Good Judgment Comes From Experience…
by Chris Langston
Thursday, January 26, 2012 16:14
…and Experience Comes from Bad Judgment
In Tuesday’s post, I gave full rein to my fears about the possible faults and flaws with current federal Medicare quality improvement demonstrations. While I stand by what I wrote, I felt the immediate guilt of being caught stones in hand in a pretty drafty glass house.
Over the last 15 years I have participated in or directed (from the funder side) more projects than I can recall, efforts to demonstrate and disseminate improved models of care. And while I will stack the Foundation’s record up to anyone’s, my contention that most things don’t work unfortunately also applies to us. Most of the demonstration efforts we have supported have failed to influence practice widely, therefore failing to meet OUR objective for them: to improve the health of older Americans.
During those 15 years we have learned more and more about what is needed to drive change in health care delivery, one painful lesson at a time. We have learned that good ideas are not enough. Even those ideas that have gone through the development and testing phase to successfully answer the question Does it work? still need to publicize their existence and set up technical assistance and tools for their adoption. They need conducive attitudinal, regulatory, and financial conditions under which they can grow and flourish. “Experiences” abound at every level. So, in the spirit of sharing lessons learned, here is a non-exhaustive list:


At least once a week for the last 10 years, I have probably said or written that our fragmented and myopic, episodically focused system of care doesn’t meet the needs of older adults with complex, chronic health problems. And if there is one growing aging issue that throws even more sand in the gears of what little systematic care we have, it’s dementia. In this week’s 
Shortly before the holidays, I had the privilege of speaking with geropsychiatrist and researcher Dr. Stephen Thielke, a recipient of the Paul B. Beeson Award, which is funded in part by the John A. Hartford Foundation. 

It seems like only yesterday that I met