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Current Opinion in Obstetrics & Gynecology:
doi: 10.1097/GCO.0000000000000031

All strategies great and small

Blumenthal, Paul D.

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Stanford University School of Medicine, Stanford, California, USA

Correspondence to Paul D. Blumenthal, MD MPH, Department of Ob/Gyn, 300 Pasteur Drive HG-332, Stanford, CA 94305-5317, USA. Tel: +1 650 725 6035; fax: +1 650 723 7737: mobile: 410 802 8384: e-mail:

Over the past several years, the art and science of providing healthcare has perhaps been second only to global ‘climate change’ in terms of the gyrations and upheavals experienced by clinicians in connection with the climates that currently characterize the practice environment. As such, healthcare providers have learned that it is not enough to have clinical acumen, surgical skill or even great patient rapport. In the current healthcare environment, especially in which obstetrics and gynecology are concerned, the clinician is increasingly required to be strategic about a wide variety of issues that would seem to be completely nonclinical, but which, beginning with training and ending with the actual global environment considered as a healthcare entity, will shape our practices for years to come.

In this issue of Current Opinion in Obstetrics and Gynecology, focusing on ‘healthcare management strategies’ a number of such ‘strategies’ are reviewed, running the gamut from a particularly patient-focused issue such as oral contraceptives as an over the counter medication to a decidedly population-based issue such as the role that the environment itself can play as a healthcare partner.

Dan Grossman and Lisa Fuentes with Ibis Reproductive Health have provided a rational, compelling overview of how and why oral contraceptives clearly meet the criteria for ‘OTC’ status, and why making them so is an effective healthcare strategy at both the patient and societal levels. Of all the strategies discussed in this issue, this is the one that is most likely to positively and directly affect patient care, but which is also the one most mired in political posturing and pantomime.

Recognizing that clinical training paradigms continue to shift away from ‘practicing’ on patients and increasingly emphasize the value and efficiency of clinical preparation using simulation, Eugene Chang, from the Medical University of South Carolina, has provided an elegant evaluation of the current state of simulation in our field, and why this will continue to emerge as an important strategy both for achieving and maintaining clinical competence. However, just at the time when practicing the unique skills necessary for successful laparoscopy is critical for the achievement of competency, the medico-legal climate as well as other regulatory sea changes have required us to increasingly bring documented competence into the operating or delivery room. This, in turn, reduces the opportunity for the clinic or theatre to be a proving ground for residents or students and requires pretheatre preparation, a role that simulation-based training is designed to help us achieve.

When completing a surgical procedure or a clinic visit for a patient, we are repeatedly told that ‘if it's not documented, it didn’t happen’. In an era when the demands of documentation multiply, is the Electronic Health Record (EHR) a help or a hindrance? Matthew Eisenberg et al., from Stanford, present both a short history of the electronic medical record and a frank assessment of the promise and pitfalls of this technology as a strategic entity.

Cost-effectiveness analysis is another tool that, over the past several years, has been emerging both as a means of improving and rationalizing healthcare strategies, but also as a strategy of its own. Rodriguez and Caughey, from the University of Oregon, present a tour de force of the art, science and value of this approach in helping us appropriately apportion healthcare resources, based on an hopefully dispassionate examination of the evidence. Although cost-effectiveness ‘modeling’ has sometimes been disparaged as being only that, a model, with a questionable relationship to reality, these experts make the case that well researched and reasoned models can be truly informative toward providing policy makers with a sensitive tool for strategizing about the appropriate use of healthcare resources.

Finally, Dr Lynne Gaffikin, from Stanford University and Evaluation and Research Technologies for Health, presents a completely unique and compelling perspective on the ultimate healthcare management strategy in the face of evolving climate change: the environment itself. Dr Gaffikin, an international authority on the integration of programs relating to health and the environment, argues that not only must the environment be preserved and protected for the natural resources it provides (which we, almost universally, take for granted) but that, because of the health-promoting ‘services’ that the healthy ecosystem can provide, our environment itself can be considered as a healthcare provider with the potential to help us improve health while saving natural resources and healthcare dollars.

In sum, the healthcare management ‘strategies’ presented in this issue of the journal span a variety of interventions ranging from the patient-centered strategy of making contraceptives more accessible to healthcare consumers, to system-oriented interventions such as EHRs and simulation training, to research tools such as decision analysis and finally to the truly global intervention of helping keep the environment healthy so that it can, in turn, keep us healthy. All of these strategies, whether considered as great or small in scope, will help make the clinical environment better for our patients whoever and wherever they may be.

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Conflicts of interest

The author has no conflicts of interest to declare.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins