Posted on March 11, 2012


Healthcare workers are driven by values that they are largely unaware of. This came to the fore while reading the New York times today. There was a brief article about Jacalyn E.S. Bennett and her company Bennett & Company which has been in business since 1984 making lingerie. The most striking part of the article […] Read More

Posted on February 20, 2012


There is nothing more frustrating than having a very sick family member in a hospital and not being given an opportunity to talk to members of the care team in order to understand what is happening. Here is a case study: Virginia had been in the intensive care unit for 9 weeks in respiratory (lung) […] Read More

Posted on February 11, 2012


PRESS TO LISTEN TO AUDIO Listen to audio (MP3) Continuity of care is similar to a football team. If all the players do what they want, then there is chaos. If there is a plan, a quarterback providing leadership and co-ordination of the players, then there is a better chance of winning. Continuity of care […] Read More

Posted on January 1, 2012


PRESS TO LISTEN TO AUDIO Listen to audio (MP3) Clara is a 62 year old patient with a complex past history. About 20 years ago, she had an early stage cervical cancer removed. Now she presents with masses in her peritoneum/abdomen from the original cervical cancer. Her oncologist had limited experience with the treatment of […] Read More

Posted on December 24, 2011


Health system problems are not only complex, they are “wicked” problems. Traditional thinking doesn’t solve wicked problems. Wicked problems have innumerable causes, are tough to describe and do not have a right answer(s). What is needed is a new way of thinking about health system service delivery. This starts with a blank sheet of paper […] Read More

Posted on December 10, 2011


There is a revolution occurring in hospitals in British Columbia. Hospitals are paid for helping patients instead of being paid for just keeping their doors open. This new method of funding for hospitals is called “patient focused funding”. This is activity and performance based funding with clearly articulated service level targets. The economic basis of […] Read More

Posted on November 13, 2011


PRESS TO LISTEN TO AUDIO Listen to audio (MP3) We have found that if a client is facing major surgery, then a second opinion can be very helpful. Here is a case study: a 45 year old previously well engineer had major chest surgery planned within two weeks. The mass in his anterior mediastinum ( […] Read More

Posted on October 23, 2011


PRESS TO LISTEN TO AUDIO Listen to audio (MP3) When we make decisions, it is common to expect consistency and therefore to be overly confident in the decision; however, this is often a common error. As Daneil Kahneman, the psychologist and author, writes in “Thinking, Fast and Slow” Farrar, Straus & Giroux Nov 2011 , […] Read More

Posted on October 8, 2011


A recent publication by the Cleveland Clinic (2007-2008) reviewing sentinel events- unanticipated events in a healthcare setting that result in death or serious physical or psychological injury to the patient, were in 43% of sentinel events related to suboptimal (poor/ineffective/non-collaborative) communication amongst providers. This is made worse if patients and family members are largely disengaged […] Read More

Posted on September 25, 2011

Don’t Ask Don’t Tell About Healthcare Costs.

Everyone is concerned about the rising cost of healthcare. Unfortunately, and somewhat ironically, no one knows the true and total costs of healthcare services. The question, of course, is how can you manage costs if you don’t know what services cost. There is a certain absurdity to this but that’s the way things are in some […] Read More

Posted on September 18, 2011


PRESS TO LISTEN TO AUDIO On a recent trip to Berlin, I was able to tour the Bauhaus archives.  This collection revealed a unique creative environment in Berlin in the 1920’s  that produced radically new and functional designs.  The shift to Modernism was striking in its effect.  There is much to learn from the Bauhaus […] Read More

Posted on July 30, 2011

Guided Care Is Smart Care With Deep Support:

Patients with complex health problems need more than just care. They need “Guided Care” which is, in our definition, smart care with deep support. Complex health problems require pro-active management that is based on knowing how to navigate the complex healthcare eco-system, how to deal with uncertainty and how to make smart decisions continuously along […] Read More

Posted on July 16, 2011


When a person has a complex healthcare problem for which there is no simple answer and many options (both conventional and alternative) are being considered, confusion can reign supreme. Here’s a case study: A mother was investigating treatment for her 13 year old daughter who had bone cancer. The cancer had been operated on. Now, […] Read More

Posted on May 22, 2011

Critical Decisions And Complex Patients

PRESS TO LISTEN TO AUDIO Listen to audio (MP3) If a healthcare organization does not properly identify and manage their critical decisions, then this can lead to big problems for everyone. Here is a case study: A 65 year old patient was found to have a large mass near the bottom of his esophagus (food […] Read More

Posted on May 7, 2011

SmartTriage- The Only Way To Get There!

When a decision is being made to go to a hospital because of a complex health care problem, most persons assume that all hospitals provide the same level of care. Not true! Some hospitals are much better at treating specific complex problems. The issue is that most people including family doctors are not aware of […] Read More

Posted on April 30, 2011

Geography Matters With Complex Healthcare Problems!

The challenge for clients with complex healthcare problems is to become aware of the medical “rules” for treatment that vary with geography. Here’s how it works: A 62 year old professional developed angina ( heart pain with exertion). He required a triple bypass. At the time of surgery, a small lung cancer was discovered. He […] Read More

Posted on April 22, 2011

Medical Tourism: Caveat Emptor/Buyer Beware!

Medical tourism is all the rage. Someone has a big healthcare problem and is a long waiting list. He/she finds a modestly priced procedure in an exotic location with no waiting list. The medical tourism company will immediately book the travel and the procedure. No problem. Just give us your credit card and start packing. […] Read More

Posted on April 17, 2011

Catastrophic Drug Insurance: A Public or Private Sector Solution?

New specialty drugs such as biological drugs are very expensive. It is reported that the average cost for a specialty drug for treating cancer is about $65,000 per year. Some specialty drugs can cost over $300,000 per year. Furthermore, doctors are becoming more familiar with the excellent benefits of specialty drugs and are prescribing two […] Read More

Posted on April 8, 2011

Intelligent Matching Of Specialty Suppliers + Customers

Rupert Case Management has , over time, developed a proprietary network of over 2000 specialty suppliers of advanced medical products and services. These suppliers are located across Canada and into the U.S. and form RCM’s speciality service providers network (SSPN). RCM’s specialty service providers network delivers a diverse, deep and complementary menu of high quality […] Read More

Posted on March 23, 2011

Why Patient Complexity Matters?

PRESS TO LISTEN TO AUDIO Listen to audio (MP3) Today, the practice in medicine is to develop standardized evidence-based treatment plans for patients. That is good science and seems efficient. But, unfortunately, the one size fits all solutions don’t always work. This is because some patients are much more complex than others. If complexity is […] Read More