7 challenges faced by all health care leaders
Health care spending, the silver tsunami, technology and epidemiology issues require innovative solutions
I’m flying home from a two-day health care leadership conference organized by Dave Williams, PhD, the executive director of improvement capability for the Institute for Healthcare Improvement and a former paramedic. In addition to Dave, the other three presenters were the current and past presidents and CEOs of IHI.
As EMS integrates more fully with the rest of health care, I thought you all might like a peek into what the most visionary leaders in the health care world are thinking about.
To kick off the conference, current president and CEO of IHI, Derek Feeley, described seven challenges faced by all leaders in health care:
- Political: We see it in the news every day and no matter what side of the political spectrum you land on, the impact politics has on health care and health care financing is undeniable.
- Economic: How do we deliver good quality care at a lower cost? Of the three trillion dollars spent on health care this year, conservative estimates are that one-third of it is waste. Waste means that the money spent provides no benefit of any kind to patients. Patients are pushing back on high costs. For example, Amos Dudley, a 20-year-old MIT engineering student, wanted to improve his smile by closing the gaps in between his teeth. The orthodontist told him it would cost $8,000. For $60, he downloaded a textbook used by dental students. He read the book, and did the calculations on what needed to be done with his teeth based on tooth selfies that he took with his smartphone. Then, using one of the engineering department’s 3-D printers, he made an oral appliance that fixed his teeth in 12 weeks. Now he’s doing it for friends.
- Demographic: Described by some as the “silver tsunami,” this group (of which I may be a member) of older Americans is having a powerful impact on strategic capacity planning throughout health care. One interesting study indicates that older folks provide more health care than they consume. Therefore, caring for aging populations as well as planning for the loss of their contributions needs to be considered.
- Epidemiological: Most of modern health care is designed to address single diseases. However, the number of people with multiple chronic conditions is rising rapidly. Our EMS education and protocols have not evolved to account for this reality. Complex clinical problems do not lend themselves to linear solutions. In many of these cases, linear thinking makes things worse for the patient, yet that’s the way we train.
- Changing expectations: It used to be that people treated their health care provider, especially physicians, as if they were all knowing. They would never think to question the diagnosis or recommendation handed out by someone with a stethoscope around their neck. Recently, I was in a hospital room visiting with a friend who was receiving chemotherapy. The oncologist walked in and her coffee cup said, “Your Google Search Does Not Beat My Medical Degree.” Today’s medical professionals need to understand their customers will push them to perform like never before. The same holds true for EMS leaders. Our employees expect us to lead effectively and will challenge us with ideas they have discovered in school, from colleagues or on the web.
- Workforce issues: The U.S. will need more than one million new nurses in the next six years. One large survey said that 92 percent of millennials do not intend to keep a job longer than three years. Effective hiring practices must take these workforce factors into account.
- Technology: There are already machine-learning systems that are more accurate at making differential diagnoses than most physicians and these systems are only getting smarter. Fifty-three percent of Kaiser’s patient visits last year were done by smartphone, videoconference or kiosk. It’s impossible to predict what’s going to evolve with technology. When I think of the EMS Agenda 2050 project, I’m aware 30 years from now, drone-delivered defibrillators and smartphone-based ultrasound will be on display in a museum of ancient artifacts and described in the history section of EMS courses.
Closing the gap in care delivery
Don Berwick, MD, MPH, the founding president and CEO of IHI who ran the Centers for Medicare and Medicaid Services under the Obama administration, took the stage next. He said, in effect: “We are making a lot of progress in health care, but it’s not nearly fast enough. We have over a trillion dollars of waste, yet we still complain that there’s not enough money. Safety is not there yet. We have enormous variability in the quality of care from place to place and sometimes within the same institution. We know what it takes to close the gap between what could be and what is, but are we using what we’ve learned? No.”
Dr. Berwick went on to describe that leadership for today is about managing continuous improvement and facilitating learning. He reminded us, “All improvement is change, but not all change is improvement.” It’s just as important to look at what we need to stop doing. Physicians spend 30 percent of their time doing what they love, caring for patients. The majority of their time is spent documenting. It’s no wonder that Dr. Berwick recommends that we cut the amount of data we collect by 50 percent, and then cut it in half again.
Curiosity quotient in EMS
Maureen Bisognano, RN, former president and CEO of IHI, told the story of her introduction to quality improvement. It was 30 years ago, and she was three weeks into her new job as the CEO of a hospital, when she was invited to be part of a group that was studying how to apply industrial principles of improvement in health care. She went to Florida Power and Light, where over the course of nine months, they improved the quality of their service, saved over $1 million dollars, and significantly increased joy for the people that worked there.
She said that the most important quality for today’s health care leaders is not intelligence IQ, and it’s not emotional competency EQ, even though this is vital. It’s curiosity quotient, CQ. She said curiosity is what led to a partnership in Dallas between barbers and primary care physicians where the barbers were trained to take blood pressures. If their client had high blood pressure, they gave them a card with the numbers written on it for the client to take to their physician. If the client brought the card back with the doctor’s initials on it, their next haircut was free.
Curiosity led Tulane’s Medical School to require all of its physicians to complete a cooking class before graduation. It’s what led an elementary school in Scotland with a 70 percent kindergarten obesity rate to start the day with a Morning Mile, which is four laps around their school. By the time the kids graduated, none of them were obese. Apparently, this idea has caught on. Our six-year-old’s public elementary school starts every day with an all-school run.
I’ll be working on turning the learning from this meeting into action and a few more articles. It’s exciting to know that one of our own is helping shape the future of health care across the country and world. Thanks for a great conference, Dave!