Steele arrives in Boston

This week, we celebrate the third annual symposium of BIDMC's Silverman Institute for Health Care Quality and Safety. The Institute was created by a generous donation from our former Board Chair Lois Silverman and her late husband Norman, and it is the focal point for our quality and safety programs, as well as academic programs in that field. The event also contains a lecture, entitled the Michael F. Epstein, MD Lectureship on Clinical Quality and Patient Safety, generously funded by numerous donors in honor of the hospital's previous chief operating officer.

Tonight's speaker was Glenn Steele, CEO of the Geisinger Health System (seen here with Lois) with a lecture entitled, "The art of the possible in American health care today."

Noting that the national health care legislation will solve an important access problem by providing insurance to millions of people, Glenn stated that other changes will be required by the increased demand this access will add to the system. "If we meet that increased demand with our least economic service line (Emergency Room service), the actual cost will be well above that predicted. The present system of care delivery is unsustainable."

"The time for fundamental redesign is now," notes Glenn. What should be changed to get there?

First, unjustified variation should be eliminated. Here, he was not talking about the kind of national variation presented in various papers, but the kind of variation that exists withing a given hospital or practice. "In any other context, we know that this kind of variation leads to lesser quality and increased cost, " and it is certainly true in medical care.

Second, reduce the fragmentation of care-giving. Focus on integrating the continuum of care from primary care doctors through specialists through surgeons within existing institutional relationships.

Third, move from a units-of-work reimbursement system to one based on outcomes, whether shared savings or capitation. Providers should take on more risk over time.

Fourth, move from a concept of patients as passive recipients of care to create a system of making patients and families feel they are partnering with us. (My comment: Read this great piece by by Kevin Clauson, hosted by Pew's Susannah Fox, entitled, "Why is participatory medicine such a hard sell?" to explore some current issues.)

How do we get there without chaos?

-- Clinical leaders need to lead the process.
-- Primary care doctors need to be paid in tandem with hospital specialists.
-- Physicians and hospitals need to work together within a single functional, if not corporate, structure.
-- Insurers and hospitals need to reframe the conversation to produce an appropriate payment relationship.
-- Tap the professional pride of purpose to provide a powerful impetus for change. Don't forget that "people get into the field because they want to help human beings."

In previous years we heard from Brent James and Steve Spear, and Glenn's talk tonight and another more extensive presentation and panel discussion tomorrow will serve to round out the themes we have heard in those previous talks..