Dr. Stephen K. Plume M.D.

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  www.improvementskills.org/aboutus/authors/plume.cfm - [Cached Version]
  Published on: 4/6/2007    Last Visited: 4/6/2007  

  Stephen Plume, MD
  
  Stephen Plume, MD is Professor of Surgery and Professor of Community and Family Medicine at Dartmouth Medical School in Hanover, New Hampshire.He served the Dartmouth-Hitchcock Medical Center as chief of Cardiothoracic Surgery for twelve years until being named President of The Hitchcock Clinic in 1990, a post he held until joining the faculty of the Center for Evaluative Clinical Sciences at Dartmouth in 2000.
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  A 1964 graduate of Harvard College, Dr. Plume received his medical degree from the University of Rochester in 1969, where he completed internship and residency in Surgery in 1975.He was then a Fellow in Cardiovascular and Thoracic Surgery at the University of Toronto for two years before joining the Hitchcock Clinic in 1977.

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  www.improvementskills.org/aboutus/advisory_board.cfm?CF - [Cached Version]
  Published on: 4/6/2007    Last Visited: 4/6/2007  

  Stephen Plume, MD

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  www.improvementskills.org/courseinfo/disclosure_stateme - [Cached Version]
  Published on: 4/6/2007    Last Visited: 4/6/2007  

  Stephen Plume, MD

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  2003_11 | 9 Ways To Reduce Unwarranted Variation - [Cached Version]
  Published on: 2/13/2002    Last Visited: 11/30/2003  

  Comparative variation data, when used to study practice patterns, can improve the quality of care, says Stephen Plume, MD, professor emeritus of surgery and community and family medicine at Dartmouth Medical School and a now retired staff surgeon at the Dartmouth-Hitchcock Medical Center."The most frustrating question we are asked, that all surgeons are asked by every patient, is 'What are my chances?' To answer that question for individuals, we need to be able to answer the question for each of our hospitals," Plume says.
  
  After studying regional variation rates for coronary artery bypass graft (CABG) surgery, Plume and a Dartmouth colleague, Gerald O'Connor, PhD, created the Northern New England Cardiovascular Disease Study Group in the early 1990s to develop a set of best practices, and their work has saved lives.
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  Plume says the study group's work began with a meeting in the early 1990s with John Wennberg, MD, director of CECS and principal investigator of the Dartmouth Atlas of Health Care, which reports nationwide practice variation.

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  2004_01 | Cardiologists Call Collaboration Heart of... - [Cached Version]
  Published on: 2/17/2004    Last Visited: 2/17/2004  

  "The most valuable part of all this is when they are in the car together," says Stephen Plume, MD, professor emeritus of surgery and community and family medicine at Dartmouth Medical School, a retired staff surgeon at the Dartmouth-Hitchcock Medical Center, both in New Hampshire, and one of the founders of NNECDSG.
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  "The stuff we learn is remarkable," says Plume."For example, a profusionist running the heart-lung machine during surgery noticed and mentioned during a visit that a variation occurring in blood count during surgery might be related to outcomes.Data showed that it did, that there is a direct linear relationship between the red blood cell count and mortality, and that now determines how low we allow the count to go."
  
  Another example is the use of aspirin, which is helpful in avoiding blood clots.According to Plume, the conventional wisdom had been that aspirin therapy should be discontinued weeks before surgery because it could promote internal bleeding.
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  "There was a big uproar, because it was the first that actually ranked and identified hospitals by mortalities," says Plume."People, including us, said the report was unfair and didn't properly reflect the demographic mix different hospitals contend with.So we set out to gather our own data and prove the HCFA study wrong."
  
  By 1990, Plume, O'Connor, and colleagues had traveled to all the hospitals that performed heart surgery in their region, observing and gathering data on CABG and other procedures.
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  "We found that in our region, at least, the variation in mortality rates they reported for CABG was not due to patient mix, but was greatly affected by processes and procedures we felt we could do something about," says Plume.
  
  It was a sobering realization, says Plume, and changed the way heart surgery is performed in New England.It was the beginning of an effort that has saved more than 1,000 lives, he says.

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  American College of Surgeons: Committee on... - [Cached Version]
  Published on: 11/3/1999    Last Visited: 7/8/2006  

  Stephen K. Plume, MD, FACS, professor of surgery, Dartmouth Medical School, and president of Hitchcock Clinic, Lebanon, NH, presented the keynote address, titled "Models for Quality Improvement: Using Data to Influence Behaviors."
  
  Dr. Plume noted that every system of data collection is perfectly designed to get the results that it actually gets."If we want different results, we'll have to use different processes to create them," he said.
  
  Dr. Plume stated that "the ultimate judges of the quality of our work are those we serve."These judges include increasingly well-informed patients, payors, and regulators."We in the medical professions do not have an exclusive right to police ourselves or to dictate choice of treatment.If we don't figure this out, someone else will," he said.
  
  According to Dr. Plume, collecting too much data related to quality improvement incurs many risks: the work of collection may preclude cooperation from those who have to do it; more data imply more errors collecting and recording it; data collection is expensive; and the credibility and importance of the effort is called into question if those individuals who are allegedly being helped by it see lots of unimportant or irrelevant elements.
  
  "If we are trying to design a more perfect operating room, we simply must get everyone into the game, using process knowledge and quantitative data and simple analyses so that we can make many rapid-cycle, small-scale tests of change.Once we have successfully piloted changes that seem effective in a local setting, we can generalize them across our practices, across our institutions, and across the practice of medicine everywhere," Dr. Plume concluded.

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  BCBSHealthIssues.com - [Cached Version]
  Published on: 12/15/2000    Last Visited: 4/4/2001  

  Stephen Plume , M.D. , professor of Community and Family Medicine and Surgery at Dartmouth Medical School , looks at the effect on our healthcare organizations and offers sound advice for the healthcare executives who run them.In her commentary , Simonetti Samuels , J.D. , PH.D. , an economist , lawyer , and professor , foresees major changes in the financing of healthcare services as a result of advances in genomics.
  
  Like the authors of our lead articles , Dr. Plume is optimistic about a genomic future.Genomics , he contends , will lead health and medical care into new territory with tremendous potential for breakthroughs in diagnostic and treatment procedures.At the same time , exploring this new territory will almost certainly involve a number of wrong turns and dead ends.Plume consequently cautions practitioners to be prepared for problems and disappointments as well as great advances.
  
  As the former president of Dartmouth-Hitchcock Clinic , Plume is well qualified to advise healthcare executives.He suggests they look at ways that organizations influence our understanding of the world and identify means of coping with disruptive expansions of knowledge , for that is surely what genomic advances will bring.He finds Weick's ( 1995 ) concept of sensemaking helpful , for it is one way of coping with rapid change.Plume suggests that healthcare managers weigh the benefits and risks of formulating strategic plans in an environment that will almost certainly shift before the plan is realized.
  
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  STEPHEN K. PLUME , M.D
  
  THIS COMMENTARY HAS two aims.One is to endorse the sense of great opportunity and of potential problems associated with the impending genomics era in healthcare , as described by two articles in this issue of Frontiers of Health Services Management.There is some urgency in beginning to address these.The other aim of this commentary is to raise a consideration that pervades everyday experience but about which leaders do not always think deeply : how organizations influence our understanding of the world.
  
  The image of scientific knowledge as a sphere whose surface is the interface between what is known and what is not known seems especially apt for genomics.Any increase in what we know entails an exponential increase in our interface with what we do not yet know.

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  PALLIN PATENT CLAIMS INVALIDATED - [Cached Version]
  Published on: 3/28/1996    Last Visited: 6/29/2005  

  "This is a tremendously satisfying victory for Dr. Singer and the Clinic," said Dr. Stephen Plume, President of Lahey Hitchcock Clinic, the successor organization of the Hitchcock Clinic following its recent merger with the Lahey Clinic.
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  Plume said.

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  Pittsburgh Hospital News Calendar - [Cached Version]
  Published on: 5/20/2003    Last Visited: 2/4/2004  

  The Forum will highlight the efforts of anesthesiology in CABG surgery, and will feature special guest keynote speaker, Stephen Plume, M.D., a cardiac surgeon who pioneered the NNE registry.

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  The D News: DHMC receives $1M donation - [Cached Version]
  Published on: 9/27/2002    Last Visited: 9/27/2002  

  The Avery family of Fairlee, Vt., announced Saturday their donation of $1 million to the Dartmouth-Hitchcock Medical Center in honor of Dr. Stephen Plume's retirement.
  
  Allen Avery described this money as a donation "in recognition of Dr. Plume for taking care of my dad and adding another 20 years to his life."
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  In the span of his career at the Center, Plume treated thousands of patients, including Borden Avery, a patient who underwent three open-heart surgeries and various other procedures starting in the early 1970s to his death in 1996, under the care of Plume and his colleagues.
  
  The money is to be donated in increments over a period of five to seven years, starting this year.The funds will be specified for cardiothoracic surgery, patient care, heart disease research and the education of physicians in order to "provide the utmost level of family center care."
  
  The gift is called "The Louise R. and Borden E. Avery Endowed Clinical Chair in honor of Dr. Stephen K. Plume."
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  Borden Avery, described as a "remarkable, public-spirited man" by Dr. Plume, always held his doctors in the highest regard.
  
  "He thought the world of Dr. Plume," Allen Avery said.
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  Borden Avery's wife, Louise, and son, Allen, found Dr. Plume's retirement a "great opportunity to give back to the community and the hospital," Allen Avery said.
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  The Averys "have always been firm supporters and frequent contributors to the hospital," Dr. Plume said.Past donations included one to build a new operating suite in the hospital in the 1980s.
  
  The announcement of the donation came at a retirement party at the Avery family owned-and-operated Lake Morey Inn Resort -- Dr. Plume was completely surprised.
  
  "I was flabbergasted and grateful to the Avery family," Dr. Plume said.
  
  Plume is currently an assistant teacher for the Health Care Improvement classes at Dartmouth Medical School.He spends about two days a week preparing for classes, and another two days teaching.
  
  The Avery family has lived in Fairlee since 1960, and has owned and operated numerous Vermont inns for over 40 years.
  
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