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StefanLarsson_2013S-_医生们可以互相学习_
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| Five years ago, I was on a sabbatical , and I returned to the medical university where I studied. |
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sabbatical:adj.安息日的;n.休假(美国某些大学给大学教师每七年一次的);
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| I saw real patients and I wore the white coat for the first time in 17 years, in fact since I became a management consultant . |
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patients:n.接受治疗者,病人;(patient的复数) management:n.管理;管理人员;管理部门;操纵;经营手段; consultant:n.顾问;高级顾问医师;会诊医师;
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| There were two things that surprised me during the month I spent. |
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| The first one was that the common theme of the discussions we had were hospital budgets and cost-cutting , and the second thing, which really bothered me, |
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budgets:n.[财政]预算(budget复数形式);v.为…做预算(budget的第三人称单数形式); cost-cutting:n.削减成本;v.削减成本(cost-cut的现在分词); bothered:adj.烦(恼)的; v.使(某人)烦恼;
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| actually, was that several of the colleagues I met, former friends from medical school, who I knew to be some of the smartest, most motivated , engaged and passionate people |
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colleagues:n.同事;同行(colleague的复数); motivated:adj.有动机的; v.使产生动机; engaged:adj.已订婚的; v.吸引住; (engage的过去分词和过去式) passionate:adj.热情的;热烈的,激昂的;易怒的;
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| I'd ever met, many of them had turned cynical , disengaged , or had distanced themselves from hospital management. |
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cynical:adj.愤世嫉俗的;冷嘲的; disengaged:adj.空闲的;自由的;已脱离的;v.脱离(disengage的过去分词);
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| So with this focus on cost-cutting, |
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| I asked myself, are we forgetting the patient? |
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| Many countries that you represent and where I come from struggle with the cost of healthcare . |
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represent:v.代表;表现;描绘;回忆;再赠送; healthcare:n.医疗保健;健康护理,健康服务;卫生保健;
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| It's a big part of the national budgets. |
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| And many different reforms aim at holding back this growth. |
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reforms:n.改革(reform的复数);v.改革(reform的单数第三人称);
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| In some countries, we have long waiting times for patients for surgery . |
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surgery:n.外科;外科手术;手术室;诊疗室;
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| In other countries, new drugs are not being reimbursed , and therefore don't reach patients. |
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reimbursed:v.偿还;补偿;(reimburse的过去分词和过去式)
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| In several countries, doctors and nurses are the targets, to some extent , for the governments. |
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extent:n.程度;范围;长度;
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| After all, the costly decisions in health care are taken by doctors and nurses. |
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costly:adj.昂贵的;代价高的; health care:n.卫生保健;
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| You choose an expensive lab test, you choose to operate on an old and frail patient. |
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frail:adj.脆弱的;虚弱的;n.灯心草篓;少妇;少女;
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| So, by limiting the degrees of freedom of physicians , this is a way to hold costs down. |
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physicians:n.[内科]内科医生(physician的复数);
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| And ultimately , some physicians will say today that they don't have the full liberty to make the choices they think are right for their patients. |
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ultimately:adv.最终;最后;归根结底;终究; liberty:n.自由;许可;冒失;
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| So no wonder that some of my old colleagues are frustrated . |
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frustrated:adj.失意的,挫败的;泄气的;v.挫败;阻挠;(frustrate的过去式和过去分词)
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| At BCG , we looked at this, and we asked ourselves, this can't be the right way of managing healthcare. |
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BCG:abbr.(=BacillusCalmette-Guérin)[药]卡介苗;
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| And so we took a step back and we said, "What is it that we are trying to achieve?" |
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| Ultimately, in the healthcare system, we're aiming at improving health for the patients, and we need to do so at a limited , or affordable , cost. |
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improving:v.改进;改善;(improve的现在分词) limited:adj.有限的; n.高级快车; v.限制; (limit的过去分词和过去式) affordable:adj.负担得起的;
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| We call this value-based healthcare. |
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value-based:基于价值的;
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| On the screen behind me, you see what we mean by value: outcomes that matter to patients relative to the money we spend. |
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outcomes:n.结果;成果;后果;出路;(outcome的复数) relative:adj.相对的;有关系的;成比例的;n.亲戚;相关物;[语]关系词;亲缘植物;
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| This was described beautifully in a book in 2006 by Michael Porter and Elizabeth Teisberg. |
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described:v.描述;形容;把…称为;做…运动;(describe的过去分词和过去式) Porter:n.门房;服务员;行李搬运工;守门人;
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| On this picture, you have my father-in-law surrounded by his three beautiful daughters. |
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father-in-law:n.岳父;公公;继父;
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| When we started doing our research at BCG, we decided not to look so much at the costs, but to look at the quality instead, and in the research, one of the things that fascinated us was the variation we saw. |
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variation:n.变异;变体;变奏;变种;
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| You compare hospitals in a country, you'll find some that are extremely good, but you'll find a large number that are vastly much worse. |
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compare:v.比较;对比;n.比较; extremely:adv.非常,极其;极端地; vastly:adv.极大地;广大地;深远地;
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| The differences were dramatic . |
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dramatic:adj.突然的;巨大的;令人吃惊的;激动人心的;
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| Erik, my father-in-law, he suffers from prostate cancer , and he probably needs surgery. |
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prostate:adj.前列腺的;n.[解剖]前列腺; cancer:n.癌症;恶性肿瘤;
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| Now living in Europe, he can choose to go to Germany that has a well-reputed healthcare system. |
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| If he goes there and goes to the average hospital, he will have the risk of becoming incontinent by about 50 percent, so he would have to start wearing diapers again. |
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incontinent:adj.失禁的;不能自制的,无节制的;荒淫的;adv.立即,即刻; diapers:n.(婴儿的)尿布,尿片;(diaper的复数)
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| You flip a coin. Fifty percent risk. That's quite a lot. |
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flip:n.浏览;空翻;轻抛;捻掷;v.迅速翻动;按(开关);按(按钮);开(或关)(机器等);
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| If he instead would go to Hamburg, and to a clinic called the Martini-Klinik, the risk would be only one in 20. |
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clinic:n.诊所;临床实习;(医院的)门诊部;门诊时间;
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| Either you a flip a coin, or you have a one in 20 risk. |
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| That's a huge difference, a seven-fold difference. |
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| When we look at many hospitals for many different diseases , we see these huge differences. |
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diseases:n.[医]病(disease的复数);[医]疾病;[植保]病害;疾病种类;
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| But you and I don't know. We don't have the data. |
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| And often, the data actually doesn't exist. |
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| Nobody knows. |
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| So going the hospital is a lottery . |
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lottery:n.彩票;碰运气的事,难算计的事;抽彩给奖法;
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| Now, it doesn't have to be that way. There is hope. |
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| In the late '70s, there were a group of Swedish orthopedic surgeons who met at their annual meeting, and they were discussing the different procedures they used to operate hip surgery. |
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Swedish:adj.瑞典的;瑞典语的;瑞典人的;n.瑞典语;瑞典人; orthopedic:adj.整形外科的(等于orthopaedic); surgeons:n.外科医生;(surgeon的复数) annual:n.年报;年鉴;年刊;adj.每年的;年度的;一年的; procedures:n.程序;规程(procedure的复数); hip:n.臀部;蔷薇果;忧郁;adj.熟悉内情的;非常时尚的;
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| To the left of this slide, you see a variety of metal pieces, artificial hips that you would use for somebody who needs a new hip. |
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variety:n.多样;种类;杂耍;变化,多样化; artificial:adj.人造的;仿造的;虚伪的;非原产地的;武断的; hips:n.臀部;髋;臀部…的;野蔷薇果(hip的复数)
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| They all realized they had their individual way of operating. |
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individual:n.个人;有个性的人;adj.单独的;个别的;
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| They all argued that, "My technique is the best," |
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technique:n.技巧,技术;手法;
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| but none of them actually knew, and they admitted that. |
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| So they said, "We probably need to measure quality so we know and can learn from what's best." |
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| So they in fact spent two years debating , "So what is quality in hip surgery?" |
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debating:v.讨论,辩论;仔细考虑;思考;盘算;(debate的现在分词)
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| '"Oh, we should measure this." "No, we should measure that." |
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| And they finally agreed. |
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finally:adv.终于;最终;(用于列举)最后;彻底地;
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| And once they had agreed, they started measuring, and started sharing the data. |
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| Very quickly, they found that if you put cement in the bone of the patient before you put the metal shaft in, it actually lasted a lot longer, and most patients would never have to be re-operated on in their lifetime. |
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cement:n.水泥;(干燥后硬化的)水泥;胶合剂;胶接剂;v.加强;胶合; shaft:n.拍杆;[机]轴;箭杆;杆状物;v.利用;在…上装杆;
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| They published the data, and it actually transformed clinical practice in the country. |
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transformed:v.使改变形态;使改变外观(或性质);(transform的过去分词和过去式) clinical:adj.临床的;诊所的;
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| Everybody saw this makes a lot of sense. |
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| Since then, they publish every year. |
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publish:v.出版;发表;公布;
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| Once a year, they publish the league table : who's best, who's at the bottom? |
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league table:n.(运动队的)积分排名表;(学校、医院等的)排名表;
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| And they visit each other to try to learn, so a continuous cycle of improvement . |
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continuous:adj.连续的,持续的;继续的;连绵不断的; improvement:n.改进,改善;
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| For many years, Swedish hip surgeons had the best results in the world, at least for those who actually were measuring, and many were not. |
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| Now I found this principle really exciting. |
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principle:n.原理,原则;主义,道义;本质,本义;根源,源泉;
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| So the physicians get together , they agree on what quality is, they start measuring, they share the data, they find who's best, and they learn from it. |
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get together:聚会
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| Continuous improvement. |
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| Now, that's not the only exciting part. |
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| That's exciting in itself. |
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| But if you bring back the cost side of the equation , and look at that, it turns out, those who have focused on quality, they actually also have the lowest costs, although that's not been the purpose in the first place . |
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equation:n.方程式,等式;相等;[化学]反应式; in the first place:首先;起初;
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| So if you look at the hip surgery story again, there was a study done a couple years ago where they compared the U.S. and Sweden. |
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compared:adj.比较的,对照的; v.相比; (compare的过去式和过去分词)
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| They looked at how many patients have needed to be re-operated on seven years after the first surgery. |
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| In the United States, the number was three times higher than in Sweden. |
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United:adj.联合的; v.联合,团结; (unite的过去分词和过去式)
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| So many unnecessary surgeries , and so much unnecessary suffering for all the patients who were operated on in that seven year period. |
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surgeries:n.外科手术(surgery复数);
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| Now, you can imagine how much savings there would be for society. |
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savings:n.节省物;节省;节约;储蓄金;存款;(saving的复数)
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| We did a study where we looked at OECD data. |
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| OECD does, every so often , look at quality of care where they can find the data across the member countries. |
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every so often:adv.偶尔;常常;时常;
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| The United States has, for many diseases, actually a quality which is below the average in OECD. |
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| Now, if the American healthcare system would focus a lot more on measuring quality, and raise quality just to the level of average OECD, it would save the American people 500 billion U.S. dollars a year. |
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| That's 20 percent of the budget, of the healthcare budget of the country. |
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| Now you may say that these numbers are fantastic , and it's all logical , but is it possible? |
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fantastic:奇异的,空想的 logical:adj.合逻辑的,合理的;逻辑学的;
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| This would be a paradigm shift in healthcare, and I would argue that not only can it be done, but it has to be done. |
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paradigm shift:n.范式转移(指行事或思维方式的重大变化);
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| The agents of change are the doctors and nurses in the healthcare system. |
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agents:n.代理人,经纪人;原动力;(agent的复数)
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| In my practice as a consultant, |
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| I meet probably a hundred or more than a hundred doctors and nurses and other hospital or healthcare staff every year. |
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| The one thing they have in common is they really care about what they achieve in terms of quality for their patients. |
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| Physicians are, like most of you in the audience, very competitive . |
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competitive:adj.竞争的;比赛的;求胜心切的;
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| They were always best in class. |
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| We were always best in class. |
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| And if somebody can show them that the result they perform for their patients is no better than what others do, they will do whatever it takes to improve. |
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perform:v.表演;执行;履行;演出;工作,运转(好/不好); no better than:几乎等于;实际上和…一样;
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| But most of them don't know. |
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| But physicians have another characteristic . |
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characteristic:n.特征;特点;品质;adj.典型的;独特的;特有的;
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| They actually thrive from peer recognition . |
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thrive:v.繁荣;茁壮成长;蓬勃发展;兴旺发达; peer:n.同辈;同龄人;身份(或地位)相同的人;(英国)贵族成员;v.仔细看;端详; recognition:n.识别;认识;承认;认可;
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| If a cardiologist calls another cardiologist in a competing hospital and discusses why that other hospital has so much better results, they will share. |
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cardiologist:n.心脏病学家;心脏病科医师; competing:adj.相互冲突的;相互矛盾的;v.竞争;对抗;参加比赛;(compete的现在分词)
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| They will share the information on how to improve. |
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| So it is, by measuring and creating transparency , you get a cycle of continuous improvement, which is what this slide shows. |
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transparency:n.透明,透明度;幻灯片;有图案的玻璃;
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| Now, you may say this is a nice idea, but this isn't only an idea. |
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| This is happening in reality. |
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| We're creating a global community , and a large global community , where we'll be able to measure and compare what we achieve. |
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global:adj.全球的;总体的;球形的; community:n.社区;[生态]群落;共同体;团体;
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| Together with two academic institutions , |
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academic:adj.学术的;理论的;学院的;n.大学生,大学教师;学者; institutions:n.机构;慈善机构;风俗习惯,制度;(institution的复数)
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| Michael Porter at Harvard Business School , and the Karolinska Institute in Sweden, |
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Harvard:n.哈佛大学;哈佛大学学生; Business School:n.(大学里针对毕业生的)工商学院; Institute:v.开始(调查);制定;创立;提起(诉讼);n.学会,协会;学院;
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| BCG has formed something we call ICHOM. |
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| You may think that's a sneeze , but it's not a sneeze , it's an acronym . |
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sneeze:vi.打喷嚏;n.喷嚏; acronym:n.首字母缩略词;
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| It stands for the International Consortium for Health Outcome Measurement . |
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Consortium:n.财团;联合;合伙; Measurement:n.测量;度量;长度;
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| We're bringing together leading physicians and patients to discuss, disease by disease, what is really quality, what should we measure, and to make those standards global. |
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standards:n.标准,水平,规格(standard的复数)
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| They've worked -- four working groups have worked during the past year: cataracts , back pain, coronary artery disease, which is, for instance , heart attack , and prostate cancer. |
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cataracts:n.[眼科]白内障;[水文]大瀑布,洪水(cataract的复数形式); coronary artery:n.冠状动脉; instance:n.实例;情况;建议;v.举...为例; heart attack:n.[医]心肌梗塞
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| The four groups will publish their data in November of this year. |
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| That's the first time we'll be comparing apples to apples, not only within a country, but between countries. |
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comparing:v.比较;对比;(compare的现在分词)
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| Next year, we're planning to do eight diseases, the year after, 16. |
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| In three years' time, we plan to have covered 40 percent of the disease burden . |
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burden:n.负担;责任;船的载货量;v.使负担;烦扰;装货于;
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| Compare apples to apples. Who's better? |
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| Why is that? |
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| Five months ago, |
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| I led a workshop at the largest university hospital in Northern Europe. |
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workshop:n.车间;研讨会;讲习班;工场;v.学习;
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| They have a new CEO, and she has a vision : |
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vision:n.视力;美景;幻象;想象力;v.想象;显现;梦见;
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| I want to manage my big institution much more on quality, outcomes that matter to patients. |
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| This particular day, we sat in a workshop together with physicians, nurses and other staff, discussing leukemia in children. |
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leukemia:n.[内科][肿瘤]白血病;
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| The group discussed, how do we measure quality today? |
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| Can we measure it better than we do? |
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| We discussed, how do we treat these kids, what are important improvements ? |
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treat:v.治疗;处理;招待;款待;n.款待;乐事;乐趣; improvements:n.改善;改进;改善的事物;(improvement的复数)
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| And we discussed what are the costs for these patients, can we do treatment more efficiently ? |
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treatment:n.治疗;疗法;对待;处理;讨论; efficiently:adv.有效地;效率高地(efficient的副词形式);
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| There was an enormous energy in the room. |
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enormous:adj.庞大的,巨大的;凶暴的,极恶的;
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| There were so many ideas, so much enthusiasm . |
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enthusiasm:n.热心,热忱,热情;
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| At the end of the meeting, the chairman of the department, he stood up. |
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| He looked over the group and he said -- first he raised his hand, I forgot that -- he raised his hand, clenched his fist, and then he said to the group, "Thank you. |
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clenched:v.捏紧,攥紧(拳头等),咬紧(牙齿等);(clench的过去分词和过去式)
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| Thank you. Today, we're finally discussing what this hospital does the right way." |
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| By measuring value in healthcare, that is not only costs but outcomes that matter to patients, we will make staff in hospitals and elsewhere in the healthcare system not a problem but an important part of the solution . |
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elsewhere:adv.在别处;到别处; solution:n.解决方案;溶液;溶解;解答;
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| I believe measuring value in healthcare will bring about a revolution , and I'm convinced that the founder of modern medicine, the Greek Hippocrates, who always put the patient at the center, he would smile in his grave . |
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revolution:n.革命;旋转;运行;循环; convinced:adj.坚信; v.使确信; (convince的过去分词和过去式) founder:vi.失败;沉没;倒塌;变跛;vt.破坏;使摔倒;垮掉;n.创始人;建立者;翻沙工; grave:adj.重大的;严肃的;黯淡的;n.墓穴,坟墓;死亡;v.雕刻;铭记;
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| Thank you. |
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| (Applause) |
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