Podcasts about bmj quality

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Best podcasts about bmj quality

Latest podcast episodes about bmj quality

Talking General Practice
How to ensure safe remote patient care in general practice

Talking General Practice

Play Episode Listen Later Feb 14, 2025 33:51


This week Emma speaks to GP and researcher Dr Rebecca Payne about what general practice can learn from the research she's been involved with on remote patient care.In this conversation Rebecca talks about her research into patient safety in remote consultations, what GPs can do to ensure remote consultations are safe and lessons for practices about the systems that they need to have in place. She also talks about the wider implications of this research including what it means for training and education.Rebecca also explains her research into how the shift to remote care has impacted on quality in primary care, what this could mean for the future of general practice - and what she hopes policymakers will take from the findings.This episode was presented by GPonline editor Emma Bower. It was produced by Czarina Deen.Useful linksPatient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis, published in BMJ Quality and SafetyTeaching patient safety in remote consultationsProject resources from the Remote by Default study including competencies for staff and advice for patientsHow to ensure safe remote consultations in your practice - from GPonline Hosted on Acast. See acast.com/privacy for more information.

Wissensnachrichten - Deutschlandfunk Nova
Kolumbus, Wirtschaftsnobelpreis, Lebenserwartung

Wissensnachrichten - Deutschlandfunk Nova

Play Episode Listen Later Oct 14, 2024 6:33


Die Themen in den Wissensnachrichten: +++ Kolumbus kein Italiener, sondern Spanier? +++ Gewinner des Wirtschaftsnobelpreises erklären Wohlstand +++ Steigerung der Lebenserwartung lässt nach +++**********Weiterführende Quellen zu dieser Folge:Cristóbal Colon fue judío y de esta zona de España. Mira el documental 'Colón ADN, su verdadero origen', rtve, 13/10/2024The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel, The Nobel Price, 2024, 14.10.2024Implausibility of radical life extension in humans in the twenty-first century, Nature Aging, 07.10.2024The relentless push for productivity misconstrues how our brains work, NewScientist, 9.10.2024Artificial intelligence-powered chatbots in search engines: a cross-sectional study on the quality and risks of drug information for patients, BMJ Quality & Safety, 1.10. 2024.Alle Quellen findet ihr hier.**********Ihr könnt uns auch auf diesen Kanälen folgen: Tiktok, Tiktok und Instagram.

Empowered Athlete Podcast
The Freedom of Structure

Empowered Athlete Podcast

Play Episode Listen Later Jul 1, 2024 38:29


In this episode, Kari Schneider delves into the surprising ways that structure can bring more freedom and joy into our lives. Through personal anecdotes and practical examples, Kari explores how small changes in daily routines can lead to increased efficiency, better decision-making, and enhanced well-being. Main themes include: The power of morning routines. How structured processes improve productivity and reduce stress. The emotional benefits of having clear guidelines. Practical tips for implementing structure in personal and professional life. Highlighted benefits: Structured processes can increase operational efficiency by 30% (Deloitte, 2022). Using checklists in healthcare reduces surgical complications by 23% (BMJ Quality & Safety, 2019). Key takeaway: Embracing structure can help you "have your own back," ensuring you are set up for success in all areas of life. The Empowered Team is your ticket to your next level - learn more via the link below: https://bit.ly/TheEmpoweredTEAM

Pharmacist's Voice
ISMP's Targeted Medication Safety Best Practices for Community Pharmacy with Matt Grissinger, RPh, FISMP, FASCP

Pharmacist's Voice

Play Episode Listen Later May 31, 2024 43:17


Matt Grissinger, RPh, FISMP, FASCP is the Director of Education at the Institute for Safe Medication Practices (also known as ISMP).  During our conversation, we talk about ISMP's Targeted Medication Safety Best Practices for Community Pharmacy first.  Then, we talk about how to report an error, CPE available from past ISMP webinars, adding education on operations to the pharmacy school curriculum, and more.  This is a great episode for any pharmacist, pharmacy student, pharmacy technician, or pharmacy owner.  Medication Safety is important.     Thank you for listening to episode 280 of The Pharmacist's Voice ® Podcast!   To read the FULL show notes, visit https://www.thepharmacistsvoice.com/podcast.  Select episode 280.   Subscribe to or follow The Pharmacist's Voice ® Podcast to get each new episode delivered to your podcast player and YouTube every time a new one comes out!     Apple Podcasts   https://apple.co/42yqXOG  Spotify  https://spoti.fi/3qAk3uY  Amazon/Audible  https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt   Bio (May 2024) Matthew Grissinger, RPh, FISMP, FASCP is the Director of Education at the Institute for Safe Medication Practices (ISMP). He first joined ISMP in 2000 as an ISMP Safe Medication Management Fellow. Prior to joining ISMP, he served as a home care and long-term care pharmacy surveyor for the Joint Commission. He was project leader for the Hospital and Healthsystem Association of Pennsylvania (HAP) Hospital Improvement Innovation Network's (HIIN) Adverse Drug Event (ADE) Project, a collaborative project engaging healthcare organizations to reduce and prevent patient harm from the use of anticoagulants, insulins, and opioids. He has published numerous articles in the pharmacy literature, including regular columns in P&T and is a journal reviewer for a number of publications including the Joint Commission Journal on Quality and Patient Safety, Pharmacoepidemiology, Journal of Managed Care and Specialty Pharmacy, BMJ Quality and Drug Safety, and Annals of Internal Medicine. He is a chapter contributor to a textbook published by McGraw-Hill entitled Pharmacy Management: Essentials for All Practice Settings, Essentials of Nurse Informatics, Remington: The Science and Practice of Pharmacy, and Medication Errors. He is recently completed the Just Culture certification course. Mr. Grissinger serves as the Chair for the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), and Co-Chair of the National Quality Form (NQF) Common Formats Expert Panel. He is also on the Faculty Advisory Board for the Pharmacy Learning Network (PLN) and the Publications Advisory Board for Davis's Drug Guide for Nurses. He also served on the WHO Focus Group on Measurement Tools for Medication Safety, United States Pharmacopeia's (USP) Safe Medication Use Expert Committee from 2005-2010, the FDA Proprietary Name Review Concept Paper workshop panel in 2008, FDA Naming, Labeling, and Packaging Practices to Minimize Medication Errors workshop panel in 2010 and the Joint Commission Home Care Compounding Pharmacy Technical Advisory Panel in 2013. He is also an adjunct assistant professor for Temple University School of Pharmacy. Mr. Grissinger received a BS in Pharmacy from the Philadelphia College of Pharmacy and Science and is a fellow of the Institute for Safe Medication Practices as well as the American Society of Consultant Pharmacists.   Subscribe to or follow The Pharmacist's Voice ® Podcast to get each new episode delivered to your podcast player and YouTube every time a new one comes out!     Apple Podcasts   https://apple.co/42yqXOG  Spotify  https://spoti.fi/3qAk3uY  Amazon/Audible  https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt   Links from this episode Matt Grissinger on LinkedIn https://www.linkedin.com/in/matthew-grissinger-63231ab/  ISMPs new website

Simulcast
185 Simulcast Journal Club May 2024

Simulcast

Play Episode Listen Later May 9, 2024 42:38


Rating and ranking debriefers and debriefing tools. Systematic reviews in simulation. Clinical debriefing. Simulation saving stroke patients. Contributions and transformation from Taiwanese SPs. Another great month on Simulcast.  The articles: -  Guimbarda, N et al. A Comparison of 2 Debriefing Rubrics to Assess Facilitator Adherence to the PEARLS Debriefing Framework. Simulation in Healthcare: April 24, 2024  Phillips EC, et al. Systematic review of clinical debriefing tools: attributes and evidence for use. BMJ Quality & Safety 2024;33:187-198.  Aljuwaiser, S. et al. Evaluating the effects of simulation training on stroke thrombolysis: a systematic review and meta-analysis. Adv Simul 9, 11 (2024).  Ho, Yun-Chi et al. Older Taiwanese Volunteers as Standardized Patients: Service Motivation, Identity Formation, and Internal Transformation. Simulation in Healthcare: November 13, 2023    Happy listening!    And… Date Claimer  Simulation Reconnect is on again   Bond University, Wednesday 27th November. Details and early registration to be released shortly. 

The Aural Apothecary
6.6 Dr Catherine Labinjoh - Realistic Medicine & The Drug Portal to The World…

The Aural Apothecary

Play Episode Listen Later Apr 12, 2024 57:16


Did you know that according to the OECD, a fifth of healthcare costs adds no value to patient care? This, along with the drive for shared decision making is the drive behind Scotland's ‘Realistic Medicine' campaign. We chat to Dr Catherine Labinjoh, Consultant Cardiologist and National Clinical Advisor to the Realistic Medicine programme about the campaign.One of the main aims of Realistic Medicine is for people using healthcare services and their families to feel empowered to discuss their treatment fully with healthcare professionals, including the possibility that a suggested treatment might come with side effects – or even negative outcomes. Everyone should feel able to ask their healthcare professional why they've suggested a test, treatment or procedure, and all decisions about a person's care should be made jointly between the individual and their healthcare team. This is a theme we have covered often on the podcast and so we explore with Catherine what this means for how healthcare is being delivered in Scotland.In our micro-discussion, we talk about a recent article in the New Statesman “I can't find a diagnosis for Ted – but he can diagnose modern medicine”. Ted explains how ““Everything's decided on thousands of people…. that can't possibly tell you what to do for any individual.” https://www.newstatesman.com/politics/health/2024/03/i-cant-find-a-diagnosis-for-ted-but-he-can-diagnose-modern-medicine In tandem we discuss a recent BMJ Quality & Safety about the coordination of care for patients with heart failure.  https://qualitysafety.bmj.com/content/33/4/232?ijkey=d1d5807c3fd3a9dff0a2cb225570adea3a3bc139&keytype2=tf_ipsecsha In a truly memorable conversation, we also pick up on the role of a ‘single-organologist' versus a generalist – “the patient is more than the organ of your choice…” We seek out that “elusive unicorn, the time rich specialist generalist!” As with all of our guests, Catherine shares with us a Memory Evoking Medicine, a career anthem and book that has influenced her life.Our new website is now live https://www.theauralapothecary.com/ and as well as being a searchable database of all episodes, we will be uploading transcripts and extra content for your enjoyment and education. Have a look and let us know what you think! Our latest blog posts talks about our first live public show - ‘Music, Memories and Medicines' - have a read here; https://www.theauralapothecary.com/blog/the-three-apothecaries-music-medicines-and-memories/. To get in touch follow us on Twitter and Instagram @auralapothecary or email us at auralapothecarypod@gmail.com . Don't forget to rate us and comment wherever you have got this podcast from. You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg You can view the Aural Apothecary Library here;  https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Clinical Conversations
Clinical Debriefing (08 Apr 2024)

Clinical Conversations

Play Episode Listen Later Apr 8, 2024 36:11


In this episode, Dr Kat Ralston chats with Dr Emma Phillips about clinical debriefing. They talk about what clinical debriefing is (and isn't) and why we should be incorporating this into our everyday work. They explore when and how to facilitate a clinical debrief and share tips on how we can embed clinical debriefing into our practice. Dr Phillips is an Anaesthetic Registrar working in South-East Scotland. She completed a simulation fellowship at Scottish Simulation Center in 2018 and maintains active role in simulation based education. Dr Phillips completed a Master's in 2022 with a dissertation examining attributes and evidence for use of clinical debriefing tools. She has also published and presented on a number of topics including non-technical skills in simulation, clinical debriefing, educational innovations and airway management. Dr Kat Ralston is a Geriatric Medicine Registrar and member of the RCPE Trainees and Members' Committee, currently working in Edinburgh. -- Useful Links -- Kolbe M, Schmutz S, Seelandt J C, Eppich W J, Schmutz J B. Team debriefings in healthcare: aligning intention and impact BMJ 2021; 374 :n2042 - https://doi.org/10.1136/bmj.n2042 Phillips EC, Smith SE, Tallentire V, et al. Systematic review of clinical debriefing tools: attributes and evidence for use BMJ Quality & Safety Published Online First: 28 March 2023. - https://doi.org/10.1136/bmjqs-2022-015464 Petrosoniak A, Gabriel J, Purdy E. Stop asking if it works, start making it happen: exploring barriers to clinical event debriefing in the ED. CJEM. 2022;24(7):673-674. - https://doi.org/10.1007/s43678-022-00396-9 Walker CA, McGregor L, Taylor C, Robinson S. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med. 2020;7(4):259-266. - https://doi.org/10.15441/ceem.19.086 Wolfe et al. (2014) Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes - https://doi.org/10.1097/CCM.0000000000000327 Rose & Cheng (2018) Charge nurse facilitated clinical debriefing in the emergency department - https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/charge-nurse-facilitated-clinical-debriefing-in-the-emergency-department/CC224433937ACBA849491A66EBC9593D Ralston et al. (2024) Overcoming barriers to clinical event debriefing through simulation - https://doi.org/10.1111/medu.15359 Recording Date: 16 February 2024 -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: cme@rcpe.ac.uk

Simulcast
182 Simulcast Journal Club February 2024

Simulcast

Play Episode Listen Later Feb 6, 2024 41:21


Mental practice, designing and testing clinical pathways/ cognitive aids and supporting communities of practice in healthcare. Another great month on Simulcast.  The articles: -  Riggs, J., McGowan, M. & Hicks, C. Dream one, do one, teach one: a mental practice script for bougie assisted cricothyrotomy. Can J Emerg Med (2023).   Marshall SD, Sanderson P, McIntosh CA, Kolawole H. The effect of two cognitive aid designs on team functioning during intra-operative anaphylaxis emergencies: a multi-centre simulation study. Anaesthesia. 2016 Apr;71(4):389-404.   Woodward M, Dixon-Woods M, Randall W, et al. How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study. BMJ Quality & Safety Published Online First: 12 December 2023  Symon B. and Walker K. Learning in healthcare virtual communities of practice; let's rethink how we connect and grow. 2023. International Journal of Healthcare Simulation.    Happy listening    vb 

KeyLIME
[449] Re-Run Ep 109 Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups

KeyLIME

Play Episode Listen Later Jan 23, 2024 13:52


In this episode: Jason chose a paper that asks ‘Is bias in the eye of the beholder?' Bias alert -  Jon Sherbino is one of the authors ;) Length: 21:45 min Authors: Zwaan L, Monteiro S, Sherbino J, Ilgen J, Howey B, Norman G. Publication details:  Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups. BMJ Quality and Safety. 2016 Jan;[ePub ahead of print] PubMed Link 

Kindness, Curiosity and Comfortable Shoes

Compilation Episode 2This is a bonus longer episode; a compilation of the episodes 4-10 of the podcast so you can listen to them back-to-back.1:54 Episode 4 - SleepWe all need it and never get enough of it. This episode focuses on those intrusive thoughts about work as you are trying to get to sleep.Easy to read articles about getting better sleep:https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/self-help-cbt-techniques/#articleshttps://www.headspace.com/sleep/how-to-sleep-better14:57 Episode 5 - ChangeIn this episode I talk about change in healthcare and why I think it is important to embrace it, and hopefully make it easier to cope with.Research showing why we should get involved in changes in healthcare from Nilsen et al in BMC Health Services Research in 2020: https://rdcu.be/dmvgDArticle from Forbes magazine about how to cope with change in the workplace by Caroline Castrillon published in Feb 2020: https://www.forbes.com/sites/carolinecastrillon/2020/02/26/how-to-cope-with-change-in-the-workplace/24:43 Episode 6 - ComplaintsAs healthcare staff we will always have to respond and react to complaints in some form.An example of a healthcare complaints analysis tool from the London School of Economics, published in BMJ Quality and Safety Journal in 2015: https://healthcarecomplaintsanalysis.com/And an article about how to handle complaints from Practice Builders in 2019: https://www.practicebuilders.com/blog/8-ways-to-handle-patient-complaints-and-defuse-their-frustrations/39:06 Episode 7 - JoyJoy is a feeling of great pleasure and happiness. Should we ever feel this in healthcare?The Institute for Healthcare Improvement has this web page with lots of thoughts on joy at work.https://www.ihi.org/Topics/Joy-In-Work/Pages/default.aspx49:34 Episode 8 - FeedbackConstructive feedback will help us work better in healthcare and help us understand our blindspot. It's good to be curious about feedback and what others think to help us grow. If you are giving feedback to others, do this with kindness.57:36 Episode 9 - LegacyWhat is your legacy at work?A great article about role-modelling in connection to fostering children but very relevant to healthcare by Marilyn Price-Mitchell:https://www.rootsofaction.com/role-model/#1:07:31 Episode 10 - NightsAnd more specifically night shifts.Most workers in healthcare will work shifts through the night at some point. In this episode I go through a few helpful points and tips to help you survive a night shift.A nice summary of top tips from the Association of Anaesthetists:https://anaesthetists.org/Home/Wellbeing-support/Fatigue/Tips-for-night-shiftsSupport the showThanks for listening,James@JMACeducation

The BMJ Podcast
Oxytocin, clinical outcomes, and patient choice, in resource constrained settings

The BMJ Podcast

Play Episode Listen Later Dec 21, 2023 39:34


There's an inherent tension between creating quality standards that are very clinically focussed, and standards which are very patient centred - especially in settings where clinical outcomes can be compromised by basic lack of resources.  The use of oxytocin to prevent bleeding after birth is an example of this - WHO quality guidelines clearly measure and incentivise use of the drug, but in more wealthy healthcare systems, adherence patient preference is the key measure. How can we ensure that less wealthy healthcare systems are also patient centred?   Our guests for this discussion; Nana Twum-Danso, ​senior vice president, Institute for Healthcare Improvement (IHI) Paul Dsane-Aidoo, health specialist, UNICEF Ghana Keith Cloete, head of department at Western Cape Government: Health Hosted by Emma Veitch, Collections editor for The BMJ   This podcast is part of The BMJ Quality of Care collection, in collaboration with the World Health Organization and the World Bank, which offers critical thinking on both the unfinished agenda and emerging priorities for improving quality of care in low- and middle-income countries. 00:00 Introduction to the podcast 00:48 Introduction of experts and their backgrounds 02:54 Challenges in healthcare systems: south africa's perspective 04:15 The importance of patient-centred care 04:56 The role of data in improving quality of care 06:11 Community engagement and feedback in healthcare 07:58 Tackling global disparities in healthcare 08:41 Balancing clinical outcomes and patient-centred care 10:58 Addressing inequities in healthcare 22:43 The role of governance in improving quality of care 32:56 Overcoming resource constraints in healthcare 36:22 The need for system redesign in healthcare 37:18 Adapting to changing times in healthcare

Kindness, Curiosity and Comfortable Shoes

Episode 6 - ComplaintsAs healthcare staff we will always have to respond and react to complaints in some form.An example of a healthcare complaints analysis tool from the London School of Economics, published in BMJ Quality and Safety Journal in 2015: https://healthcarecomplaintsanalysis.com/And an article about how to handle complaints from Practice Builders in 2019: https://www.practicebuilders.com/blog/8-ways-to-handle-patient-complaints-and-defuse-their-frustrations/Support the showThanks for listening,James@JMACeducation

RNZ: Nine To Noon
The impact of the Covid-era ban on people visiting dying relatives

RNZ: Nine To Noon

Play Episode Listen Later May 14, 2023 22:28


New research has found much harm was caused to families of end of life patients and the clinicians caring for them. The study published in the BMJ Quality and Safety - was led by University of Auckland Associate Professor in the School of Nursing Rachael Parke, and funded by a grant from the Health Reserch Council of NZ.. She says grief, anger and stress were just some of the unintended consequences of the patient visiting ban, which was initially aimed at keeping people safe. And this was experienced by families and by nursing and medical staff who had to enforce the rules. Dr Parke says before the pandemic, families were increasingly recognised as collaborators in the safety and quality of care for people in hospital. But early in the Covid outbreak visitor bans were seen as contributing to a low spread of infection and low mortality, but came to be seen as restrictive and oppressive by many. One of the conclusions from the study is that visitor rights and visitor policy at the end of life require greater protection during a pandemic, and there's a need for informed ethical guidelines around visiting during a future disaster or disease outbreak in order to avert a legacy of disenfranchised grief.

Don't Just Read the Guidelines
#19 How to fix the NHS with Gordon Caldwell

Don't Just Read the Guidelines

Play Episode Listen Later Mar 3, 2023 52:34


Gordon Caldwell is a recently retired NHS medical consultant who has worked all over the UK. His passion is quality in healthcare and he has spearheaded efforts to improve efficiency in the NHS. He is an advocate for improving the use of IT to diminish the need for repetitive tasks and has started a campaign called #CutTheCrap. This has the aim of liberating healthcare staff from burdensome paperwork and freeing them up to spend more time with patients, delivering excellent care. If you are an NHS manager and you are interested how you can improve your organisation, this would be a great place to start. Gordon can be found on Twitter: @DoctorCaldwell. I quote a study in the episode - here's the link: Webster et al. 2011. Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial). BMJ Quality & Safety https://qualitysafety.bmj.com/content/20/4/297

Faces of Digital Health
Best of 2021: (OVER)DOSE - How Can We Prevent Medication Errors and Patient Harm?

Faces of Digital Health

Play Episode Listen Later Jul 21, 2022 57:44


This is a short documentary about medication-related patient safety. The documentary explores and offers an overview of the current challenges and technical solutions related to medication safety to raise awareness about the need to further improve medication-related patient safety. Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors has been estimated at $42 billion USD annually. Errors can occur at different stages of the medication use process. More than 237 million medication errors are made every year in England, the avoidable consequences of which cost the NHS upwards of £98 million and more than 1700 lives every year, indicate national estimates, published online in the journal BMJ Quality & Safety. The documentary premiered on 29 June 2021. Watch the documentary and full interviews with the speakers: https://www.facesofdigitalhealth.com/overdose-documentary Learn more about Better Meds: https://meds.better.care/ Speakers in the movie and this episode: David W. Bates, Medical Director of Clinical and Quality Analysis, Information Systems, Patient Safety Expert and Harvard MD (Clinical & Research Perspective) Professor John Horn, PharmD, University of Washington School of Pharmacy, coauthor of “The Top 100 Drug Interactions”; A Guide to Patient Management” Martina Viduka, Practicing Nurse, Co-Founder of Advosense David Kliff, author and publisher of the Diabetic Investor eNewsletter, former investment advisor, and as a person living with diabetes (Patient Perspective) Duncan Cripps, Electronic Prescribing and Medication Management Lead at University Hospitals Plymouth NHS Trust (Pharmacist Perspective) Roni Shiloh, CEO of Seegnal, MD degree, specialized in Psychiatry (CDS provider and doctor perspective) Hicham Naim, Global Head Integrated & Personalized Patient Care Program, Digital Advisory Board at Takeda (Pharma Perspective) Marinka Žitnik, Assistant Professor of Biomedical Informatics, Harvard Medical School (Research perspective Lea Dias, Clinical Pharmacist, Founder and CEO of Quaefacta Abdulelah Alhawsawi, Ex - founding Director-General of the Saudi Patient Safety Center (SPSC) Roi Shternin, Founder of the patient-led Israeli society for Dysautonomia (Patient perspective).

News.med.br
HDL alto e risco na DAC / Nova terapia para câncer pancreático / Terapia genética para doenças fatais infantis

News.med.br

Play Episode Listen Later Jun 18, 2022 11:18


The Aural Apothecary
4.3 – Professor Delyth James – Applying behavioural change - to yourself

The Aural Apothecary

Play Episode Listen Later Jun 1, 2022 51:54


In this week's episode we are thrilled to be joined by Delyth James. Professor James is Professor of Health Psychology in Pharmacy Practice at Cardiff Metropolitan University. Delyth is a pharmacist with experience of training and education and working as a renal pharmacist in hospitals across the world. Delyth's main area of research is ‘Health Psychology and Medicines use.Paul is away this week so Steve and Jamie are joined by guest apothecary Clare Howard. We chat about Delyth's experience of a heart condition and how she used her experience as a health psychologist to deal with it. We discuss behavioural change and the COM-B model and reflect on how it feels to make a dispensing error. We also found out how Steve has broken the podcast – frankly we are surprised it took him this long.Our micro discussion focuses on the paper “Effectiveness of a medication adherence management intervention in a community pharmacy setting: a cluster randomised controlled trial” – a recent paper from the BMJ Quality and Safety that looks at how a focus on adherence may improve chronic disease management https://qualitysafety.bmj.com/content/qhc/early/2021/03/28/bmjqs-2020-011671.full.pdf.As with all our guests we ask Delyth to pick a career influencing drug, anthem and a book that has influenced her work. Her song choice is a karaoke classic!To get in touch follow us on Twitter @auralapothecary or email us at auralapothecarypod@gmail.com You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg You can view the Aural Apothecary Library here; https://www.goodreads.com/review/list/31270100-paul-gimson?ref=nav_mybooks&shelf=the-aural-apothecary

CMAJ Podcasts
Is it time to re-think the quality improvement enterprise?

CMAJ Podcasts

Play Episode Listen Later May 9, 2022 31:28 Transcription Available


In this episode, Dr. Kaveh Shonjania argues that despite the billions of dollars spent on clinical and quality improvement research, most of the interventions that are studied are shown not to work and those that do work produce only marginal benefits for some patients.Dr. Shojania is the Vice Chair of Quality and Innovation for the Department of Medicine at the University of Toronto and past Editor-in-Chief of BMJ Quality and Safety. He joins Drs. Blair Bigham and Mojola Omole to discuss a study published in CMAJ recently, entitled Inappropriate Use of Clinical Practices in Canada: A Systematic Review, in which the authors sifted through 174 studies to identify ineffective clinical practices that are either overused, effective practices that are underused, or other practices that are just misused..  Dr. Shojania wrote a short commentary related to the study, entitled What problems in health care quality should we target as the world burns around us? In which he called for health research resources to be shifted more towards research on the social determinants of health, for a greater return on investment.  Drs. Bigham, Omole and Shojaniadiscuss how this might actually work in practice.

EM Pulse Podcast™
TeamSTEPPS

EM Pulse Podcast™

Play Episode Listen Later Sep 17, 2021 32:26


TeamSTEPPS is a curriculum designed for health care professionals that emphasizes good communication and teamwork. This toolkit is evidence based and available for free from the AHRQ and we use it at UC Davis to improve communication, teamwork and patient safety. In this episode we talk with our TeamSTEPPS champions about the curriculum and how we can be better team members. Share with us on @empulsepodcast if you use team steps and if so what your favorite tool is.  Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests:   Dr. David Barnes, Professor of Emergency Medicine at UC Davis, TeamSTEPPS Physician Champion Leigh Clary, RN, UC Davis Emergency Department TeamSTEPPS Nurse Champion Resources: Contact us @empulsepodcast to connect with Dr. David Barnes or Leigh. About TeamSTEPPS. Content last reviewed June 2019. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/teamstepps/about-teamstepps/index.html Morey, J. C., Simon, R., Jay, G. D., Wears, R. L., Salisbury, M., Dukes, K. A. (2002). Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project.Health Services Research 37(6), 1553-81 Mazzocato, P., Forsberg, H., & Schwarz, U. (2011). Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work. Scandinavian Journal Of Trauma, Resuscitation And Emergency Medicine 19:70 Patel, P., & Vinson, D. (2005). Team assignment system: expediting emergency department care. Annals of Emergency Medicine 46(6), 499-506 Patterson, M. D., Geis, G. L., et al. (2013). In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Quality and Safety 22(6), 468-77 Turner, P. (2012). Implementation of TeamSTEPPS in the emergency department. Critical Care Nursing Quarterly 35(3), 208-12

Faces of Digital Health
F138 (OVER)DOSE Part 2 - after documentary expert panel discussion

Faces of Digital Health

Play Episode Listen Later Jul 5, 2021 74:16


This is a panel discussion that happened after the premiere of the documentary (OVER)DOSE - How can we prevent medication errors? which aired on 29 June. You can listen to the adapted audio-only version of the documentary in episode 137. The documentary explores and offers an overview of the current challenges and technical solutions related to medication safety to raise awareness about the need to further improve medication-related patient safety.  Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors has been estimated at $42 billion USD annually. Errors can occur at different stages of the medication use process. More than 237 million medication errors are made every year in England, the avoidable consequences of which cost the NHS upwards of £98 million and more than 1700 lives every year, indicate national estimates, published online in the journal BMJ Quality & Safety.  This panel further highlights issues related to medication safety. Watch the documentary and the panel on Youtube: https://www.facesofdigitalhealth.com/blog/overdose-how-can-we-prevent-medication-errors Speakers on the panel: Tjaša Zajc, Author of (OVER)DOSE, Host of Faces of Digital Health Stefan Siekierski, Nurse, Electronic prescribing Project Manager, Better Delivery Manager UK & IE Katrina Azer, Pharmacist, Patient Advocate, Board Member of the Pharmacy Council of New Zealand Robert Johnstone, Board Member of the European Forum for Good Clinical Practice (EFGCP) and International Foundation for Integrated Care (IFIC) Alexander Jankuloski, CEO at Kuwait Hospital Hicham Naim, Global Head Integrated & Personalized Patient Care Program, Digital Advisory Board at Takeda Prof. Yu-Chuan Jack-Li - a researcher of artificial intelligence (AI) in medicine and medical informatics, and a practicing dermatologist, the Editor-in-Chief of BMJ Health & Care Informatics Opportunity: HRSA Announces New Loan Repayment Program for Behavioral Health Providers. Learn more and apply here: https://bhw.hrsa.gov/funding/apply-loan-repayment/star-lrp

Faces of Digital Health
F137 (OVER)DOSE Part 1 - documentary adapted for radio

Faces of Digital Health

Play Episode Listen Later Jul 2, 2021 58:23


This is a short documentary about medication-related patient safety. The documentary explores and offers an overview of the current challenges and technical solutions related to medication safety to raise awareness about the need to further improve medication-related patient safety.  Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors has been estimated at $42 billion USD annually. Errors can occur at different stages of the medication use process. More than 237 million medication errors are made every year in England, the avoidable consequences of which cost the NHS upwards of £98 million and more than 1700 lives every year, indicate national estimates, published online in the journal BMJ Quality & Safety.  The documentary premiered on 29 June and was accompanied by an expert panel discussion which you can listen to in episode 138. Watch the documentary: https://www.facesofdigitalhealth.com/blog/overdose-how-can-we-prevent-medication-errors Speakers in the movie and this episode: David W. Bates, Medical Director of Clinical and Quality Analysis, Information Systems, Patient Safety Expert and Harvard MD (Clinical & Research Perspective) Professor John Horn, PharmD, University of Washington School of Pharmacy, coauthor of “The Top 100 Drug Interactions”; A Guide to Patient Management” Martina Viduka, Practicing Nurse, Co-Founder of Advosense David Kliff, author and publisher of the Diabetic Investor eNewsletter, former investment advisor, and as a person living with diabetes (Patient Perspective) Duncan Cripps, Electronic Prescribing and Medication Management Lead at University Hospitals Plymouth NHS Trust (Pharmacist Perspective) Roni Shiloh, CEO of Seegnal, MD degree, specialized in Psychiatry (CDS provider and doctor perspective) Hicham Naim, Global Head Integrated & Personalized Patient Care Program, Digital Advisory Board at Takeda (Pharma Perspective) Marinka Žitnik, Assistant Professor of Biomedical Informatics, Harvard Medical School (Research perspective Lea Dias, Clinical Pharmacist, Founder and CEO of Quaefacta Abdulelah Alhawsawi, Ex - founding Director-General of the Saudi Patient Safety Center (SPSC) Roi Shternin, Founder of the patient-led Israeli society for Dysautonomia (Patient perspective). Thanks to our Sponsor: Health Resources and Services Administration: Receive up to $250,000 in student loan repayment in exchange for service in a community disproportionately affected by the opioid crisis. Learn more and apply to join STAR LRP - that stands for the Substance Use Disorder Treatment and Recovery Loan Repayment Program. Applications Close on July 22, 2021

Scrubbed In
E85: The computer science grad who discovered authenticity through GP, Surgery and Microbiology - Dr Imran Qureshi

Scrubbed In

Play Episode Listen Later May 2, 2021 65:47


In this week’s episode we are joined by Dr Qureshi, a consultant microbiologist who shares with us his story. We discover his unusual journey as a computer science graduate transitioning from GP to core surgical trainee before settling for a career in microbiology. Imran shares the obstacles and challenges he has faced so far in his career and his ethos in life of being authentic. We discuss the evolving role of technology in healthcare, the story behind creating and selling the first comprehensive Gentamicin calculator and his new found initiative Code Med.  We discuss why he became extremely passionate about microbiology and explore his relationship with patient safety and quality improvement. Imran tells us about the importance of healthy workplace cultures and supportive leadership in his role as Foundation Programme Director. Dr Imran Qureshi is a Consultant microbiologist at Croydon University Hospital, he is a Foundation Programme Director and more recently Associate Medical Director.  His is passionate about Patient Safety and Quality Improvement which led to setting up DAPS Global, then became the first clinical lead for BMJ Quality then an Honorary Clinical Associate Professor for UCL. He co-founded Code Med, an organisation which is dedicated to teaching coding to healthcare professionals as well as developing apps and providing consulting services.  Twitter: @reachimyq --------------------------------- Episode sponsored by MySuture  MySuture™  is an all in one suture practice kit and digital learning platform with direct access to Surgeon advice & training. With this all in one suture practice kit and the MySkills™ digital learning platform, you can learn to suture anytime, anywhere.    MySuture™  is here to share your journey in medical education by helping you learn the art of suturing and provide you with access to training and advice for your career in healthcare.  The all in one suture simulation kit includes high quality silicone made of advanced nontoxic materials, with height simulation skin, 14 pre cut wounds, 3 layers including skin, subcutaneous fat and muscle with a mesh reinforcement to provide suture retention, mimic natural anatomy and create a true to life texture.  Buy your suture kit now at: mysuture.com  MySuture Socials: Twitter | Instagram --------------------------------- Learn more about Scrubbed In: Twitter - @ScrubbedIn_ Instagram - @Scrubbedin_ Download the PodCases Mobile app Now - iOS (App Store) or Android (Google Play) PodCases lets you Step into the shoes of Doctors to experience medicine. Listen to high quality audio cases and reinforce your learning with interactive quizzes.  www.scrubbedin.co.uk Hello@scrubbedin.co.uk

Two Paeds In A Pod
Episode 56: Adverse events following Paeds ED attendance.

Two Paeds In A Pod

Play Episode Listen Later Aug 2, 2020 34:36


We all want a positive outcome for any child attending our ED but recognise that doesn't always happen. But how often to adverse events happen, how serious are they and what can we do to prevent them? In this podcast we talk to Dr Amy Plint from the Children's Hospital of Eastern Otario in Canada who has recently published a study looking at exactly these questions in the BMJ Quality and Safety Journal. The article is open access and can be found here: https://qualitysafety.bmj.com/content/qhc/early/2020/04/28/bmjqs-2019-010055.full.pdf This podcast was originally recorded by 2 Paeds for Don't Forget the Bubbles.

Don't Forget the Bubbles
The DFTB Podcast – Adverse Events after PED attendance

Don't Forget the Bubbles

Play Episode Listen Later Jul 12, 2020 35:48


In this week’s DFTB podcast we talk to Dr Amy Plint, Faculty Medicine Research Chair in PEM at the University of Ottawa about adverse events following attendance in the paediatric emergency department. Dr Plint, who is a former chair of PERC, discusses her paper from BMJ Quality and Safety on the subject and highlights lessons...

Naturalistic Decision Making
Episode #10: Interview with Shawna Perry

Naturalistic Decision Making

Play Episode Listen Later Jun 28, 2020 66:16


Date: 6/18/2020 Show Description: Today we welcome Shawna Perry. Shawna is an emergency medicine physician and runs a consulting firm called SJP Consulting. In both her roles as a physician and a consultant, she actively advocates for systems level views of patient safety. She is an active member of the naturalistic decision making community, the human factors and ergonomics society, and the resilience engineering association. She uses her vast and varied clinical experiences to mentor countless resident physicians and also to inform applied research. Shawna very generously serves on panels, gives invited talks, and collaborates on writing projects to share her front-line perspective on the organizational constraints, competing goals, and other challenges emergency department physicians face every day as they care for patients. Dr. Perry spent 6 years as the Director for Patient Safety System Engineering at Virginia Commonwealth University Health Systems and is currently an Associate Professor of Emergency Medicine at the University of Florida Health Science Center in Jacksonville, FL. Where to find Shawna: 1. Klein, G., Pliske, R., Crandall, B., & Woods, D. D. (2005). Problem detection. Cognition, Technology & Work , 7 (1), 14-28. DOI: 10.1007/s10111-004-0166-y 2. Cook, R., & Rasmussen, J. (2005). “Going solid”: a model of system dynamics and consequences for patient safety. BMJ Quality & Safety , 14 (2), 130-134. doi: 10.1136/qshc.2003.009530 3. Perry, S., Wears, R. L., Anderson, B., & Booth, A. (2007). Peace and war: Contrasting cases of resilient teamwork in healthcare. In Eighth International Naturalistic Decision Making Conference, Pacific Grove, CA . Learn more about NDM: NaturalisticDecisionMaking.org Journal of Cognitive Engineering and Decision Making Where to find hosts Brian Moon and Laura Militello: Brian's website Brian's LinkedIn Brian's Twitter Laura's website Laura's LinkedIn Laura's Twitter Timestamps: How did you become interested in NDM? [1:50] What are different attitudes that you've observed in regard to patient safety in clinical settings? [12:30] What are some times you've gotten pushback on your ideas? [23:35] What's a favorite story where you had to rely on your intuition? [42:40]

Pravidelná dávka
114. Strojové učenie v medicíne II. Aké výzvy nám stoja v ceste?

Pravidelná dávka

Play Episode Listen Later Jan 17, 2020 18:22


V tejto Pravidelnej dávke budeme pokračovať v našej diskusii o využití strojového učenia a umelej inteligencie v medicíne. Akým prekážky stoja v ceste využitia strojového učenia v medicíne? A čo musia inžineiri a lekári robiť, aby niektoré z nich odstránili? ----more----Referencie:[1] Ching, T., Himmelstein, D. S., Beaulieu-Jones, B. K., Kalinin, A. A., Do, B. T., Way, G. P., … Greene, C. S. (2018). Opportunities and obstacles for deep learning in biology and medicine. Journal of the Royal Society Interface, 15(141). https://doi.org/10.1098/rsif.2017.0387[2] Komorowski, M., Celi, L. A., Badawi, O., Gordon, A. C., & Faisal, A. A. (2018). The Artificial Intelligence Clinician learns optimal treatment strategies for sepsis in intensive care. Nature Medicine, 24(11), 1716–1720. https://doi.org/10.1038/s41591-018-0213-5[3] Rigby, M. J. (2019, February 1). Ethical dimensions of using artificial intelligence in health care. AMA Journal of Ethics. American Medical Association. https://doi.org/10.1001/amajethics.2019.121[4] Yu, K. H., & Kohane, I. S. (2019, March 1). Framing the challenges of artificial intelligence in medicine. BMJ Quality and Safety. BMJ Publishing Group. https://doi.org/10.1136/bmjqs-2018-008551[5] Kelly, C. J., Karthikesalingam, A., Suleyman, M., Corrado, G., & King, D. (2019). Key challenges for delivering clinical impact with artificial intelligence. BMC Medicine, 17(1), 195. https://doi.org/10.1186/s12916-019-1426-2[6] Badgeley, M. A., Zech, J. R., Oakden-Rayner, L., Glicksberg, B. S., Liu, M., Gale, W., … Dudley, J. T. (2019). Deep learning predicts hip fracture using confounding patient and healthcare variables. Npj Digital Medicine, 2(1). https://doi.org/10.1038/s41746-019-0105-1[7] Chen, I., Johansson, F. D., & Sontag, D. (2018). Why Is My Classifier Discriminatory? Retrieved from http://arxiv.org/abs/1805.12002  ***Dobré veci potrebujú svoj čas. Pomohla ti táto dávka zamyslieť sa nad niečím zmysluplným? Podpor tvoj obľúbený podcast sumou 1€, 5€ alebo 10€ (trvalý príkaz je topka!) na SK1283605207004206791985. Ďakujeme! Viac info o podpore na pravidelnadavka.sk/#chcem-podporit

Pravidelná dávka
110. Strojové učenie v medicíne: Nádejné riešenia a obrovské výzvy (I. časť)

Pravidelná dávka

Play Episode Listen Later Dec 20, 2019 19:28


V ďalšej epizóde Pravidelnej dávky si s Mirom povieme niečo o strojovom učení, jeho výhodách a o jeho využití v medicíne. Je to prvá zo série zameranej na strojové učenie a umelú inteligenciu v medicíne.----more---- Referencie:[1] Ching, T., Himmelstein, D. S., Beaulieu-Jones, B. K., Kalinin, A. A., Do, B. T., Way, G. P., … Greene, C. S. (2018). Opportunities and obstacles for deep learning in biology and medicine. Journal of the Royal Society Interface, 15(141). https://doi.org/10.1098/rsif.2017.0387[2] Komorowski, M., Celi, L. A., Badawi, O., Gordon, A. C., & Faisal, A. A. (2018). The Artificial Intelligence Clinician learns optimal treatment strategies for sepsis in intensive care. Nature Medicine, 24(11), 1716–1720. https://doi.org/10.1038/s41591-018-0213-5[3] Rigby, M. J. (2019, February 1). Ethical dimensions of using artificial intelligence in health care. AMA Journal of Ethics. American Medical Association. https://doi.org/10.1001/amajethics.2019.121[4] Yu, K. H., & Kohane, I. S. (2019, March 1). Framing the challenges of artificial intelligence in medicine. BMJ Quality and Safety. BMJ Publishing Group. https://doi.org/10.1136/bmjqs-2018-008551[5] Poplin, R., Varadarajan, A. V., Blumer, K., Liu, Y., McConnell, M. V., Corrado, G. S., … Webster, D. R. (2018). Prediction of cardiovascular risk factors from retinal fundus photographs via deep learning. Nature Biomedical Engineering, 2(3), 158–164. https://doi.org/10.1038/s41551-018-0195-0[6] Day, N., Hemmaplardh, A., Thurman, R. E., Stamatoyannopoulos, J. A., & Noble, W. S. (2007). Unsupervised segmentation of continuous genomic data. Bioinformatics, 23(11), 1424–1426. https://doi.org/10.1093/bioinformatics/btm096***Dobré veci potrebujú svoj čas. Pomohla ti táto dávka zamyslieť sa nad niečím zmysluplným? Podpor tvoj obľúbený podcast sumou 1€, 5€ alebo 10€ (trvalý príkaz je topka!) na SK1283605207004206791985. Ďakujeme! Viac info o podpore na pravidelnadavka.sk/#chcem-podporit

KeyLIME
[109] Diagnosis: the Bias Emperor has no clothes

KeyLIME

Play Episode Listen Later May 10, 2016 21:47


In this episode: Jason chose a paper that asks ‘Is bias in the eye of the beholder?’ Bias alert -  Jon Sherbino is one of the authors ;) Length: 21:45 min Authors: Zwaan L, Monteiro S, Sherbino J, Ilgen J, Howey B, Norman G. Publication details:  Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups. BMJ Quality and Safety. 2016 Jan;[ePub ahead of print] PubMed Link  View the abstract here Follow our co-hosts on Twitter! Jason R. Frank: @drjfrank  Jonathan Sherbino: @sherbino  Linda Snell: @LindaSMedEd  Want to learn more about KeyLIME? Click here!

The BMJ Podcast
Mistakes were made

The BMJ Podcast

Play Episode Listen Later Apr 8, 2016 16:03


The Francis report, the Berwick report, the Keogh review - all of these have highlighted how important learning from mistakes is in healthcare. Reporting incidents is key to this, and in this podcast Jen Perry, from BMJ Quality, tells Harriet Vickers the whats, hows and whys of incident reporting. And Emily Hotton, previously a foundation doctor at Royal United Hospital Bath, UK, talks about how her project helped junior doctors at the hospital become more confident at incident reporting, and bumped up the number of incidents they logged. Read Emily's full report: http://qir.bmj.com/content/3/1/u202381.w2481.full Check out BMJ Quality: http://quality.bmj.com

Making the difference
Mistakes were made

Making the difference

Play Episode Listen Later Apr 8, 2016 16:03


The Francis report, the Berwick report, the Keogh review - all of these have highlighted how important learning from mistakes is in healthcare. Reporting incidents is key to this, and in this podcast Jen Perry, from BMJ Quality, tells Harriet Vickers the whats, hows and whys of incident reporting. And Emily Hotton, previously a foundation doctor at Royal United Hospital Bath, UK, talks about how her project helped junior doctors at the hospital become more confident at incident reporting, and bumped up the number of incidents they logged. Read Emily's full report: http://qir.bmj.com/content/3/1/u202381.w2481.full Check out BMJ Quality: http://quality.bmj.com

Making the difference
Plan, do, study, act

Making the difference

Play Episode Listen Later Apr 8, 2016 14:20


Plan, do, study, act cycles, or PDSA cycles, are the basis of many quality improvement projects, they're a model to trial changes and feed the lessons from each test into the next. Why are they a popular method, and how do you get the best out of them? And what on earth happens when they explode? Harriet Vickers asks Julie Reed, National Institute for Healthcare Research CLAHRC (Collaboration for Leadership in Applied Health Research and Care) for north west London. Read all of Julie's paper (for free): http://qualitysafety.bmj.com/content/25/3/147 Check out BMJ Quality: http://quality.bmj.com

leadership care study plan national institutes pdsa bmj quality julie reed applied health research
The BMJ Podcast
Plan, do, study, act

The BMJ Podcast

Play Episode Listen Later Apr 8, 2016 14:20


Plan, do, study, act cycles, or PDSA cycles, are the basis of many quality improvement projects, they're a model to trial changes and feed the lessons from each test into the next. Why are they a popular method, and how do you get the best out of them? And what on earth happens when they explode? Harriet Vickers asks Julie Reed, National Institute for Healthcare Research CLAHRC (Collaboration for Leadership in Applied Health Research and Care) for north west London. Read all of Julie's paper (for free): http://qualitysafety.bmj.com/content/25/3/147 Check out BMJ Quality: http://quality.bmj.com

leadership care study plan national institutes pdsa bmj quality julie reed applied health research
Lean Blog Audio
What Virginia Mason's CEO Dr. Gary Kaplan Warns Against

Lean Blog Audio

Play Episode Listen Later Mar 6, 2016 8:25


Dr. Gary Kaplan is the CEO of Seattle's Virginia Mason Medical Center, considered one of the world leaders in the adoption of Lean healthcare principles. He wrote the foreword for my book The Executive Guide to Healthcare Kaizen.He co-authored a recent editorial in the BMJ Quality&Safety journal:"Lean and the perfect patient experience" http://leanblog.org/audio127 --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/lean-blog-audio/support

ceo safety warns kaplan bmj quality healthcare kaizen