AAMC Reporter: October 2006

Remaking American Medicine

PBS Series Highlights Academic Medicine in Examination of U.S. Health Care

Johns Hopkins Medical Center's Peter Pronovost, M.D. - Photo credit: 2006 Crosskeys Media ®

Each Thursday this October, PBS plans to air a four- part series examining the quality of the U.S. health care system and the innovative solutions some providers, patients, families, and institutions — including some from academic medicine — are implementing to transform care.

Creators of the series, titled "Remaking American Medicine: Health Care for the 21st Century," said they used unprecedented access to health care institutions across the nation to tell stories of the struggles, setbacks, and victories of doctors, nurses, administrators, and patients. According to the series' producers, the programs offer solutions by showcasing the stories of individuals and institutions that are working to ensure better health care.

The series is part of a larger campaign to create a national dialogue on how to improve the U.S. health care system. The consumer-oriented documentary was developed largely by the Institute for Healthcare Improvement (IHI), with the Amgen Foundation and Robert Wood Johnson Foundation (RWJF) as lead sponsor and major underwriter, respectively. The Nathan Cummings Foundation, the Josiah Macy, Jr. Foundation, the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality are also key organizers and sponsors of the series. Approximately 50 other organizations — including the AAMC — are program national partners.

"The scientific notion that health care could perform better is extremely strong," said Donald Berwick, M.D., IHI founder and CEO. "One element that is missing, however, is the public and political will to change. This will is going to come from the emotional side of people, and I believe the visual power of television, when it is at its best, can mobilize the emotions of the public not just intellectually, but emotionally."

"Remaking American Medicine" evolved from a program called "Pursuing Perfection, Raising the Bar for Health Care Performance," launched in 2001 by IHI and RWJF. The program aimed to examine the health care system and devise potential changes in such areas as shared care plans and multidisciplinary patient rounds.

"As the documentary developed, it became broader [than the experience of the 'Pursuing Perfection' grantees], and the 'Remaking American Medicine' campaign became an independent entity from 'Pursuing Perfection,'" said Jonathan Small, vice president of marketing communications at IHI. "'Remaking American Medicine' focused more broadly on how to improve health care delivery with true stories from a wide range of sources."

The first installment of the series, "Silent Killer," sets the stage for the issues that will be explored throughout the series. The program highlights the advocacy efforts of Sorrel King, whose 18-month-old daughter, Josie, died at Johns Hopkins Hospital, in part because of a lack of communication.

"It was probably the lowest point that I have been at this institution, that the whole institution knew something was dreadfully wrong and that we had killed somebody," said Edward D. Miller, M.D., dean of medical faculty and CEO of Johns Hopkins Medicine, in a statement on the "Remaking American Medicine" Web site.

King has since gone from a grieving victim to an engaged advocate, using a settlement from the hospital to establish the Josie King Foundation, a patient safety organization. King and Johns Hopkins Hospital have since worked together to make strides in the reduction of medical errors, with the help of The Patient Safety Group, a safety business founded by the King family.

Lauren Koniaris, M.D., stands next to a medical robot at HUMC - Photo credit: 2006 Crosskeys Media ®

The second installment, "First Do No Harm," details unique undertakings in patient care at Hackensack University Medical Center (HUMC) and a coalition of Pittsburgh health care facilities, including Veterans Affairs Pittsburgh Healthcare System.

The Pittsburgh coalition is attempting to eradicate MRSA, a deadly infection usually acquired in hospitals. At HUMC, a new $40 million technology system allows doctors to order medications and tests electronically and communicate with other providers.

Gerard A. Burns, M.D., director of medical informatics at HUMC, said both the technology itself, as well as the profile in "Remaking American Medicine," have transformative potential.

"We knew that we had to do things radically different [in health care delivery], and we received the funds to test new things and then share the results, both the flaws and the successes," he said. "In this process we needed to be very transparent — sharing the results — as part of our participation…[The series producers] were able to edit it so that it told a story through which others could see how health care can work; how things can be done differently in order to make American health care more cost-effective, efficient, and safe. Finally, the series shows that health care institutions, which have not historically been open to change, need to try new things to make health care better for everyone."

"The Stealth Epidemic," the series' third installment, examines the human and economic costs of effectively managing chronic conditions, such as diabetes, that consume nearly 70 percent of all heath care resources. The final program, "Hand in Hand," tells the story of patients and families at the Medical College of Georgia (MCG) Health System, which is at the forefront of a movement to increase family participation in patient care. MCG as a whole features family advisory groups that offer input on various system decisions, and its Children's Medical Center offers a variety of family-friendly amenities.

 "We would not be able to tell any of these stories if it were not for the health care institutions cooperating with us," said series executive producer Frank Christopher. "They have embraced the concept of transparency and breathed life into it. They have shown us their problems as well as their struggles to pursue perfection in the care they deliver."

Berwick said the prominence of academic medical centers in the series was no accident, and said academic medicine had a clear role to play in the effort to reinventing the health care system.

"Academic medical centers are seen as standard setters," Berwick said. "If they change, others will follow.

Academic medical centers also create the future because they nurture our young. If students are trained in the past, nothing will change. But if they're trained for the future, things can change."

As a way of advancing dialogue on the issue, sponsors hosted "Remaking American Medicine: Champions of Change, A National Symposium on Improving Health Care," in Washington, D.C., a week before the series began airing. Speakers included Berwick and Carolyn Clancy, M.D., director of the federal Agency for Healthcare Research and Quality.

For more information, visit PBS or Remaking American Medicine.

— By Lora Meisner, Special to the Reporter

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