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On May 6, 2018, Guess commented on Increasing Length of Stay :

I actually really liked Nicola s comment on setting very clear expectations with the patient. In fact, this gives me an idea of transforming the lenght of stay as a measure of performance to share with the patient. Indeed, many patients see our willingness to send them home as an economical pressure only. By setting the expectation in advance with the patient we can transform it as a common goal. Thanks for sharing the post and potential solutions.

On May 6, 2018, Guess commented on Optimized Care through Easy-to-Consult Protocols :

I am really interested in discussing this with you during the next module. I am also willing to implement such tool in the division of primary care I am in while considering patient reported outcomes as well like awellhealth propose. Thanks for sharing this post.

On May 6, 2018, Guess commented on New Innovation – Primary Care Models of Care :

Nice to see that these challenges are universal. Primary care models are being more and more considered as the solution for a high qualitz lower cost healthcare system. Yet, as you wrote fewer physicians embark now in primary care. Not that it is the absolute solution but Medical Home or Health Home [Maison de Sante] are one approach to favour not only the team/interpro based concept but to improve the access of the population to them. By making the Health home accountable of the health of a given population [usually defined by a geographic area] bz you may further improve the medical and cost outcomes.

Nice discussion. I would like to suggest two other KEY WORDS that might contribute to understanding the existing gap between investment and outcomes in some places and the efficiency in others. EDUCATION and INEQUALITIES. PROMOTION and PREVENTION are actually being implement (although without enough precision) and actually successfully used by SOME but NOT ALL. Depending on education level and socio economic situations the prevention messages make sense or not. Is eating apples and oranges instead of fast food the main daily life problem of all of us? Is having enough sleep hours an obession for all of us? Is having physical activity thrice a week the main weekly goal for all of us? Are we all living the enjoyable lives that prevent us the need to use addictive substances such as alcohol to forget the huge difficulties one can face? The problem is that as long as inequalities keep growing it counterbances prevention efforts and SUCCESS. Coming back to the data, the countries that perform best are the one with the lowest INEQUALITIES and highest EDUCATION levels. What about making a ‘Department of Disease Care’ accountable for improving the care of people with disease and investing in a ‘Department of Education and Equality’ to make it much more accountable for improving the population health overall not for some of us only.

On May 6, 2018, Guess commented on Physician :

Very interessting topic and discussion. We can see that the discussion slowly moved to sanction and inappropriate behavior and how to track them. For sure, it is important and challenging. Yet, in the beggining of the case it was mentionned “a new dialogue with physicians concerning changes in behavior and education”. I am particularly concerned about ways institution [hospital, clinic, medical university hospital, etc.] must adapt themselves to establish an appropriate sustainable dialogue with young physicians. The latter have new expectations and desires [work life balance, fun, democraty in decision, transparency, etc] and we depend on their willingness and work in our institutions. In that sense, I wonder whether one aspect of a new dialogue should not be revising our own procedures, not only telling young physicians what is a good physicians and what is not but also being told what is a good management style of good physicians *what about a “Language of Caring Physicians”.