1. WHAT KIND OF
ANCESTOR WILL
YOU BE ?
seeking an inflection point so we can leave
behind a health care legacy to be proud of.
WRITTEN by JAC K COC HRAN , MD
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2. IS EXCELLENT GOOD ENOUGH?
a
s physicians, we are trained to diagnose and treat disease. We dedicate ourselves to searching for cures and perfecting procedures that
will restore the health of our patients. Over the last 50 years, we’ve
made some remarkable progress. We’ve reduced the death rate from
heart disease by 32.5% with a better understanding of primary and
secondary prevention and advances in treatment. We’ve made similar
progress in cancer care with better treatment options through radiation, surgery, chemotherapy, and genomics. We’ve changed an HIV
diagnosis from a hopeless death sentence with limited treatment
options to a manageable, chronic condition.
These truly excellent accomplishments in medicine have been
life-changing for millions of people. But is excellent good enough?
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3. What Kind of ancestor Will You Be?
While we have made great strides in clinical
care, the American dream is faltering. Americans are more obese, more medicated and more
in debt than at any other time in the history
of our nation. One-third of our nation’s total
health-care spending, about $750 billion per
year, is wasted on unnecessary treatments,
redundant tests, and uncoordinated care [1].
Health Care Reform will have limited impact
on this waste. While the rate of increase of
health care spending has slowed in recent years,
the United States still spends 2.5 times more
than most developed nations on health care
[2]. U.S. health care spending is on track to
reach $4.8 trillion in 2021, almost 20% of our
gross domestic product [3].
This trend, compounded by one of the
longest and most serious economic downturns
we have ever faced has created a crisis for families, businesses, and communities that is tearing
the fabric of the American dream. Health care
is right in the middle of this crisis. The total
cost of health care for an average family now
exceeds $20,000 a year. When I began practicing as a surgeon, health care was at 10 percent
of the GDP. Now it is at 18 percent of the
GDP. These are investments health care have
taken away from education, the environment,
and infrastructure.
This has happened on my watch. I do not
want an 18 percent drain to be the legacy of
my generation. This insidious drain on families’
hopes and futures has to stop, and the trajectory in health care needs to change. Rather
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One-third of our nation’s total health-care spending, about $750
billion per year, is wasted on unnecessary treatments, redundant
tests, and uncoordinated care
than causing despair and disappointment, it should be a
positive enabler for a better life – physically, personally,
socially, financially and psychologically. As an industry,
we need the will and the resolve to create an inflection
point and declare that excellent is not good enough.
CREATING AN INFLECTION POINT TO
TRANSFORM HEALTH CARE
It wasn’t too long ago when health care was centered
around the doctor’s office or hospital. Physicians practiced with minimal support staff and subscribed to one
journal. The problems physicians faced could be solved
using the knowledge and skills they acquired in medical
school. Patients went to the doctor’s office for all the
information on their condition and for treatment. That
was the industrial age of medicine.
Today, health care is much more complex. Physicians
are accountable for a population of patients, whether the
patients come in to the office or not. There are now more
medical journals than physicians could possibly read or
digest on their own. What physicians learned in medical
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4. What Kind of ancestor Will You Be?
school is no longer sufficient. Often, patients
have extensive information about their diseases from Google searches and online patient
communities like PatientsLikeMe. In these
instances, physicians still play an important
role as a trusted source – helping patients interpret the information they find and providing
more context, evidence, and nuance so that
patients and physicians can make informed
decisions together. However, make no mistake,
the locus of information and
“power” has moved from the
doctor’s office to the patient.
We’re forging the information age of medicine.
In order to be effective, we
must optimize the use of
information, technology,
tools, and teams. We need
to turn masses of patient
data, science, and clinical evidence into clinical
knowledge. This information
must be available to patients,
physicians, and care teams.
And they must have access
to technology and tools to make the right thing
easier to do. Physicians and care teams should
have clinical decision and panel support tools
that not only put the latest evidence at their
fingertips, but also enable them to provide
personalized care to each patient.
TRANSFORMING HEALTH CARE
INTO A LEARNING INDUSTRY
We need to make health care a “Learning Industry.” The inflection point won’t come from one
bright leader or one superb organization. We
have a wide range of interconnected issues in
health care. We can spend time
blaming different parts of the
industry for these challenges, or we can realize that we
can influence and accomplish
much by working together. We
need talented people who have
deep expertise in specialized
areas and at the same time an
understanding of the broader
impact of their actions. We
need to draw from all parts of
the industry; harnessing our
collective knowledge from
the practice of medicine, the
pharmaceutical industry, and
medical research; as well as from a variety of
disciplines, such as policy, economics, and engineering. We can only achieve this inflection point
by being interconnected, by working collaboratively, by learning together. We can’t treat our way
out of this crisis, we must learn our way out of it.
Health care needs to become a community
However, make
no mistake,
the locus of
information
and “power” has
moved from the
doctor’s off ice to
the patient.
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5. We can only achieve this inflection point
by being interconnected, by working
collaboratively, by learning together.
Participants across the healthcare industry signing up during the ILN
(R)evolution Healthcare Open Space Meeting. Photo by Ted Eytan.
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6. What Kind of ancestor Will You Be?
that embraces measurement, comparison,
acknowledgement, learning, and improvement.
As physicians, we believe, and have every intention, that we are providing the highest quality care to our patients. But it is only when
we measure and compare our performance
that we can see if we are truly providing the
best possible care or if there are gaps in our
preventive care and treatments. Once we
have the appropriate data, clinical guidelines,
and resources, we can engage patients and
close those care gaps. And then we won’t just
believe we’re providing the best care; we’ll have
proof. We must have the openness and spirit
of collaboration to achieve this. We must also
be willing to share our failures as broadly as
our successes. As physicians, we often hear
about the latest breakthrough treatments or
procedures, but we are much less likely to hear
when those procedures produce complications
in the long-term.
OUR GREATEST RESPONSIBILIT Y
IS TO BE GOOD ANCESTORS
As I look back on my career, I consider the
legacy I will leave behind for my 6-year-old
grandson and the generations that follow.
Today, we talk about accepting “accountability” in health care for a patient population,
across the continuum of care. Dr. Jonas Salk,
inventor of the polio vaccine and one of the
most important innovators in medicine, took a
longer-term view of what accountability meant.
Dr. Salk asserted that “Our greatest responsibility is to be good ancestors.”
By building a learning coalition, we can
learn from challenges and successes across the
health care industry. The innovations that can
transform our industry are out there. They’re
just not everywhere yet. We need to become
rapid learners through connectivity, openness,
discipline, collaboration, and a sense of curiosity. Organizations like the Institute for Healthcare Improvement, Alliance for Community
Health Plans, American Medical Group Association, and Department of Defense are fostering connections among health care organizations as well as other health care stakeholders,
and their efforts are gaining momentum.
The American dream is faltering. We need
to restore hope and give some of the 18 percent
back to the American people. Ultimately,
within each of us must be the resolve. Resolve
is not about hard work and dedication. Those
are table stakes. It’s a relentless focus on the
reality and the mission. The future is going
to be tough, but it’s in our hands. We have
the ability and talent to create that inflection
point that transforms health care and restores
the American dream for future generations.
Our patients, families, and communities are
depending on us.
What kind of ancestor will you be?
Jack Cochran, MD, FACS
Executive Director, The Permanente Federation / Follow him on twitter @JackHCochran
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