Tuesday, February 19, 2008

An open letter across the sea

Dear friends,

As many of you know, I am a relative neophyte in the health care world, taking this CEO position just six years ago. Since then, it has been OJT (on-the-job-training) to learn this business while also using experience from other fields to enhance the working environment for our staff, upgrade the quality of the patient experience for those visiting our hospital, and also try to participate in a helpful way in the public policy debates of our time.

On this latter point, I have seen persistent comments from many observers about the flaws of the US health care system. Those flaws are indeed evident, and it is very healthy for society to focus on them to improve the situation. However, you often hear comparisons of the system in the US with the health care environments in other countries; and those countries are often described as being "ahead of us" on this or that aspect. Such comments, for example, point to greater levels of insured coverage for the population or stronger delivery of primary care.

I used to think that the main reason the US has not moved towards some of the European models of care had mainly mainly to do with the power of interest groups here that causes gridlock at both the state and federal level. And, indeed, I still would not deny the strength of those opposing forces. Yet, I often wondered, if our system is so flawed and "theirs" is so much better, wouldn't political leadership arise to break the logjam and move us in that direction? But, now, having had a chance to view several of those systems more closely, I see that the grass is not nearly so green as one might have thought. Each country has designed variations of insurance and coverage and access for its population, but each country is also going through the same kind of debates as are we -- in the hope of improving the equitable distribution of care, enhancing quality and safety, and increasing efficiency.

My purpose in mentioning this -- which to many of my more experienced and knowledgeable readers may not be news at all -- is not to get into a debate about the relative merits of each country's health care system. It is to make the point that there is a cadre of people around the globe with a strong commonality of interest in learning from one another for the sake of improvement.

When I was first invited to Iceland to meet with health officials from the Nordic countries, I was bemused that they thought I might have anything to offer in their environment of state managed systems. Yet I was told after my meetings there that several of our initiatives at BIDMC were of great interest and potential value in their hospitals. Ditto in the Netherlands. And, just this week, ditto in the UK.

As satisfying as that might be, these visits are even more valuable for me in providing a fresh perspective on issues at my own hospital and in suggesting particular ideas that we might want to borrow to improve how we deliver health care, how we make a better workplace, and how we relate to the community. Equally satisfying, there is a warmth and camaraderie among people engaged in the delivery of care that offers even a newcomer like me entry into the "club" of extremely well-intentioned people who devote their lives to alleviating human suffering caused by disease.

The point of all this rambling? Well, in a somewhat wordy manner, I write this as an open thank-you note to Lord Darzi, David, Ruth, Steven, Rachel, Tom and all their colleagues in the UK for allowing me the opportunity to be in their company, to share ideas, observations, perspectives, and, yes, even some poorly delivered across-the-pond jokes. Although it may not alway be emphasized in some of the press reports about your strategies and plans, your overwhelming sense of public service and desire to build the best possible health care delivery system for your citizenry is ringingly clear.

In our clumsy way here in the US, we pursue the same goal. Whether in a single hospital or for the country as a whole, we do not seek to design, a piori, the best complex system. Like you, we seek to discover it by honestly viewing and admitting our faults and errors in an open, blame-free environment in which respectful engagement leads to constant improvement. Thank you for letting me participate with you to learn from your experience.




Michael Barnett said...

Paul - What a well-written and thoughtful letter on your views of international comparative health. I get the clear sense that your visits to these countries have sharpened your view of the care you want to deliver at the BIDMC and given you great insight into the strengths of the American system of health care.

I'm very much looking forward to being a third year clerk in your hospital in the spring - it's an exciting time to be a part of the BID team, even as a confused and extraneous member of said organization ;)

Anonymous said...

Thank you, Michael.

Oh, are you confused and extraneous, too? Happy to meet someone else who feels as I do . . .

Eve said...

I suspect if Beth Israel would recognize the workers' rights to unionize and come to the table and bargain fairly, the "playbook" would go away.

Anonymous said...


I think you posted this on the wrong item. I'll copy it to the right place. But, in any event, we do recognize workers' rights to organize.