NATIONAL HARBOR, Md.—In the convention business, some say an annual meeting is only as good as its keynote addresses. Those people would call HM15 a home run, because the thousands of hospitalists who made their way to just outside the nation’s capital last month were treated to a trinity of talented talkers.
First up was patient safety guru Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI), echoed his patient-centered focus in her address. The four-day confab ended with hospitalist dean Bob Wachter, MD, MHM, reading from his new book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.”
The three came from different perspectives but ended up in the same place: Hospitalists can use technology, teamwork, and talent to be the people who make healthcare in this country safer. In fact, HM has the responsibility to do so.
“We are the only hope that the healthcare system has of improving quality and safety,” Dr. Pronovost said.
Famous for creating a five-step checklist designed to reduce the incidence of central line-associated infections, he talked about healthcare in terms of physicians telling “depressing” stories that hold change back.
“The first is that we still tell a story that harm is inevitable,” he said. “‘You’re sick, you’re old, you’re young, stuff happens.’ Second, we still tell stories that [show that] safety and quality are based on the heroism of our clinicians rather than design of safe systems. And, third, we still tell a story that ‘I am powerless to do anything about it.’
“We need some new stories.”
Reframing the discussion of healthcare into a story of preventing all harm is ambitious but doable, he added. Hospitalists need to team with others, though, because an overhauled healthcare system needs buy-in from all physicians.
“The trick of this is to have enough details that people want to join you, but don’t completely tell the story, because others have to co-create it with you,” Dr. Pronovost said. “You tell the why and the what, but the how is co-created by all of your colleagues who are working with you.”
Bisognano says hospitalists can help hospitalists achieve IHI’s Triple Aim, an initiative to simultaneously improve the patient experience and the health of populations, reducing the per capita cost of healthcare. But, like Dr. Pronovost, her argument is based on a new view of the healthcare system.
“We need not a system that says, ‘What’s the matter?’ but a system that understands deeply what matters to each patient,” Bisognano said.
That prism requires speaking a new “language,” one that uses quality of care delivered and defines it more broadly than simply mortality rates and adverse events.
“You can look at health and care, but you also can drive out unnecessary cost,” she said. “And being a former hospital CEO, I can say it was magic when a clinician could walk in and be able to talk in both languages.”
Dr. Wachter spoke of the past, present, and future of the digital age of medicine. He is as frustrated by poor electronic health record (EHR) rollouts as front-line hospitalists but notes that healthcare in the past five years has seen a digital revolution in a much shorter time period than most industries, thanks to federal incentives.
“Most fields that go digital do so over the course of 10 or 20 years, in a very organic way, with the early adopters, the rank and file, and then the laggards,” he said. “And in that kind of organic adoption curve, you see problems arise, and people begin to deal with them and understand them and mitigate them.
“What the federal intervention did was essentially turbocharge the digitization of healthcare. We’ve seen this in a very telescoped way. … It’s like we got started on a huge dose of chemo, stat.”
Moving forward, Dr. Wachter said the focus has to be on improving the use and integration of healthcare to ensure that it translates to better patient care. For example, going to digital radiology has in many ways ended the daily meetings that once were commonplace in hospital “film rooms.” In essence, the move from “analog to digital” meant people communicated less. Now, multidisciplinary rounds and other unit-based approaches are trying to recreate teamwork.
“Places are doing some pretty impressive things to try to bring teams back together in a digital environment,” Dr. Wachter said. “But, the point is, I didn’t give this any thought. I don’t know whether you did. What didn’t cross my own cognitive radar screen was that when we go digital, we will screw up the relationships, because people can now be wherever they want to be to do their work.”
Richard Quinn is a freelance writer in New Jersey.