A Word From the President

Healthcare Improvement: Time to Stop Talking and Start Doing

No one needs to be reminded that our country's healthcare system is not delivering nearly as much value to patients as it could for the money we are spending. One of the root causes for this discrepancy is the outmoded system of healthcare delivery that we have inherited from an era less burdened with chronic disease, less empowered by useful but expensive and complicated technologies, and less aware of the hazards patients endure from the many avoidable errors that occur in our complex settings. Tinkering at the margins of our outmoded system won't bring about the fundamental changes that are needed. We must find ways to radically redesign how we deliver care. We need to devise and implement systems that will enable us to do the things that we know will enhance quality and improve outcomes for our patients.

My contention is that academic medicine has a key role to play in moving the healthcare system toward better performance. Medical schools and teaching hospitals have a justly earned reputation for leadership in our core missions of medical education, medical research, and complex patient care. We have not, as a community, taken the same kind of concerted leadership in creating and mounting better operational systems of care. Whether or not one agrees with me that academic medicine is well positioned to assume such a leadership role, our responsibilities as educators argue strongly for embracing health system redesign as an additional core mission. Medical schools and teaching hospitals can prepare students and residents optimally for future practice only if they have access to learning environments for clinical education that incorporate the highest quality patient care attainable. No one is going to provide such learning environments for us. We must create them within our own systems of care so that the formative clinical experiences we offer our students and residents are uniformly consonant with high-performance practice.

That reality is the principal rationale for the AAMC's new Center of Clinical Care Improvement (CCCI). Formally launched last July, the CCCI is now taking concrete shape. An advisory committee has been appointed and had its inaugural, daylong meeting early last month. The committee, co-chaired by Fred Sanfilippo, M.D., senior VP for health sciences and dean, Ohio State University College of Medicine and Public Health, and Gary Gottlieb, M.D., president, Brigham and Women's Hospital, comprises recognized leaders from both within the academic medicine community and, very importantly, from other stakeholder groups. Nursing, pharmacy, patient advocates and quality improvement experts are all represented.

If the energy and enthusiasm evident at its first meeting is any indication, the committee is destined to provide the center and its director, David Stevens, M.D., with just the kind of grounding and guidance needed to achieve an ambitious purpose to stimulate the academic medicine community to initiate large-scale innovations to improve the way health care is delivered. A consensus quickly emerged among the members of the committee that the principal obstacles the center's efforts are likely to encounter will be in the realm of the "academic culture," that is, the norms of behavior that have proven so successful in the past and that are now so deeply ingrained in our institutional ethos. Among the most problematic for the challenge at hand are our sacrosanct devotion to physician autonomy and our tendency to be territorial, hierarchical, paternalistic, complacent, even—dare I say it—arrogant at times.

How are we to move beyond these now counterproductive tendencies and achieve the required cultural transformation? Advice from the committee focused on the following high-impact factors:

• Leadership - An indispensable prerequisite for any meaningful change to occur is the commitment and involvement of institutional leaders. Not sufficient, to be sure, but unquestionably necessary. And here is an obvious opportunity for the CCCI to fulfill its catalytic potential, namely by identifying and engaging interested hospital CEOs, deans, department chairs, practice plan executives, and other influential individuals who are prepared to enroll their institutions in serious operational redesign efforts.
• Financial incentives - Among the most powerful incentives for inducing change, like it or not, are financial. Here again is an opportunity for the CCCI to play a pivotal role, namely by advocating governmental and/or private sector funding for promising innovations and by assisting our constituents in the development of novel proposals for outside support.
• Data - Academic medicine prides itself on being data driven and, indeed, when presented with valid measurements documenting shortcomings in any of our efforts, we are strongly motivated to improve our performance. The reason traces to one of the most treasured assets of our community - our inherent value system. Not to impugn other sectors of our society, but individuals composing the healthcare sector are highly self-selected. Deep down, most of us want to do the right thing - especially when it comes to our patients. So, another recommended objective for the CCCI is to tap into this innate desire and unleash a groundswell of operational improvements by promoting sound measurements of care processes and disclosure of the resulting data.

I have especially high hopes for the AAMC's Center for Clinical Care Improvement and for the potential of medical schools and teaching hospitals to seize the opportunity to take leadership in transforming our faltering healthcare system. My motto for the center is this: Let's stop talking about it, and do it!

Jordan J. Cohen, M.D.
AAMC President

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