By Archelle Georgiou. At 9:55 am on a Wednesday morning. I was 15 miles from home and making good time getting to my 10:30 meeting until I realized that I’d left the power cord for my Mac computer at home. There was no way I’d have enough battery power to get through my presentation. So, I had a choice: turn around, go home and be late or run by the mall and buy a new power cord at the Apple store.  Since the mall was only ¼ mile away, I could arrive just as the store opened and likely be the first customer. The decision was easy.

As expected, the parking lot had a scant number of cars and I got a plum spot by the entrance. Racing past several stores en route to my destination, I noticed employees in the sporting goods store dribbling basketballs waiting for their first customers. Gap associates were folding and re-folding jeans while Sephora employees were sampling products and primping in the mirror. The mall was empty.

And, then I got to the Apple store…it was packed. No, this wasn’t the day the iPad2 was being released although the store had already received 200 calls since 8 am from people wanting to know if it was available. What were all those people doing there? Buying Apple products; playing with Apple products, taking classes on how to use Apple products, and getting expert help from the Apple whiz kids at the Genius Bar.

After witnessing this scene, it was no surprise that Apple was in the #1 spot on Fortune’s List of Most Admired Companies in America—again–for the 4^th year in a row. Apple’s wildly successful performance is not new news to any of you; the high level themes are innovation, product, and brand.  We’ve read about them many times. But, how can CEO and leaders of companies translate these themes into their business? That’s the diplomatic way to tee up this blog. The real question is: What can health care companies do to be more like Apple?

1.    Fit in: In 2008, Apple leaped into the #1 spot in Fortune’s rankings (from #7 in 2007.) Steve Jobs himself said, “Apple products work, and if you buy more than one, they work better.” In other words: integration.

Yes, Apple has a fully integrated platform. But, Apple wouldn’t be as successful without the relationship and integration with Microsoft products. Early on, the company recognized they needed to fit into the prevailing system.

The number of new health care developments that are being generated are dizzying: billing programs to accelerate payment of patients’ copayments; software to maximize performance in pay for performance initiatives, IVR systems that increase patient engagement, incentive programs to enhance compliance with needed behavioral changes. The founders/developers are passionate that their cutting edge innovation will increase “quality and decrease cost.” However, too many of these great ideas aren’t designed to fit into the operational complexities of a hospital, doctor’s office, health system, or payor. And, despite the promise of more revenue and profitability, decision-makers can’t bear to layer any more chaos to an already chaotic system.

True systems integration may be prohibitively expensive for start-up or early stage companies, but at a minimum, be prepared to offer a feasible operational/process solution that achieves integration. How? Roll up your sleeves and invest time in learning how the system is wired: the back office operations in a doctor’s office, the politics of hospital revenue management, the benefits, claim and administration realities of insurance.   (more…)

By Jane Sarasohn-Kahn. Wellness and disease prevention were the meta-themes at Health 2.0′s Spring Fling held earlier this week in San Diego. where the discussions, technology demonstrations, and keynote speakers were all-health (as opposed to health care), all-the-time. Dr. Dean Ornish told the attendees in the standing-room-only ballroom space that the joy of living is a greater motivator than the fear of death. And the 1.0 version of managing health risks has been more the latter than the former. As a result, Ornish’s two decades of research have shown that health is more a function of lifestyle choices than it is drugs and surgery. In fact, people have a “spectrum” of choices to make based on their personal preferences — not a one-size-fits-all “diet,” Dr. Ornish has learned.

While genes are our predisposition, they are not our Fate: good news for every human being. Furthermore, he said that, “healthcare needs more connection and community. It’s as important as food and water.” He and other researchers have learned that a person’s greater social connectedness (friends, family, community) contributes to better health. People who are lonely and depressed have 3 to 7 times greater mortality, Ornish told us. The largest unmet need is for intimacy and connection.

While Dr. Ornish’s research continues to demonstrate the power of lifestyle changes on health and longer, more joyful living, sponsors of health plans are now getting into a next generation of wellness and prevention in the context of value-based benefit design. With health premium increases that now have a family of four’s coverage indexed at nearly $20,000 per year based on the Milliman Medical Index, fewer employers are confident they’ll be able to cover employee health benefits a decade from now as the chart’s declining red line illustrates.

Thus, employers in 2011 are looking to link benefits with health and productivity, based on the Towers Watson and National Business Group on Health’s survey  into employer-based benefits in the post-reform era. While companies will continue to offset increasing health costs to employees (with a 45% increase in employees’ share of health costs since 2006), they’re also using incentives more aggressively to motivate lifestyle behavior changes in a new-and-improved approach to wellness and prevention. (more…)

Women experience differences in their health care services and outcomes. The fact sheet, Healthcare Quality and Disparities in Women: Selected Findings, summarizes key findings from the National Healthcare Quality and Disparities Reports related to health care for women.

Addressing the inevitability of nurses caring for older adults with mental health and substance abuse issues, the American Academy of Nursing’s Geropsychiatric Nursing Collaborative (GPNC) released a new short video: “Discover Mental Health: The Forgotten Piece in Elder Care.”

The video conveys that while not every student will become a geropsychiatric nurse, almost all nurses at some point in their careers will care for older adults with mental health issues. Therefore, nurses will need the requisite knowledge, skills and compassion to improve the quality of life for this most challenging, rewarding and neglected population.

View the video. Note that this video can be used as a standalone resource or segments can easily be excerpted for specific uses. It is available for free download on the Portal of Geriatric Online Education: POGOe, Product #20893   (You must have an account to access the video for download, but registration is free.)

Please share with your colleagues. GPNC would love to hear who is using it in what venues and any responses about its utility and value. Send comments to Pamela Dudzik at pdudzik@aannet.org.

The following is a guest post by Nicole Sweeny, originally posted on Policy Mic on March 22nd.

By Nicole Sweeny. In October 2010, seven months after the passage of health reform, hundreds of health care industry stakeholders gathered in an overcrowded conference room at the Centers for Medicare & Medicaid Services. They were all eagerly waiting to give their input on one of the most buzzworthy provisions of health reform: the Accountable Care Organization. Implemented by Section 3022 of the Patient Protection and Affordable Care Act, Accountable Care Organizations, or “ACOs,” are vaguely defined as groups of providers that will manage all aspects of care for the Medicare beneficiaries assigned to them (seniors over the age of 65 are eligible for Medicare). ACOs will have to meet quality standards, and if they meet cost savings targets they will receive a percentage of the savings as a monetary bonus. Dr. Donald Berwick, Administrator of the Centers for Medicare & Medicaid Services, has lauded ACOs as a means to further the goals of health reform and correct the fragmented health care delivery system in the United States.

However, the legislative framework for ACOs is so vague that, almost six months after this stakeholder meeting, the Centers for Medicare & Medicaid Services is still struggling to answer some of the most basic questions surrounding their formation. Who can legally be an ACO? Hospitals? Groups of physicians? How will antitrust and anti-kickback laws affect ACOs? What percentage of savings will be the monetary bonus?

Initially scheduled to be released in November, the regulation that will answer these questions has been delayed again and again, and stakeholders are getting frustrated. And with less than nine months to go until the ACO program is statutorily required to be implemented (January 1, 2012), many are rightfully worried that they still don’t know what their role will be in the program.

The passage of the Patient Protection and Affordable Care Act was viewed by many as monumental. With over 1,000 pages and hundreds of provisions ranging from implementing state insurance exchanges to improving elder care in nursing homes to enacting approval changes for the biotechnology industry, the Patient Protection and Affordable Care Act literally impacts every American. However, like ACOs, many of the provisions are vague and leave the details to be hammered out bureaucratically. As a result, stakeholders are left in an anxious state of limbo, not knowing how to move forward in implementing one of the most extensive pieces of legislation to ever move through Congress.

As we move forward one year after health reform, we must remind ourselves that the bill was not signed, enacted, and implemented on March 23, 2010. The delay of regulations impacts stakeholders and consumers, and will ultimately affect the patient experience of care. The health reform bill is aptly named the Patient Protection and Affordable Care Act, and those charged with its implementation need to do so in a manner that is both statutorily timely and consistent with its mission to improve the U.S. healthcare system.

It’s been one year since the landmark health reform legislation was passed.

Are you better off today because of it?  Are we as a nation better off today because of it?

 Let us know by commenting below..we want to hear your thoughts!

• A year after President Obama signed health reform into law, the public remains deeply divided over the landmark legislation, with a year of political debate over its merits and the beginning stages of its implementation doing little to alter Americans’ opinions about the law. In March, one year after enactment, 42 percent of Americans hold favorable views of the law while 46 percent view it unfavorably, a basic division that has changed little during the last 12 months. (In April 2010, 46 percent had favorable views and 40 percent unfavorable ones, but both figures have ticked up and down over the last year.) Opinion of the law continues to break sharply along partisan lines, with 71 percent of Democrats backing the law and 82 percent of Republicans opposing it.

• About half (51%) of Americans who like the law cite expanded access to insurance and health care as the reason. Those who do not like it give a greater variety reasons: 20 percent are concerned about costs; 19 percent have concerns about government’s role; and 18 percent mention opposition to the individual mandate.

• A majority of Americans do agree on something: 53 percent are confused about the law, the major provisions of which won’t take effect until 2014. This is nearly identical to the 55 percent who reported being confused in April 2010. Further, 52 percent this month say they do not have enough information about health reform to understand how it will impact them personally, while 47 percent think they do. Members of the groups most likely to benefit from health reform — the uninsured and those living in low-income households — are the most likely to say they do not know enough about the law’s potential impacts. (more…)

By Meryl Bloomrosen. “They” say that being a teenager is NOT easy.  Well, being the parent of a teenager is certainly isn’t easy either.  And it is usually the case that all of us will experience some bumps along the way.  

Yet, to some such concerns and crises seem insignificant or trite in comparison to recent headlines such as those about the Tsunami, earthquake and nuclear reactor explosions in Japan; Haitian elections; social unrest and justice in Egypt and elsewhere; and attacks in Libya. Or the ongoing headlines about the economic meltdowns on Wall Street; bank, savings and loans failures; or the continuing high unemployment statistics; and plummeting real estate values.  Or even NCAA March madness.

Although, there has been periodic news and media attention on teen and school bullying and some new efforts are in process to take a look at this growing challenge.  It  has been in the past several weeks, months and years, that I have learned about adolescent mental health services along with a bit about the legal/justice and educational systems.  Having worked in the health care “system” for almost 35 years, I thought that I was fairly well informed…I was wrong.

Maybe it was the early morning phone call stating that the teen was being taken to the county emergency crisis unit.  Or how about the parent who called 911 and was (thankfully) coached to “say the right thing” because the teen was standing in the house with two huge kitchen knives pointed at himself? Or the parents who got the phone call asking them to come down to the police station because of their teen’s arrests at an underage drinking party. Or the parents who came home one night and found their teen unconscious suffering from what turned out to be alcohol poisoning.   Or maybe it was the parents whose teen jumped out of the window at her therapeutic boarding school in spite of the promise of 24/7 supervision?   Or maybe it was the crisis center stating that given the history the teen needed to be evaluated at an emergency department because the teen posed a safety threat to self? Only the crisis center did not seem to know any local “teen-appropriate EDs”. (more…)

Tina Krall

The following is a guest post by Fibroid Relief Executive Director Tina Krall.

By Tina Krall. One in four women in this country suffers from uterine fibroids — benign tumors that develop in the uterus. Not only can uterine fibroids be uncomfortable, inconvenient and sometimes even painful, but they create a number of less-than-desirable situations “down there.” 

Until recently, being diagnosed with uterine fibroids meant the strong possibility of a hysterectomy and sterility – a scary outcome considering they usually develop and become symptomatic during a woman’s childbearing years.

Advances in biotechnology have changed all that. Now, minimally invasive options – and even a noninvasive option – exist. Not only do these procedures have comparable success rates and significantly reduced recovery times, but the noninvasive option – Focused Ultrasound (we try to not refer to it as surgery) – preserves fertility. The only obstacle – getting the word out that these options exist.

That’s where Fibroid Relief – a non-profit dedicated to educating women about uterine fibroids and all of the options available to treat them — comes in. Fibroid Relief works tirelessly to not only make all of the treatment options — and their pros and cons — known, but also to create a forum for women at all stages of the treatment process to discuss their choices and personal experiences and offer each other support and advice (which we largely accomplish via our Facebook and YouTube pages).

Our efforts go beyond cyberspace, though. Together with hospitals and medical centers with the capabilities to perform many of the treatment options, including Focused Ultrasound, we host “Fibroid Relief At Last” patient education events all over the country (and in the UK, too!). These events include panel sessions featuring patients who have successfully undergone different treatments and the physicians who treated them. You can check out a video of our most recent event in Charlottesville, VA here.

Next month, Fibroid Relief At Last is coming to Houston, TX. We’re teaming up with Methodist and St. Luke’s Hospitals in Houston to host a night of conversation and education at the Houston Galleria on April 27th. Besides hearing from the panelists, patient coordinators from both hospitals will also be on hand to discuss personal situations and set up consultations. Registration for this event is now open and free of cost.

A letter from the Ovarian Cancer National Alliance (OCNA) CEO, Karen Orloff Kaplan, to the Washington Post explains the importance of the Defense Department’s Ovarian Cancer Research Program. Her letter, published March 18, 2011, is included below.

The Pentagon’s Valuable Cancer Research

I am one of the advocates prodding lawmakers to increase funding for the Defense Department’s Ovarian Cancer Research Program [“Cancer research is in Pentagon budget,” news story, March 13]. Advocacy groups and members of Congress have been strong champions of Pentagon-conducted cancer research for one reason: Defense Department cancer researchers get amazing results with minimal investment.

Cancer research performed by the Pentagon is unique in that it funds high-risk, high-reward projects that may yield nothing or a spectacular breakthrough. Many of these projects have gathered enough data to receive funding from the National Cancer Institute, taking the research even further. The Pentagon’s annual budget for ovarian cancer research is only $12 million, but it has yielded multiple discoveries that benefit women with the disease. One example is the OVA1TM test, which helps physicians determine whether a pelvic mass is benign or malignant. Another breakthrough is a compound that slows ovarian cancer growth.

Ovarian cancer is the most deadly gynecologic cancer, killing about 14,000 women annually. As Congress weighs additional budget cuts, I hope it will not sacrifice programs that have proved their worth.

Karen Orloff Kaplan, Washington
The writer is chief executive of the Ovarian Cancer National Alliance.

By Mary Grealy. An interesting comment was made today at the annual national health research forum sponsored by the non-profit organization Research! America, and it drove home the conflict lawmakers face in trying to balance deficit reduction against the need for quality healthcare and better preventive care.

Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that the ideal American, from a budget standpoint, “is one who dies at age 65 on the drive home from his retirement party.”  His comment gets to the heart of the budget conundrum.  If our healthcare system takes steps to help people live longer in their retirement years, then they consume more Social Security and Medicare resources.

Yet, as Frieden also said, we should all be able to agree to the societal goal that “Americans are better off not dead.”

There are some important points here.  First, that there is not necessarily a perfect alignment between budgetary goals and the imperative to have a healthy population, that funding for medical research and the effort to prevent and cure disease should not be viewed in the same vein as other areas of discretionary spending.  And, second, as Frieden also pointed out, investments in disease prevention do not always fit into the neat, tidy 10-year window that Congress and federal budgeters like to use to score spending, that health prevention measures can sometimes take 20 or 30 years to fully assess their return on investment.

At the same Research! America event, former Congressman Mike Castle said that the need to contain Medicare and Medicaid costs will be one of the major campaign issues in the 2012 elections.  No doubt he’s correct, but let’s hope we hear office holders and candidates provide some creative solutions on how to curb cost growth while still achieving the greater objective of keeping Americans alive and healthy.

First posted on the Prognosis Blog on March 15th.

The following is a guest post by Sandra Phillips Sperry and Caryl Mahoney. Sandra Phillips Sperry, MPA, APC, RN, CMC, FACHE is the Principal & EVP of Management Transitions a health care transition management firm and Founder & CEO of Connect2Care America, LLC an internet based health care advocacy service established in 2010. She is a senior healthcare executive with over 20 years of diverse experiences in hospital operations, financial management, clinical integration, business development, and hospital facilities planning and design. Caryl Mahoney has extensive executive experience in Human Resources, Organizational Development, Strategic Planning, Employee Relations, Coaching and Communications.Caryl’s experience includes healthcare management as a senior executive, consultant to Fortune 100 corporation and the intelligence community of the federal government.

By Sandra Phillips Sperry and Caryl Mahoney. An unavoidable fact of business life is that the workplace is fraught with the potential for conflict. High performing organizations and effective teams must attend to not just the work that gets done, but how it gets done.  Unfortunately, intimidating and bullying behaviors have always been an unwelcome part of the healthcare workplace.  Unresolved, these toxic behaviors can lead to debilitating consequences such as lowered morale and productivity and loss of quality staff.  These toxic behaviors effect performance and are evidenced among peers, patients towards staff, staff towards patients, and throughout the matrix of the organization.  Toxic behavior or personalities can be defined as exhibiting counterproductive work behaviors that demoralize and incapacitate individuals, teams, and organizations.  These behaviors reflect a disconnect between stated organizational values and performance.  The behaviors are often tolerated because an individual is viewed as talented, in a position of power, a significant contributor to the bottom line, a “driver” of other’s performance or simply affected by situational stress.  There is significant evidence that toxic behaviors are no longer just an irritant to can be put up with but are serious disruptions that contribute to decreased productivity, safety and increased cost.  The nature and form of bullying is often unclear in the workplace.  Overt bullying behavior is more easily recognized in a schoolyard, but can be masked or more subtle in the workplace.  Dealing with bullying in the workplace is a compelling reason for the broadening of organizational goals and culture.  Developing individual and group awareness can result in positive organizational outcomes and wise personal and professional relationships.

The Institute for Safe Medical Practices (ISMP, 2010) survey findings found that 49% of health care professionals felt that intimidating behaviors had altered their ability to manage medication orders.  The Joint Commission for the Accreditation of Hospitals (JCAH) found that 70% of sentinel events were directly correlated with poor communications that are the result of negative, toxic behavior and bullying in the environment.  Findings were of such significance that standards for the management of bullying and toxic behavior were established (JCAH, 2009).  Another example is the work of Kusy and Holloway (2009) who found that 64% of individuals surveyed from a range of industries responded that they were currently working within a toxic situation or with a toxic individual.   Unprecedented interest in workplace bullying in the U.S. and globally has arisen out of the recognition that bullying, intimidation and other toxic behaviors have severe consequences and are on the rise first in our families, then in the education system, and finally in the workplace. (more…)

Edward Grandi

“Women need their sleep,” says Edward Grandi, Disruptive Women’s March Man of the Month. Grandi is the Executive Director of the American Sleep Apnea Association (ASAA), the leading non-profit organization dedicated to educating the public and the medical community about sleep apnea, supporting those in treatment for the condition, and advocating on behalf of patients and their families.

Grandi discussed a common misperception he felt Disruptive Women readers should be aware of – obstructive sleep apnea (OSA) is an ailment of middle-aged, overweight men. While it is true that twice as many men as women have OSA, after menopause women are affected in the same numbers as men.

OSA is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. Sleep apnea is as common as adult diabetes, affecting more than twelve million Americans, according to the National Institutes of Health. Sleep apnea can strike anyone at any age, even children. Because of the lack of awareness by the public and health care professionals, the vast majority of OSA cases remain undiagnosed and therefore untreated.

The misperception that women are not as prone to OSA as men has dangerous consequences. Women who complain to their health care providers about being tired, putting on weight, losing interest in sex, are often misdiagnosed with depression. They are then likely to be prescribed medications that can only make their situation worse.

Providers unfamiliar with sleep apnea don’t ask the obvious question: “Do you snore?” Other pertinent questions that health care professionals should pose: “Do you have unrestful sleep? Do you awaken with a headache? Do you find yourself making frequent trips to the bathroom at night?”

While snoring itself is not necessarily diagnostic of sleep apnea, in combination with the symptoms mentioned above, it indicates that there is a problem that requires treatment. Sleep apnea does not just rob women of much-needed sleep. It has serious health consequences, such as heart disease, diabetes, and yes, depression.

There are different treatment options for OSA. The right option is determined by the severity of your sleep apnea (from a sleep study), the physical structure of your upper airway, and other aspects of your medical history. The various options are positional therapy, weight loss, avoidance of alcohol and other CNS depressants, oral appliances, surgery, and Positive Airway Pressure therapy.

The takeaway from all this, Grandi says, is “Women should be aware that they can be affected by OSA which luckily is very treatable. Know the symptoms and be prepared to question your provider if they don’t consider OSA as a diagnosis. Bottom line…we all need sleep.”

The ASAA is the leading source of information about sleep apnea diagnosis and treatment. Disruptive women everywhere are encouraged to visit their newly updated website for more information.

By Hope Ditto. The passing of the Affordable Care Act was intended, at least in part, to make life easier for those living with chronic medical issues –ensuring them access to affordable insurance despite their “pre-existing condition” status.

While the passage of ACA last March has improved this for many people in this situation, there are still condition-specific problems regarding insurance coverage and reimbursement that desperately need addressing.

Adi Renbaum

I recently sat down with Adi Renbaum, Senior Vice President of Health Policy and Reimbursement for The Neocure Group regarding one such issue –addressing the need of nearly half of patients with diabetes who do not make a yearly trip to the ophthalmologist. How could this be accomplished? By allowing primary care physicians to perform eye exams for diabetes patients right there in their offices via retinal imaging (capturing a digital retinal photo) and transmitting the image to an ophthalmology-based reading center for review and feedback. Adi has, in one way or another, been involved in this issue for the past decade and has seen the highs and lows of the struggle to compel insurance companies to acknowledge the need, and cover retinal imaging exams performed by primary care providers, and then reimburse physicians for these exams at a reasonable rate.  What follows are all the gritty details of this particular issue summarized from my conversation with Adi.

Several big “political” issues facing the health care community today are tangled up in issue of getting more patients with diabetes to have primary-care based retinal exams:  diabetes health policy, remote monitoring services and telemedicine and physician reimbursement economics.  It is a complicated issue – but here is what it boils down to:  People with diabetes type I or diabetes type II as a population, are at risk of developing retinopathy, which can lead to blindness if not caught in time (caught relatively early, it can be treated via laser surgery, and patients can go on living a normal life, enjoying normal vision).  For this reason, every major health organization supports diabetes guidelines that recommend annual examinations by a qualified eye care professional (American Diabetes Association, American Academy of Clinical Endocrinologist; American Academy of Ophthalmology, Veterans Administration, Indian Health Service and CMS, to name a few).  Unfortunately, the reality is that the majority of people with diabetes do not follow through on this, even while they receive all other recommended diabetes examinations.  So, what is it about the retina exams?  Many hypothesized that it was the necessity of visiting an ophthalmologist, because it required a different appointment at a different location on a different date and time.  So, if it was somehow possible to combine the retinal exams in with annual primary care visit, it seems reasonable that a greater percentage of people with diabetes would complete the yearly retinal examination.  The plan to achieve this — give primary care providers the ability to perform retinal imaging examinations in their own offices.  How would this work?  By allowing these providers to take digital retinal images, which would then be electronically transmitted to a centralized reading center, where readers trained in diabetic eye disease would assess and grade the images and send results back to the primary care provider.  One visit at one time on one day to one provider in one office would yield all the medical results the provider needs to ensure the patient is managing their diabetes well, or to direct the patient to additional treatment.  Sounds pretty cool, and pretty simple, right?

Medical experts have given this solution this seal of approval, it received FDA approval process with no problems and the American Diabetes Association changed their guidelines to include retinal imaging, when reviewed by an eye care professional,  as an acceptable form of diabetic eye exam.  All of this happened in the early 2000s.  So this should be a done deal, available in a majority of primary care offices that treat patients with diabetes, saving thousands of people from a terrible fate of vision loss and blindness every year, right? (more…)

The following is a guest post by Elizabeth Madigan, PhD, RN, FAAN who is a professor of nursing at the Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, Ohio. She has been an RN for more than 30 years and has spent the last 14 years as a researcher focused on quality and safety in health care, primarily home health care.

By Elizabeth Madigan. There really is no low hanging fruit in safe health care. The “hurray for checklists in health care” mantra that has been recently promoted in the popular media, misses a couple key points—it’s not the checklist that improves the outcomes—it’s the change in the organizational culture and where that cultural change happens. Anyone who has worked in quality improvement or performance improvement long enough knows the familiar story of a blip of improvement in patient outcomes following one simple intervention that is not maintained and often falls to worse when QI and PI attention moves to another problem. Persistent changes come about through changes in organizational beliefs and operations. The Institute for Healthcare Improvement has identified the importance of the engagement of key leadership in bringing about organizational change, but it also requires the frontline workers, regardless of the health care setting, who do the heavy lifting in making changes in day-to-day work practices. The implication of the popular media is that if the health care industry would adapt the same successful and (oh by the way) very simple approaches (the checklists) from aviation or nuclear power, we would see big and persistent improvements in patient safety. Here’s the rub: on the other end of that checklist is a person, not an airplane or a nuclear plant. And people, particularly people seeking health care, are complicated in ways that airplanes and nuclear plants are not and deserve a provider who recognizes their unique perspectives, needs, backgrounds and current status. The other part of the story from both the aviation and nuclear power industries is that the successes associated with the checklists resulted from changes in the organization as well. For example, in the aviation industry, co-pilots were encouraged to and actually empowered to question the pilots about safety issues. Can using checklists help improve health care quality and safety? Should checklists be integrated in some parts of health care? Absolutely on both counts. Are checklists low hanging fruit that the health care industry has chosen to ignore because health care providers are (pick one) greedy, not caring, resistant to change or not smart enough to recognize? Not a chance. All of health care is under increased scrutiny for quality and safety outcomes; implying that the industry and all the research to date has missed the simple “silver bullet” solutions is not helping and is actually counter-productive to addressing the complex issues here.