Putting Patients Above Politics

In a speech delivered at the Institute for Healthcare Improvement Forum 0n Dec. 7, 2011, Dr. Donald Berwick, former administrator of the Centers for Medicare & Medicaid Services and former president and CEO of IHI, issued a powerful challenge to the health care community. He said, “If improvement [of the American health care system] is the plan, then we own the plan. Government can’t do it. Payers can’t do it. Regulators can’t do it. Only the people who give the care can improve the care.”

We are those people.

Only we can improve health care processes — because we create, manage and use them; we know what works and what doesn’t.

Only we can improve the quality and safety of care — because we are the people defining and delivering that care. More than anyone else, we see where there is unnecessary duplication, vulnerability for medical errors and barriers that reduce efficiency and effectiveness of care.

Only we can move the nation toward a patient-centric health care system — because unlike politicians, policy makers and others, we interact with patients and their families each and every day; nobody is better positioned to witness, understand and act on their experiences and suggestions.

All of this, done in parallel, will reduce costs, improve care and promote health equity.

In this New Year, as we continue to navigate a tumultuous economy and a historic time in the history of health care practice and policy in the United States, I ask you to consider Dr. Berwick’s words.

This isn’t about politics. It’s about patients. It’s about medicine and science. It’s about you, me, your colleagues, your neighbors and your families. And, ultimately, it’s the reason we are here.

Let’s commit this year more than ever to show the nation why Michigan is leaders and best in health care, to create the future of health care through discovery and to leave a maize and blue mark on the history of health care innovation and improvement. And let’s do it because we know that it is the right thing to do.

We all have a voice and we all have a choice in how we use our voices. I invite you to share your voice, your thoughts and your ideas on improving health care here, on my new website, Medicine That Speaks, which I created to be a forum for ideas and conversations about taking health care to a better place.

What have you done on your unit or in your department to improve processes, care and the patient and family experience?

Where do you see opportunity?

What do you think of Dr. Berwick’s challenge?

22 thoughts on “Putting Patients Above Politics

  1. Garrett Griffin on said:

    Thank you for your excellent leadership in this new year.

    While it is unpopular to focus on the cost of health care delivery in this country, I would actually see this as the most important issue facing health care systems and practitioners. You do mention “cost” in one sentence above, but it is not the focus of the blog entry.

    Delivering safe and high-quality care is certainly our primary mission, but I think that this goal will be increasingly unobtainable in the future if the overall cost of health care is not checked. At some very near point, I expect and in some ways hope that our political system enacts changes that require health care costs to level off and decrease. Yet if lawmakers are the ones cutting costs, it is perhaps less likely that the quality of care will improve; after all, it is those of us on the front lines (not politicians) that understand what is is to deliver quality and value to our patients.

    As Dr. Berwick has challenged, it would be a much better solution if fine academic centers like the University of Michigan could take the lead on this.

    I have often thought than a smartphone “app” that quickly told a practitioner the cost of various medical supplies could go far in cutting costs. As a surgeon and son of a frugal businessman, cost is always on my mind, but I have no tools available with which to make cost-based decisions. How much does a 4-0 Monocryl cost? I have no idea. I have heard that Nylon suture is less expensive than Prolene suture…is this true? Prolene is a little easier to work with, but I am happy to use Nylon if it is less expensive. Integra is $4000 a sheet. I suspect it is used in many cases where a xeroform bolster could be used instead. If these types of applications do exist, UMHS could do a better job publicizing their existence to their employees.

    Are there applications that are part of MiChart to help caregivers make cost-based decisions? If not, can they be added?

    I view health-care costs as the single greatest challenge facing this great nation over the next decade. Without significant health care cost-containment, job growth will fall, the national debt will rise, and we will be increasingly unable to compete with, as one author has called it, not “cheap labor” but “cheap genius” in Asia and the other BRIC nations (health care makes the total cost of US employees significantly higher than in many countries).

    • Ehab Youssef on said:

      I agree with you 100%, I have medical experiance outside US and I see that a lot of cost oriented choices can save a lot from the medical bills without affecting the quality of service.

    • Ora Pescovitz on said:

      You bring up excellent points. Containing health care costs is one of our nation’s most critical challenges right now, and one that impacts many facets of our economy and social fabric. We need to address the issue from many angles. Improving the quality and efficiency of the current system is one of the ways we can make a dent. People like you, and institutions like UMHS, should definitely take the lead in finding innovative and effective solutions. With regard to MiChart, I don’t know off-hand about applications associated with it – have you shared your thoughts with the MiChart team?

      • Garrett Griffin on said:

        I will share the idea with a colleague that is heavily involved with MiChart implementation. I think MiChart would be best suited to making cost-based decisions about medications and dressing supplies.

        But in terms of things that are used on inpatient units and in the OR, perhaps the easiest solution would be a simple webpage where caregivers could look up the cost of a certain product. This wouldn’t be that hard to create, and could be put under the “clinical resources” tab on the main clinical page. Ideally the cost to the hospital, and the cost that is billed to the patient, should both be listed…I realize the potential implications of this information being disseminated outside the hospital, but it is a secured site. And it is the right thing to do. Functionality would be maximized by having a simple “keyword” search, so one could just type Monocryl and it would pull up the different types of monocryl suture.

        I do realize that our hospital needs to at least break even, and admit that I am completely naive of any revenue-generating issues that this type of decision-making might create.

        That said, this is an idea that could be studied for cost-savings and potentially published, in keeping with our motto “the leaders and the best.” One potential study model would be to give 20 residents a smartphone with the app (or website that is made) and 20 residents a smartphone without the app (or website), and to tabulate the cost of medicines and dressings that were “prescribed” by those residents over a certain period of time. An alternative would be to study surgeons who were or were not informed of the cost of sutures/dressings/medications used in the OR to see if this made a difference. There are so many supplies that we use that are essentially identical but that likely cost very different amounts.

        Always easier said than done, but doable. This would be an excellent project for a graduate student in health policy or a similar field.

    • Amber Kroeker on said:

      Dr. Giffin,

      I absolutely support your ideas. There is already research out there to support consumer directed health-care. However, in this case the provider is also considered a consumer and can, I believe, help directly influence the cost of a procedure or treatment if they were properly aware of these prices. And I suspect in many cases, the outcome for the patient would be the same regardless of which product was used (if research were available to support this). There are many unanswered questions as to why providers choose one product over another (you reference Integra vs xeroform bolster). Perhaps training but perhaps something else?

      Some states already have health care price disclosure statues in place, but each state can decide what that looks like. It may be as cursory as a hard-to-find website. The National Conference of State Legislators (NCSL) website has some interesting information on the current movements of any legislation pertaining to health care price transparency. However, you are correct in stating that Michigan should be a leader in this area! As consumers, we know the price of nearly EVERYTHING we buy before purchase- why can’t this be the same with health care. I understand this is an oversimplification but with knowledge there is power.

  2. clcraig on said:

    With the arrival of the ACO concept, we will need to provide full service to patients we see in outpatient areas in order to control costs. At present we are not able to provide orthotics to all of the patients seen in our outpatient clinics. It would appear this will need to be rectified either by contracting with appropriate insurances or eliminating from our clinics patients we can’t fully service.

    • Ora Pescovitz on said:

      Accountable Care Organizations and similar frameworks to provide care for populations do indeed offer an opportunity to control costs. I think two areas of strategic focus for the Health System – payer contracting and looking at diverse care setting opportunities – address exactly the issues you describe for orthotics patients. Our solutions need to put patients needs’ first, however, and we want be sure that all patients have access to important services in their local communities.

  3. Kelly Scheu, NP on said:

    My thoughts on improving health care at UMHS, is that we need UMHS and the leaders to take a stance at the State level to help remove the barriers placed on Advanced Practice Nurses such as Nurse Practitioners. The Public Health Code has not been changed since 1978. Nurse Practitioners are limited on prescriptive authority and cannot write for scheduled II pain medication which is makes it very difficult to manage pain when physicians are away, as an example in my current role, cancer pain.
    Nurse Practitioners in Michigan also cannot write for respiratory and physical therapy. This is just a few examples of some restrictions.

    Many studies have shown that Nurse Practitioners provide safe and effective care so the barriers really limit our ability to provide the effective and efficient care we all want for our patients.
    I thank UMHS for hiring and utilizing Nurse Practitioners.
    We do provide improved access to care for many patients throughout UMHS. I also feel the collaboration with UMHS physicians is a good team approach to patient focused care.
    My challenge to UMHS and its leaders is, can we rally together as one strong voice in Lansing to get some of these barriers removed? I believe if big institutions like UMHS could help Nurse Practitioners push for change in Lansing that this would improve access to care for many Michigan residents; and the removal of barriers would allow for improved effective and efficient care that we are all striving for.

    • Ora Pescovitz on said:

      This is an important conversation in health care right now as we look at how we improve the patient experience and the efficiency of health care delivery – in Michigan and beyond.

    • Allison Krieger on said:

      Hi Kelly…I work in Ora’s office and contacted Rick Bossard in UMHS Government Relations to learn more. He suggested that you might be interested in Senate Bill 481 and House Bill 4774, which address prescriptive authority for nurse practitioners. These bills have been sent to the respective Health Policy Committees, and will likely be debated in the early months of 2012.

  4. Stephanie Smith on said:

    Although I am new to UMHS, I am also a graduate student pursuing a degree in Health Administration and I think patient education will play a major role in cost containment over the next decades. Cost containment will continue to be difficult especially considering the aging population, so it is the responsibility of every provider to ensure that his or her patients are not exacerbating the problems associated with cost. Patients may request costly tests that they do not need, for example. I have often felt that if patients were able to see the true costs of their medical care instead of being insulated by insurance perhaps they would make more informed decisions. (Not saying that insurance is a bad thing of course, but it does keep patients ignorant of the true costs of those CT scans, MRIs, etc).

    There has also been talk of personnel shortages–nursing in particular. Ensuring that there is an appropriate nurse to patient ratio is detrimental to patient safety. Although I am confident UofM has no problem attracting highly qualified nurses, I have read reports that discussed the large number of Baby Boomer nurses who will be retiring in the coming years and will need replacements.

    Overall I agree with Dr. Berwick’s assessment that the best ones to change the face of health care are the people who work in the field every day, as we are the ones who interact with the patients and the system and have direct access to any shortcomings.

  5. Scott Olson on said:

    As managing director of the U-M Medical Innovation Center, I am fortunate to see the breadth and diversity of innovative ideas from our faculty, staff and students. From novel surgical devices and clever diagnostic assays to simple solutions to common problems, our community has already begun to accept the challenge of owning the plan to improve healthcare both here at U-M, nationally and on a global scale.

    One part of the solution will be innovation. The term is widely used, but in healthcare I see it meaningfully applied in two distinct ways: incrementally and breakthrough. Breakthrough innovations like organ regeneration, wearable robotics and cancer vaccines will continue to capture headlines, but no less important to healthcare improvement are incremental innovations. Incremental innovations can improve patient outcomes (better imaging to guide minimally invasive procedures), track patient symptoms (home monitoring), or lower costs (handheld ultrasound). Even simple things like procedural checklists can eliminate complications and reduce deaths—innovative to be sure for the patients who benefit!

    Thinking beyond technology to the delivery of healthcare is something our practitioners have done for years, whether in the guise of healthcare quality, continuous improvement, or lean practices. Our opportunity now is to broaden those efforts, informed by processes that support, guide and shape the ultimate impact. The most effective innovation processes follow guidelines—so here are FIVE SIMPLE STEPS TO MEDICAL INNOVATION.

    1. Observe. Watch what goes on around you with a beginner’s eye, without criticism. Then watch again, and again, and again. Take in everything; leave nothing for granted.

    2. Sift. Capture your observations in writing and pictures and notes. Then sift through them to identify patterns. State those patterns in the form of a problem. Better yet, an opportunity.

    3. Hypothesize. State what you believe is one solution to the problem. Then state another one. While you’re at it, ask a bunch of people to brainstorm likely solutions. Go crazy here—the best ones are not found at the beginning of the process, or in the middle, but at the end.

    4. Test. Put the best solution into a model—a procedure, or a prototype, or a mock-up. Then give it to people who might use it and ask for their input. This will propel you back a step—and that’s good! Just do it again and return to the users (note the “s”—one user is never enough).

    5. Implement. OK, I’ll oversimplify here. Approvals might be required, regulatory schemes may apply, further testing and refinement could be required. But these are manageable and act as safety brakes for the innovations that are well positioned to improve the patient experience.

    The call to innovate is coming loud and clear from our leadership, with resources such as the Medical Innovation Center, FIGS, MICHR, and departmental support to back your efforts. There are meaningful challenges ahead—but the talent and creativity of our people will be just what is required to meet them.

  6. Sue Hadden on said:

    Thank you for the opportunity to contribute. I have seen some great managers and leaders and some leaders that needed mentoring and feedback. I believe there should be a mechanism for feedback and evaluation of managers that is from the staff being managed. My impression is that evaluations are being done from “above” without getting grass roots information. Marge Callarco is the only administrator I know who asks for yearly feedback.

    • Ora Pescovitz on said:

      Thank you, Sue. Many of our leaders seek feedback from their staff and colleagues, as part of their ongoing development. 360 degree feedback is recommended as part of our Performance Management and Leadership Development processes,as well. In fact, supervisors and managers who attend one of our leadership development programs participate in a 360 degree assessment as part of the training.

  7. Pingback: U-M’s Ora Pescovitz: U.S. can’t wait for politicians to fix health care system | Michigan News Press | Michigan Breaking News Headlines | Michigan News Directory

  8. Branka Holtzman on said:

    I am an Interpreter at the hospital. I spend a lot of time walking around to different locations in order to interpret and, as I do so, I observe everything around me. I often think how wonderful it would be if our hospital had more natural plants all over the corridors and walkways and even stairs. If I were the patient, afraid and worried about my illness, I would be happily “distracted” by the beauty around me. More plants, just like in our CVC building would create an atmosphere of natural healing and calmness needed for the human spirit to heal faster, while in great distress of being there. I would make our hospital a beautiful place for our guests and our patients to come to. A calm and peaceful healing oasis. It would be a great project to work on!

  9. Ora Pescovitz on said:

    This is one of the reasons we designed the CVC that way. Creating a healing environment is an important way we enable an ideal experience for patients, loved ones and visitors.

  10. BhavanaJagat on said:

    What is Man? It is important to express our understanding of man to defend his well-being. The concern for patient-centered or disease-specific interventions may miss the opportunity to address the needs of the Whole Human Person. I would like to hear from you as to how you would choose to define man and explain the term health as to how it delivers or promotes the well-being of that man. Unless the terms used in a discussion are stated in clear and meaningful words, we may not come to know the nature of the problem for which we are trying to find solutions.

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