The New Year - Let's Not Waste It

Humans strive to improve themselves and hopefully support those around them. It’s been about 6 months since I’ve had a chance to share with you. As I anticipate another trip to Milot, I am also both reflecting on how my perspectives have evolved after working at Cedars for a year.

Both HSC and CSMC have significant challenges. At the core of their existence, however, is a commitment to patient care and education, support by core beliefs. Cedars Sinai is located in one of the most affluent areas in the world, yet outside our doors are the homeless, and those making tough choices as they have lost jobs. At HSC, we have been fortunate to acquire significant supplies and materials through generosity and the work of CRUDEM, yet at the same time we run short of some essentials, while trying to find a place to store thousands of crutches that arrived after the quake. Cedars provides excellent care at a very high costs: CRUDEM does remarkable things in a very constrained environment. The two institutions can learn from each other.

I am currently returning from a seminar examining reducing waste in health care. Whether it is a catchword like LEAN or Six Sigma, the basic concept is to understand a process, and look at whether we are adding value by each step. In a resource rich environment, we tend to respond by putting more personnel or technology, which can have incremental effect. Yet the greatest improvement comes when you involve those at the front lines. Finding how people “work around” a system gives you a far greater understanding of the constraint, than imposing an external fix with another policy.

In Milot, I saw the value of face to face communication, and learned of ways to use equipment and supplies in innovative ways. People were thrilled to have a job, even at a relatively low wage, and we were able to use human capital to accomplish much. The physical examination could be supplemented with a careful history and focused laboratory studies. The lack of routine CT scanning did not have as much of an effect as one would believe. By the same token, it was often difficult to know when supplies were running low, and the commitment to develop an inventory system will be a key technology with a high ROI. Just as with any new process, however, we learn of other needs, such as a manual determination of our baseline utilization.


Cedars Sinai Medicine is our clinical transformation initiative optimizing our institution and its people to provide the patient with the most appropriate, evidence based care, delivered in an efficient and compassionate manner. We are learning that expectations and reality are often in different places, and much of what our patients want doesn’t cost a lot. We are finding that some of the most valuable conversations are those that occur before an acute illness, and that prevention doesn’t just happen. We are a remarkable institution, with remarkable resources, and like Milot, the greatest resource are our people.

 I did make it through this blog with talking about New Year’s resolutions. I have no excuse for not writing more frequently. Perhaps I’ve been a bit preoccupied. I do enjoy sharing my thoughts and hope that you find my perspectives helpful as you look at your own life. We who are fortunate to be in medicine has much to be grateful for, and many challenges ahead. I’ll look forward to being enlightened by you, my readers.