Paul Levy: How to Choose A Hospital President

Monday, March 19, 2012

Paul Levy, GoLocalWorcester MINDSETTER™

The announcement that John G. O’Brien will step down as president and chief executive of UMass Memorial Health Care in early 2013 is bittersweet. John is among the best of health care executives in the region, but, as he realized, ten years is enough for anyone running a major hospital system. Now it turns to the UMass Memorial trustees to find a successor.

I have a proposal for the trustees as they seek to fill this job. Normally, hospital trustees focus on finding someone with the business background to keep a hospital in the black. That’s fine, but this hospital can be something more. It can be the hospital in the region that takes on the challenge of being the safest hospital in the nation. It can be the hospital that, together with UMass Medical School, sets the standard for medical education that trains doctors to engage in patient-centered care and process improvement. It can do all this while achieving financial stability and health. And it can do so in a way that sets an example for those Boston-based hospitals and medical schools that like to claim they are the best but often shy away from actions and from the transparency that would truly make them the best.

Let’s start with medical education, as it begins there. In 2010, the Lucian Leape Institute at the National Patient Safety Foundation reported that U.S. “medical schools are not doing an adequate job of facilitating student understanding of basic knowledge and the development of skills required for the provision of safe patient care.” The report comes approximately 10 years after the Institute of Medicine’s landmark 1999 report “To Err Is Human,” which found that 98,000 Americans die unnecessarily from preventable medical errors. “Despite concerted efforts by many conscientious health care organizations and health professionals to improve and implement safer practices, health care remains fundamentally unsafe,” said Lucian L. Leape, MD, Chair of the Institute and a widely renowned leader in patient safety. “The result is that patient safety still remains one of the nation’s most solvable public health challenges.”

Progress is slow because medical schools and teaching hospitals have not trained physicians to follow safe practices, analyze bad outcomes, and work collaboratively in teams to redesign care processes to make them safer. These education and training activities, the report states, need to begin on Day 1 of medical school and continue throughout the four years of medical education and subsequent residency training.

“The medical education system is producing square pegs for the delivery system’s round holes,” said Dennis S. O’Leary, MD, President Emeritus of The Joint Commission, a member of the Institute, and leader of the initiative. “Educational strategies need to be redesigned to emphasize development of the skills, attitudes, and behaviors that are foundational to the provision of safe care.”

Even the University of Michigan Health System, an exemplar in many respects when it comes to quality improvement, has found that a substantial majority of its 22 residency training programs do not provide systematic didactic training with project experience. A researcher at that medical system concluded that there is a need for active institutional involvement to encourage and facilitate the development of such training, and specifically to develop faculty leaders and to share pedagogical materials across all the residency programs.

On the clinical care front, as GoLocalWorcester reported last week, the Commonwealth Fund recently found that Worcester ranked in the lowest 25% of the percent of patients who reported hospital staff always managed pain well, responded when needed help to get to bathroom or pressed call button, and explained medicines and side effects. As I noted, this is a symptom of the fact that nurses are forced to spend too much of their time away from patients, filling out paperwork and fetching medicines and other supplies. We have great nurses in the region, but hospitals need to improve their work flows to make it easier for them to respond to basic patient needs.

Changing these patterns requires a leadership commitment, a CEO who is advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement. University of Michigan Health System CEO Ora Pescovitz recently wrote to her staff:

Health care is a human system, and humans are fallible. There is not and never will be a perfect person or a perfect hospital. The most educated, experienced and well-intended people make mistakes, and the most prestigious health care organizations make medical errors. That is why a culture of safety requires processes and systems that minimize human error.

While it may be impossible to be perfect, we most certainly can be exemplary.

I am proud of the University of Michigan Health System. But, to be a leader in safety, we must demand excellence from ourselves every single day. Because we can never be perfect, we must be resolute in our commitment to continuous improvement. I know that this Health System has what it takes to be the safest hospital in the nation. I call on all of you to engage, to recognize the important role you play and to be more diligent than ever in pursuit of this foremost goal.

We need a CEO at U Mass Memorial who displays this kind of leadership commitment, and leaves U of M in second place in this version of the Final Four!

Paul Levy, former CEO of Beth Israel Deaconess Medical Center, is an advocate for patient-driven care who writes a blog about health care issues entitled Not Running a Hospital.