Justifying mediocre work

Another great post from Seth Godin. How does your doctor and stroke hospital justify even less than mediocre work? Or complete failure like the following?

Full recovery using tPA is only 12%.

Full recovery after stroke rehab is only 10%.

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

 

 

 

 

Justifying mediocre work

The list of reasons is nearly endless.
We need all of them to explain the shortcuts, phone-ins and half-work that we’re surrounded by.
All of them are pretty good reasons too. We’re in a hurry, the system is unfair, the market demands it, no one will notice, it’s not my job, I was handed a lousy spec, the materials are second-rate, the market won’t pay for quality, competition is cutthroat, my boss is a jerk, it’s actually pretty good, no one appreciates the good stuff anyway…
On the other hand, there’s only one way to justify work that’s better than it needs to be: Because you cared enough.  Obviously our stroke associations don't care enough to solve stroke.

Three kinds of corporate mediocrity - applied to stroke

Brilliant analysis from Seth Godin. Which way are our fucking failures of stroke associations doing it? And our stroke hospitals and doctors? And our boards of directors don't see this and fire the lot?

Three kinds of corporate mediocrity 

Uncaring mediocrity, in which employees have given up trying to make things better
Focused mediocrity, in which the organization is intentionally average
Accidental mediocrity, in which people don’t even realize that they’re not delivering excellence.
Uncaring mediocrity is the most common form, and it often accompanies scale. It’s the accidental outcome that comes from trying to emulate an organization that’s focused on its mediocrity.
The mechanization and industrialization of cottage industries (like hotels, restaurants and healthcare) has led to a convenient homogenization for many. It means you can travel around the world and find better than decent accommodations and safe food, all at a fair price.
But it also means that most of the people working in these entities are treated like interchangeable cogs. They have no say at all about how things are done (or at least feel that way) and so they’ve emotionally checked out. It’s easier that way.
The products and services revert to the mean, sucking the humanity out of not just the people who work there, but from the interactions the customers have as well.
If you have a lousy meal at a real restaurant, the owner could hear from you and, it’s likely, not only fix it, but get back to you. Have a lousy experience with a Host, a Taco Bell, or a JW Marriott, though, and the odds are that the individual who reads your review has never even visited the place you’re talking about, and certainly doesn’t care enough to do anything about it.
One of the promises of the worldwide behemoth corporation was that reliability and quality was assured. The downside is that the chances that an internal insurgent can make things better go down.
As we see so many organizations seek to emulate the scale, influence and profits of the Fortune 100, it’s worth remembering that uncaring mediocrity shouldn’t be a north star.
Focused mediocrity is different. It’s intentional. It’s the act of chasing the banal, so that the largest possible number of people will be satisfied enough not to complain. This is the sieve of deliverability and the sword of mass.
The third kind of mediocrity happens when someone is uninformed. When they’re too busy or too lazy to pay attention to the taste of those they seek to serve or they don’t care enough to deliver it with quality and humanity.
At least have the guts to be mediocre on purpose.

Enriched environments in stroke rehabilitation - Eventbrite

This should be totally unnecessay since a protocol should have been written up and distributed worldwide from this in 2011. But baby steps to get stroke rehab to some semblance of mediocrity.

This enriched environment talked about by Dr. Dale Corbett in 2011?

 

Enriched environments in stroke rehabilitation - Eventbrite

Date and Time

Sat 1 December 2018
09:30 – 15:30 GMT

Add to Calendar

Location

Basement Lecture Theatre
The Clinical Neuroscience Centre
33 Queen Square
London
WC1N 3BG
United Kingdom
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Description

London ACPIN are delighted to present a fantastic study day with Heidi Janssen, exploring environmental enrichment (EE) in acquired brain injury.

Heidi Janssen is a Physiotherapist and Researcher at the Hunter Medical Research Institute, Newcastle, NSW, Australia.

Heidi will be speaking about about the theory of enriched environments, animal models, evidence base, in community and inpatient environments. Click HERE for link to article

This study day aims to;

Provide evidence in animal models of acquired brain injury regarding the anatomical, molecular and behavioural effects of exposure to enriched environments.

Outline the main hypotheses concerning the underlying mechanisms of effect

Discuss barriers and enablers to activity and implementing enriched environments from both perspective of patient with ABI and staff, based on delegates’ experiences and research findings.

Present published evidence for the use of enriched environments with people recovering from or living with an ABI: in the Acute, Sub-acute and Chronic stages

09:00 registration for 9:30 start

Head of stroke programme condemns HSE inertia - Ireland

 The whole world of stroke is condemned to less than mediocrity, INCOMPETENCE, and the poor outcomes are visited upon the stroke survivors, not the stroke medical world. 
https://www.irishtimes.com/news/health/head-of-stroke-programme-condemns-hse-inertia-1.3200224

Prof Joseph Harbison: ‘No one ever got fired in HSE for maintaining the status quo’

Widespread inertia in the health service is leaving Ireland unprepared to cope with a huge increase in the number of stroke patients over the next decade, the outgoing head of the national stroke programme has warned.

In a scathing review of progress in the programme he has led since 2010, Prof Joseph Harbison is strongly critical of resistance to change within the Health Service Executive.

Doctors have encountered “huge problems” progressing the aims of the programme, he says. Having been informed at the outset that implementation was “key” to the success of the programme, they were told by the HSE this was not their responsibility.

Crucial elements of the programme, even those fully supported by HSE management, were frequently ignored at local level, according to his review, seen by The Irish Times. “Like in many organisations, the ‘status quo’ can be terribly hard to change and ‘implementation-free zones’ can be encountered, but the status quo in stroke is often very poor and inadequate.”

Third biggest killer

Stroke is the third biggest killer of Irish people after heart disease and cancer, and the single biggest cause of severe physical disability. Up to 8,500 people a year suffer a stroke, and more than 800 die from the condition. The incidence of stroke is set to rise by up to 50 per cent over the next decade as the population ages.

Elaborating on his remarks, Prof Harbison told The Irish Times, “No one ever got fired in the HSE for maintaining the status quo. You get in more trouble doing something and screwing up than for doing nothing, which allows you to evade responsibility when things go wrong.”

• Stroke care: Condemned to mediocrity
• Stroke treatment a rare Irish health success but progress could be lost
• From smart beds to smart sticks: The health technology transforming our lives

“We realised at a very early point that if we were not willing to implement, to agitate and pressurise people, little would be achieved.” the review says. “With current HSE structures, implementing and managing change is extremely challenging. Even when a plan is in place and resources found, it is our experience it is a mistake to assume that this will automatically happen without continued attention, intervention and agitation.”

It took three years to appoint 40 staff, he points out. “We have even found ourselves resorting to external political pressure to try to persuade hospitals to open stroke units.”

Six out of 27 hospitals have no stroke unit, the review points out. These are also the hospitals with the highest death rates.

Stroke represents a huge and looming challenge for the health service, Prof Harbison says. “We cannot properly cope with the numbers of stroke patients currently requiring treatment. The majority of patients suffering stroke in Ireland still cannot access what would be considered basic care in most developed countries.”

National clinical strategy

A separate national clinical strategy for stroke, such as there is for cancer, is now needed, he believes.

Prof Harbison says that although outcomes have improved substantially since the national stroke programme was developed, they are still worse than in comparable European countries.

“Demographic changes will result in a huge increase in stroke numbers in the next 10 to 15 years. Ireland is currently unprepared for this and I am not aware of any contingency plans in development.”

The existing stroke programme is inadequate to meet the demands of a condition costing the country €1 billion a year, he says.

The existing programme has shown that outcomes can be improved in the absence of resources with effort, reorganisation and a willingness to pull together. “However, there is a point where even innovation and imagination is insufficient. We cannot appropriately discharge patients who still need rehabilitation where there is nobody to provide rehabilitation in the community.

“We cannot expect good outcomes for stroke patients where the basic structures and systems necessary to achieve these are simply absent. These are not problems we can innovate past.”

 

Big improvements in performance follow changes to Gwent stroke services

Absolutely nothing on results, this article told you nothing about how good this hospital is getting you to full recovery. Improvements in care mean nothing if results don't improve. Are you even measuring results? This is what incompetent/mediocre organizations focus on; processes, not results. 

Big improvements in performance follow changes to Gwent stroke services

CHANGES to the way stroke services are provided in Gwent are delivering big improvements in the care of patients in hospital and after discharge, early figures show.
A new stroke care pathway for patients was launched in January and a single hyper-acute stroke unit - at the Royal Gwent Hospital - began admitting new patients from across Gwent.
And stroke service performance has since improved against a range of UK standards measuring factors such as the time it takes for patients to be admitted, to receive a CT scan, and to be assessed by stroke consultants and nurses.
Lengths of stay in hospital, either in the hyper-acute unit, or in a specialist acute stroke rehab ward are also falling, with the work of a new community neuro-rehab service helping patients cope at home.
New figures indicate that direct admission to a stroke unit within four hours was achieved for 66 per cent of patients in Gwent in March - up from less than 20 per cent in November - and the figures for April and May are above 70 per cent.
Close to 95 per cent of stroke patients in May will have received a CT scan within 12 hours, up from 71.4 per cent in April.
At the Royal Gwent, during the past 12 months, 72 per cent of patients have been assessed by a consultant within 24 hours. But during January-March this year, performance has been at 99 per cent, the best in Wales.
Assessments by a stroke nurse within 24 hours are currently running at 100 per cent.
Lead stroke physician Dr Yaqoob Bhat is delighted with the improvements and believes there is more to come.
"Providing a uniform service for everyone is vital, and we now have one hyper-acute stroke unit and a seven-day service," he said.
"It is very hard work, very challenging, but we are heading in the right direction, improving the service."(Are you improving the results?)
He added that having a stroke specialist in the emergency department means assessments can be made quickly, speeding up the pathway for procedures such as scans and reviews.
If patients are considered medically stable enough to be discharged from the hyper-acute unit or a stroke rehab ward, they come under the care of the community neuro-rehab service.
This can involve input from physiotherapy, occupational therapy, dietetics, speech and language therapy, nursing and psychology.
After 74- year-old Jean McCook, of Alway, Newport, had a stroke last December, she could not initially move her legs and arms, and was affected down her left side.
"Jean was quite severely affected and when she came home she was having to sleep downstairs," said Adele Griffiths, acting clinical manager for the service.
"We can come in on a daily basis or once or twice a week. It's about working with people to reconstruct meaningful lives."
Mrs McCook said the team has helped her get her mobility back more quickly, and helped her confidence too.
"They've been fantastic," she said.

Mediocrity

An affliction that seems to have settled on our stroke associations. Between the ASA and NSA they seem to be working on who can be the most bland in the race to the bottom. WSO is even below those two.
This quote from Seth Godins book, Poke the Box is instructive.
Mediocre services or products do what they are supposed to do, but have set the bar so low that it's hardly worth the energy to cross the street to buy them.