Paper of the week: 09.08.18

Muir Gray’s paper of the week: Seven Deadly Sins Resulting From the Centers for Disease Control and Prevention’s Seven Forbidden Words

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Reference: Castro KG, Evans DP, Del Rio C, Curran JW. Seven Deadly Sins Resulting From the Centers for Disease Control and Prevention’s Seven Forbidden Words. Ann Intern Med. 2018;168:513–514. doi: 10.7326/M17-3410

Bottom line, chosen by Muir from the paper

On 15 December 2017, The Washington Post reported on 7 words to be avoided by the Centers for Disease Control and Prevention (CDC) in official budget documents . The forbidden words are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,”

“evidence-based,” and “science-based.” Although the source of the prohibition is uncertain, this censorship, if real, carries the risk of jeopardizing the work of U.S. government–funded health care practitioners and professional organizations.

Implications for value improvement

In a healthcare organisation there are three principal elements- structure, systems and culture (as seen in the diagram below). Of these three elements most people would regard culture as the most important, although most energy is spent on reorganising the structure, but how can culture be changed by the leadership with the key role distinguishing leadership from management is that leadership creates the culture whereas management works within it.

“When we examine culture and leadership closely, we see that they are two sides of the same coin; neither can really be understood by itself.  If one wishes to distinguish leadership from management or administration, one can argue that leadership creates and changes cultures, while management and administration act within a culture.”

Source:  Schein, E.H.   (2004)   Organizational Culture and Leadership.  John Wiley & Sons Inc. (pp.10-11). 

We have tried to change the culture of healthcare by introducing a new language about value, using the triple value definition given below

  • Personal value determined by the outcomes that matter to an individual for a given amount of resources used by the health system and the individual and their family

and, for the population, two types of value

  • Allocative value determined by how well the assets are distributed to different sub groups in the population
  • Technical value, determined by how well the resources allocated for investment for a particular subgroup of the population, for example people with a symptom such as back pain, or a condition such as breast cancer or a common characteristic such as having multiple conditions or being in the last year of life are used for all the people in need in the population

This paper describes a move to change the culture of healthcare in the USA by banning language but whether or not this will be effective, only time will tell.