Variation to Deliver ValueA RightCare Presentation at NHS ExpoManchester, 7 September,2016Professor Albert G. Mulley, Jr., MD, MPPDartmouth Institute for Health Policy and Clinical Practice

Making Health Care Decisions, The President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research, 1983 The Dartmouth InstituteLearning from Variation to Deliver What is Valued

Discovering Variation in Vermont, Science, 1973Variation in Rates and Outcomes of Surgery

Replicating Variation in UK, Norway, US, N Engl J Med, 1982

Variation in Rates of Surgery

Comprehensive Study of Variation in the US, Dartmouth Atlas of Health Care, 1996-2016

Variation in Inputs, Rates and Outcomes of Diagnostic, Medical and Surgical Interventions

Comprehensive Study of Variation in the UK, NHS Atlas of Health Care, 2010-2016Variation in Inputs, Rates and Outcomes of Diagnostic, Medical and Surgical InterventionsLearning from Variation to Deliver What is ValuedThe Dartmouth Institute

4

How bothersome is urinary dysfunction? How bothersome will sexual dysfunction be?

Learning from Variation: Closing the Perception Gap

The Dartmouth Institute

When Linda was diagnosed with breast cancer, she was devastated. She was 58. She quickly found support from others who had dealt with the disease. Nonetheless, her anxieties as she awaited surgery nearly overwhelmed her. Lindas operation went well. However . When Susan was diagnosed with breast cancer, she was more stoical than Linda. She was 78, other members of her family had had breast cancer, and she had already been treated for a serious illness heart failure. She dreaded having surgery, but her surgeon was insistent. Susans mastectomy was routine.Learning from Variation: Closing the Perception GapThe Dartmouth Institute

How much does keeping your breast and a higher risk of recurrence matter? How much does chance of a longer life and side effects of chemotherapy matter?

The Dartmouth InstituteLearning from Variation: Closing the Perception Gap

7

Different levels of motivation amongst patients with CVDDifferent levels of confidence amongst patients with CVD

The Dartmouth InstituteLearning from Variation: Closing the Perception Gap

The Care They Need and Want No Less But No MoreChildren and adolescents who have behavioral and physical health needs People who need support to be productively employedPeople who need care and compassion when frail or when death is near A Massive Opportunity for the NHS and The World

The Dartmouth Institute

It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying. I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. "Another event at Elsterhorst had a marked effect on me. The Germans dumped a young Soviet prisoner in my ward late one night. The ward was full, so I put him in my room as he was moribund and screaming and I did not want to wake the ward. I was ashamed of my misdiagnosis and kept the story secret."

I examined him. He had obvious gross bilateral cavitation and a severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect.

Archie Cochranes Education at Elsterhorst: A Story to End With

The Dartmouth Institute