by Jan Simpson.
Michael Porter, Atul Gawande, Richard Bohmer. These are not household names. Yet they are among the voices leading the charge for improvements in the way health care is provided in America. Recently, I was among 150 participants in a two-day think tank at Harvard. Physicians mingled with attorneys, business executives chatted with professors, public health experts lingered over lunch with entrepreneurs. The topic was innovation in health care.
Years ago, I might have taken copious notes during a meeting like this, but after a decade navigating the system trying to get decent care for my parents, I listen somewhat skeptically to pundits. Today, I am more hopeful than in the past and you should be too. Here’s why.
Say the name Michael Porter among business elites and all will nod their heads in recognition. Brilliant and intimidating, Porter resembles an adult version of Peter Pan’s John Darling, lithe and bookish, whose skill lies in his ability to distill complex topics into simple concepts that mere mortals can understand. In 2005, Porter turned his attention to health care and published a book “Redefining Health Care” that I cannot recommend, although I purchased it then with great interest. Having cared for my parents for so many years, I was sure Dr. Porter would know how to fix the problems with the health care system. The book was disappointing; I use it as door stop. Fortunately, Porter’s research and thinking have evolved.
In simple terms, he advocates that the goal of health care delivery is to provide value to the patient, and he defines value in economic terms, comparing the cost of a service (e.g., hip replacement) to the achievement of a favorable outcome. In other words, if your elderly mother has her hip replaced, a favorable outcome is not only that she survived the surgery, a typical measure of quality in the past, but that she returns to her activities of daily living without complications. This isn’t rocket science, is it? Anyone having a hip replaced would hope to avoid infections or medical complications and, with therapy, return to full strength. But having that outcome built into the way hospitals deliver care and measure performance requires change, and systemic change is influenced by people like Dr. Porter. We should applaud his advocacy and buy his next book when it is published.
Atul Gawande is the Justin Bieber of health care. A brilliant surgeon, author, and father of three, Gawande writes periodically for the New Yorker, and brings a fresh voice to the health care discussion. He doesn’t shy away from controversial subjects such as end-of-life care and he challenges group think. Last September, he wrote “Letting Go” arguing that “modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.” Thoughtful and provocative, his January article “The Hot Spotters” is the current buzz among those in the know as he shows how to cut health care costs and improve care by providing health coaches to the heavy users of the system. For example, in Camden New Jersey, only one percent of people account for nearly one-third of all medical costs. Gawande challenges conventional thinking with his pragmatic counsel: provide health coaches to the sickest among us, and help those with a terminal illness avoid suffering at the end of their life with palliative care.
His latest hot button is checklists. Dr. Gawande advocates for more widespread use of checklists by surgeons in hospitals. Go figure. I would have thought they already use them in surgery. After all, I prepare a checklist before I do grocery shopping and when my family packs for vacation. Isn’t a quick run through a checklist before heart surgery more important than if I forget laundry detergent or clean socks? Apparently this is a major innovation. So before your loved one goes under for prostate surgery, perhaps you should ask the surgeon if he or she uses a checklist. Let’s help Dr.Gawande get this done.
Richard Bohmer is a third player. A cross between Marcus Welby, M.D. and House, Dr. Bohmer received his medical education in New Zealand and brings an outsider’s perspective to the American system. He studies pockets of health care excellence in America, places such as Intermountain Healthcare, where hospitals and insurance providers work collaboratively to improve patient care. Dr. Bohmer then educates teams of health care executives and clinicians on how to improve their own health care practices through leadership programs such as “Managing Healthcare Delivery.”
Porter, Gawande and Bohmer are three powerful voices working on our behalf to improve health care delivery, three men whose words influence the decisions of those business, government and health care leaders who impact all of our lives. So, on those days when you need to run, once again, to help your parents, I want you to know that there is a glimmer of hope that our children will not have to do the same for us.
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