Saturday, January 07, 2012

Physicians study leadership at HSPH

Each year, I am delighted when Jim Conway invites me to be a guest lecturer in a class on Physician Leadership at the Harvard School of Public Health.  The attendees are senior doctors from institutions around the world who come to Boston several times over two years for four-day weekends of classes.  Jim, as many of you know, served from 1995-2005 as Executive Vice President and Chief Operating Officer of the Dana-Farber Cancer Institute.  After leaving that position, he was senior vice president and senior fellow at the Institute for Healthcare Improvement.  During my tenure as CEO of BIDMC, he was a true mentor to me in learning about the process of quality and safety improvement.  He also played a key role in helping our hospitals' boards learn how to exercise strong governance over clinical matters.  To the extent we were successful as an institution in reducing preventable harm, he was a major contributor.

Jim is accompanied in this teaching course by Ron Goodspeed, former President of the Southcoast Hospitals Group.  Another committed practitioner of process improvement, Ron was highly regarded throughout the state.  For example, in 2006 he was named President of the Board of Directors of the Massachusetts Coalition for the Prevention of Medical Errors. As noted by Paula Griswold, president of the coalition, he was selected because his "credentials, experience and dedication to quality patient care [were] invaluable as the coalition worked to educate the health care industry about best practices in preventing medical errors." 

The topic of the day was the case study written at Harvard Business School about my arrival as CEO of Beth Israel Deaconess Medical Center in 2002 and actions thereafter.  As is my practice, I warned class participants that I would take pictures of those who asked really good questions or made particularly insightful remarks.  There were many and I don't have space here for them all, so I can only offer prominence to a few. I am especially pleased, though, to include Dr. Holmes (above), who was born at the Beth Israel Hospital and who confirmed again my assertion that all of the babies born in that hospital and the successor BIDMC are above average!


Jeff said...

"Reducing preventable harm" - an incredibly insightful and distinctive phrase. Definitely going to keep that one on hand...

Curious - was BIDMC able to reduce all preventable harm by January 1st this year? It's quite an incredible goal - but worth striving for.

Old motto of mine - aim high and that's where you'll fly!

Thanks for your good work!

- Jeff

Jim Conway said...

Paul, thanks again for a great class with the physicians in the Masters in Health Care Management program. As one of the students said at the end of the class "Paul and the BIDMC not only talked about what needed to be done but, THEY ACTUALLY DID IT." Your collective legacy provides great learning for all of us.

Paul Levy said...

Dear Jeff,

I haven't yet seen the final figures. I do know that the record over the four years was very good.

Regardless, the words of Dr. Mark Zeidel, the Chief of Medicine, when the Board adopted the goal, are the ones to remember, "Even if we don't get all the way to zero, there will still be several dozen more people each year who walk out of our hospital rather than dying in it. I think that makes this worthwhile."

The lesson, of course, is that you need to establish an audacious goal to make transformational change.

Anonymous said...

I, too, was curious as to the results of this 5 year program to eliminate harm, and I assume no results have been announced. Jeff's question points out a weakness of most hospitals' management with these 'audacious goals' - that is, there is lots of hoo-ra and fanfare when the goals are announced, and then when the time of reckoning comes, nothing is said - whether the goal is attained or not. I do not see this as a deliberate coverup (since I don't think anyone expected the actual elimination of preventable harm), but as a failure of management follow-through. And what message does this send to the staff who have actually worked toward this goal and look forward to hearing the results of their efforts?
I daresay that if the goal had been financial, the results would have been prominently displayed - not at BIDMC in particular, but in any hospital.

We have a ways to go yet in realigning the priorities of leaders in hospitals.


Paul Levy said...

The numbers have been posted every quarter without fail on the hospital's wensite, so I don't know why you are saying what you say. It usually takes sime time to compile the most recent period's figures. That transparency was an integral part of the Board's vote. It took real guts and commitment on their part to do that.

Anonymous said...

Paul, you caught me as I had not reviewed the website. However, what I was speaking of was something beyond routine posting of monthly or quarterly data - something like you used to do in a global email or special presentation or whatever, saying - "We did it!" or "We didn't do it, but we came darn close, and here's what we need to do to get there", etc. Something with an equally big 'splash' as the announcement of the intiative at its beginning. In addition, some kind of formal report to the Board and the staff at the end of the 5 year period.


Paul Levy said...

I see your point, which is a good one. Rest assured, though, that there have been regular reports to the Board and its patient care assessment committee, as well as the clinical and administrative leadership. So, the figures are not just passively displayed on the website. As to what will be done more broadly once this last quarter's data is compiled, I don't know. As you suggest, there is a good lesson to be learned whatever the numbers are:

As noted above, even if the answer isn't quite zero, the whole effort has to be deemed a success in terms of helping to drive transformational change in the hospital.

Brigitta U. Mueller, MD, MHCM said...

As a 2007 graduate of this program, I am glad to hear that this specific class continues! It was most impressive then and I am sure that the current class enjoyed it just as much as we did!

I only wish that other organizations made such far-reaching changes...!