Top Tweets for #marginallosses
@Matlalor I asked my local burrito shop for uncastrated wild boar but they only had chicken and pork 😅 #marginallosses
Froome's wheel identity crises before the Tour:
Discs or no discs
Lightweights or Black Inc
#marginallosses
Mental disadvantage starting a race with a Garmin mounted upright like this. Surely that's at least -1 watt? #notsoaero #marginallosses
Min träningsfilosofi: cykla mest mellanmjölkspass, strunta i styrketräning, dieta med vin, kaffe och choklad, samt återhämtning med jobb dygnet runt #marginallosses
@doctorcaldwell @DrGrumble Now I get the impression that they not only don't know these basics, but actively know and act on a number of ideas that are actively harmful to performance and improvement.
@DrUmeshPrabhu @DanielBayley80 @theveindoc @ProfDemartines @NusratMedicine @yeh_james3 @MOReilly01 @Silverangel882 @pttopt @NevilleGaunt @JKMVidimo @bottomdoc @David_ukan @K_G_Spearpoint @amirhannan @GarethRoberts0 @MiracleTraining @CelestinoGutirr @KatieB_NP @SWexner @FezaRemziMD @escuelavargas @juliomayol @Cirbosque @ALMATEC_SOCIAL @gmacscotland @escp_tweets @researchactive @DCharabaty @YouESCP @Morochoguzman @jcragostini2012 @sminaev2015 @rogerkline @DrAmirKhanGP @ann_poppy @AnastasiaSMihai @FahmiJFarah @WomenSurgeons @svig2 @BrennanSurgeon @ParagSinghal09 @datta_vikram @nqocnhealth @COSMakin @TheKingsFund @Prerana_Issar @NHSLeadership @NHSEngland @curetheNHS Waiting on a trolley for any minutes after a decision admission is necessary is wrong. On a trolley access to water, food & toilet is difficult. Yet #NHSEngland is now complacent about 4hr target & considering dropping it because of spectacular failings through #MarginalLosses
@jimfinlayson @Uk_BowelDoc @theveindoc @ProfDemartines @NusratMedicine @DrUmeshPrabhu @yeh_james3 @MOReilly01 @Silverangel882 @pttopt @NevilleGaunt @JKMVidimo @bottomdoc @David_ukan @K_G_Spearpoint @amirhannan @GarethRoberts0 @MiracleTraining @CelestinoGutirr @KatieB_NP @SWexner @FezaRemziMD @escuelavargas @juliomayol @Cirbosque @ALMATEC_SOCIAL @gmacscotland @escp_tweets @researchactive @DCharabaty @YouESCP @Morochoguzman @jcragostini2012 @sminaev2015 @rogerkline @DrAmirKhanGP @ann_poppy @AnastasiaSMihai @FahmiJFarah @WomenSurgeons @svig2 @BrennanSurgeon @ParagSinghal09 @datta_vikram @nqocnhealth @COSMakin @aneezesmail @RCPCHPresident @ingridbrindle Yet more #MarginalLosses to slow down patient flow - #NHSScotland could strike a mutual deal with England Wales & NI to build one #UK wide GP Database for ‘The #NHS’ @hamish_laing
@NevilleGaunt @David_ukan @NusratMedicine @DrUmeshPrabhu @yeh_james3 @MOReilly01 @Silverangel882 @pttopt @JKMVidimo @bottomdoc @K_G_Spearpoint @amirhannan @GarethRoberts0 @MiracleTraining @CelestinoGutirr @KatieB_NP @SWexner @FezaRemziMD @escuelavargas @juliomayol @Cirbosque @ALMATEC_SOCIAL @gmacscotland @escp_tweets @researchactive @DCharabaty @YouESCP @Morochoguzman @jcragostini2012 @sminaev2015 @ProfDemartines @rogerkline @DrAmirKhanGP @ann_poppy @AnastasiaSMihai @FahmiJFarah @WomenSurgeons @svig2 @BrennanSurgeon @ParagSinghal09 @datta_vikram @nqocnhealth @COSMakin @aneezesmail @RCPCHPresident @iona_heath @MayoClinic @westernsussex @NHSLeadership @gmcuk #NHS is also ‘so screwed’ because every vested interest group has been allowed to add its bureaucracy to the paperwork without any studies on Time & Immobility whilst diseases progress unchecked
Multiple #MarginalLosses have paralysed Clinical Care & 4hr target failed ++++++
@yeh_james3 @HannahGals @Siggers1000 @JonathanWHinton Application of the theory of #MarginalGains can result in runaway success
#NHS has introduced multiple #MarginalLosses - new processes that slow Care down until #NHSEngland has out of control failure of flow, as shown by collapse of 4hr target
@JKMVidimo @VP_Scot_RCEM @DrGrumble @ChooiLee3 @DrJennyVaughan @drkimholt @DrUmeshPrabhu @DrLindaDykes @djbeckett @vincentconnolly @westernsussex @drkathrynmannix @RCEMPolicyVP @j59dd @TheIHI @nialldowney @PeteGordon68 Rewriting Meds list 12 times by hand is clear example of multiple #MarginalLosses of time in the stagnation
Seeing & discharging patient in 10mins then taking 15mins to load discharge summary software & do summary
Multiple reclerkings beyond 2 adding little @csubbe
I’ve just found an email I sent to @PBottomleyMP in March 2014 about How Too Much Nursing Paperwork is slowing down care of inpatients.
These #MarginalLosses may be why 4hr Target is failed throughout #NHSEngland @PeteGordon68 @MattHancock
@DrUmeshPrabhu @K_G_Spearpoint @amirhannan @GarethRoberts0 @MiracleTraining @CelestinoGutirr @KatieB_NP @SWexner @FezaRemziMD @escuelavargas @juliomayol @Cirbosque @ALMATEC_SOCIAL @gmacscotland @bottomdoc @escp_tweets @researchactive @DCharabaty @YouESCP @Morochoguzman @jcragostini2012 @sminaev2015 @ProfDemartines @rogerkline @DrAmirKhanGP @ann_poppy @AnastasiaSMihai @FahmiJFarah @WomenSurgeons @svig2 @BrennanSurgeon @ParagSinghal09 @datta_vikram @nqocnhealth @COSMakin @aneezesmail @David_ukan @RCPCHPresident @iona_heath @MayoClinic @westernsussex @thegoodsummit @HIC2016 @davidickinson @PAG1962 so many bureaucratic #MarginalLosses that their is no time left to either fill in the forms properly nor do care properly #DoubleWhammy and hand the notes and staff over to be disciplined and/or sued with all the poorly filled forms as clear evidence of incomplete care
@ParagSinghal09 patient assessed by
Paramedics
A&E Nurse
A&E Junior
A&E Senior
Med Reg
AMU Junior
AMU Nurse
AMU Consultant
Ward Junior
Ward Nurse
Ward Consultant
For simple pneumonia
11uplication
https://t.co/M1PjFCs3BE
We’ve drifted into #MarginalLosses and failure
https://t.co/NnrJU01oZf
@ParagSinghal09 @PeteGordon68 I should have been able to type History and Exam into Laptop, write a 2 sentences summary & have finished the job in 8 minutes not just over 22 minutes and @NHSScotland wonders why we get 4hr breaches - so many cumulative #MarginalLosses @CathCalderwood1 @DrCJM @VP_Scot_RCEM
@K_G_Spearpoint @DrUmeshPrabhu @amirhannan @GarethRoberts0 @MiracleTraining @CelestinoGutirr @KatieB_NP @SWexner @FezaRemziMD @escuelavargas @juliomayol @Cirbosque @ALMATEC_SOCIAL @gmacscotland @bottomdoc @escp_tweets @researchactive @DCharabaty @YouESCP @Morochoguzman @jcragostini2012 @sminaev2015 @ProfDemartines @rogerkline @DrAmirKhanGP @ann_poppy @AnastasiaSMihai @FahmiJFarah @WomenSurgeons @svig2 @BrennanSurgeon @ParagSinghal09 @datta_vikram @nqocnhealth @COSMakin @aneezesmail @David_ukan @RCPCHPresident @iona_heath @MayoClinic @westernsussex @thegoodsummit @HIC2016 @davidickinson So many #MarginalLosses in #NHS eg our #WardClerk fills in on paper every morning how many patients discussed at morning handover
Why?
I don’t know
Who gets the data & what happens?
I don’t know
@jotalbotbowen @Drlesleyfish @danlevitin @wield1 @roshni_beeharry @lucyhunter75 @ImproveDX @hdx @IMreasoning @drjamesboyle @rakeshspatel @TheIHI I’m thinking of writing
#BlackHole Thinking: #MarginalLosses and the Failure to Meet the #NHS 4hr Target @matthewsyed @MartinBromiley @nialldowney @TheKingsFund
@DrUmeshPrabhu @keithmallinson1 @Phoebejoy1611 @ShareenIdu @sharmilaxx @WeeksKimD @VadodaraAirport @wussydoc @somersetwyvern @DrGrumble @NHSEngland @MattHancock @Jeremy_Hunt @didoharding @RobBehrens1884 @gmcuk @rakeshspatel @RoyLilley #MarginalLosses ‘This will only take a minute extra’ until all the minutes are taken up and Doing The Care safely and on time becomes impossible eg Nursing Documentation #Formification Results in #Gridlock
@22Q11_Ireland #MarginalLosses eg more forms introduced with aim of improving safety or flow but undermine both - why does #NHS not study the ergonomics of #ClinicalConsultations? Ward nurse today says recording her ward admission consultation takes 40 minutes paperwork #Formification
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