A design thinking framework for healthcare management and innovation.

The business community has learned the value of design thinking as a way to innovate in addressing people's needs--and health systems could benefit enormously from doing the same. This paper lays out how design thinking applies to healthcare challenges and how systems might utilize this proven and accessible problem-solving process. We show how design thinking can foster new approaches to complex and persistent healthcare problems through human-centered research, collective and diverse teamwork and rapid prototyping. We introduce the core elements of design thinking for a healthcare audience and show how it can supplement current healthcare management, innovation and practice.

Vestibular disorders and dual task performance: impairment when walking a straight path.

Locomotion is impaired in some people with vestibular disorders. Performance on cognitive tasks is also impaired in many people with vestibular disorders. The goal of this study was to determine if patients with vestibular disorders have decreased ability to complete a dual task performance involving a cognitive task, an additional motor task or both tasks, combined along a linear path. Subjects were normal, had benign paroxysmal positional vertigo, or had various vestibular disorders that caused unilateral weakness. They were asked to walk 7.62 m in a straight line with eyes open or closed, without extra tasks, and while nodding the head, naming things, and both nodding and naming. The patients walked significantly slower than controls, especially when performing the cognitive task. Patients had greater ataxia and began veering sooner than normals. The subjects' veering increased significantly with the addition of cognitive tasks. The patient groups did not differ significantly from each other. The changes in velocity did not affect the veering. These data suggest that patients with vestibular disorders are impaired in their ability to complete a linear path when cognitive tasks are added.

Otolaryngology resident workflow: a time-motion and efficiency study.

OBJECTIVE: To investigate workflow in an otolaryngology-head and neck surgery residency program over 1 year and identify areas for improvement in the efficiency of resident education and training. STUDY DESIGN: Time-motion study. SETTING: An urban, county hospital and a Veterans Affairs medical center hospital. Subjects and Methods. Eight otolaryngology residents (4 residents at postgraduate year [PGY] 2 and 4 at PGY 4) were studied using direct observations early and late in the 2008-2009 academic year. Resident activities were categorized, and a database program was generated for a handheld computer to facilitate time entry. Resident activities were classified into a taxonomy of tasks and their educational value was assessed. For each PGY level studied, observations were made for clinic and operative days. RESULTS: Residents spent their day on direct patient care (43.5%), indirect patient care (33.7%), didactic education (9.6%), personal activities (7.5%), and transit (5.8%), with activities of marginal educational value consuming 16% of their time. Major inefficiencies included managing administrative tasks, scheduling, and technical difficulties. On average, residents devoted significantly more time to marginal tasks on clinic days (19%) than on operative days (12%; P < .001). These data were compared with previously published data obtained during the pre­Accreditation Council for Graduate Medical Education (ACGME) duty hour mandates era. CONCLUSION: This study evaluates resident workflow and efficiency over the course of a PGY in an ACGME-accredited otolaryngology residency program. By understanding the time motion of residents, interruptions and inefficiencies in workflow can be identified to direct future changes to enhance resident education and training in the era of the ACGME duty hours mandate.

No evidence of sex-related survival disparities among head and neck cancer patients receiving similar multidisciplinary care: a matched-pair analysis.

PURPOSE: It is unknown whether there are survival disparities between men and women with squamous cell carcinoma of the head and neck (SCCHN), although some data suggest that men have worse outcomes. We conducted a matched-pair study that controlled for several potentially confounding prognostic variables to assess whether a survival advantage exists for female compared with male SCCHN patients receiving similar care. EXPERIMENTAL DESIGN: We selected 286 female patients and 286 matched male patients from within a prospective epidemiologic study on 1,654 patients with incident SCCHN evaluated and treated at a single large multidisciplinary cancer center. Matching variables included age (±10 y), race/ethnicity, smoking status (never versus ever), tumor site (oral cavity versus oropharynx versus larynx versus hypopharynx), tumor classification (T(1-2) versus T(3-4)), nodal status (negative versus positive), and treatment (surgery, radiation therapy, surgery and radiation therapy, surgery and chemotherapy, chemoradiotherapy, or surgery and chemoradiotherapy). RESULTS: Matched-pair and log-rank analyses showed no significant differences between women and men in recurrence-free, disease-specific, or overall survival. When the analysis was restricted to individual sites (oral cavity, oropharynx, or larynx/hypopharynx), there was also no evidence of a disparity in survival associated with sex. CONCLUSIONS: We conclude that there is no evidence to suggest that a survival advantage exists for women as compared with men with SCCHN receiving similar multidisciplinary directed care at a tertiary cancer center.

Kaposiform hemangioendothelioma (with Kasabach Merritt syndrome) of the head and neck: case report and review of the literature.

An infant initially diagnosed with a parotid hemangioma presented with stridor and thrombocytopenia. Diagnosis of Kaposiform hemangioendothelioma was confirmed with biopsy. The child succumbed to multi-system organ failure related to consumptive coagulopathy despite aggressive medical management. Kaposiform hemangioendothelioma is a rare head and neck tumor that may be mistaken for a hemangioma on preliminary diagnosis, which may lead to increased morbidity and mortality especially in the setting of Kasabach-Merritt phenomenon. A platelet count may provide an early and important clue to the possibility of coagulopathy; prompting physicians to look for a diagnosis other than a simple hemangioma.