Sunday, March 01, 2009

Congratulations, Dr. Gottlieb

Congratulations to Dr. Gary Gottlieb on his appointment as the next CEO of Partners HealthCare System, the largest health care delivery system in Massachusetts. Gary has been serving for several years as CEO of Brigham and Women's Hospital, one of the two (with MGH) PHS flagship hospitals. He is a warm, thoughtful, humorous, and intelligent person, doctor, and administrator, and he is an excellent choice for this job.

Because of its size and prestige in the Massachusetts health care environment, PHS carries special obligations. Also, that very presence makes PHS the lightening rod for criticism of the current health care system. Finally, because of its market power, PHS draws its own special set of commentary in Massachusetts.

The PHS hospitals are competitors of BIDMC, but, as I have explained elsewhere, we are also part of an important cooperative educational and research network that produces great value for Boston and the world. (Here are two examples.)

Because of that relationship, and because the health of PHS is a bellwether for the status of the medical system in the region, we at BIDMC have an overriding interest in the success of the Partners hospitals. That I have made this statement will come as a shock to the people in the PHS hospitals who listen to rumors about me rather than read what I actually say here, but let me expand on the thought with some examples.

First, PHS is the major regional advocate in Washington, DC for matters relating to academic medicine. Whether the topic is research funding at NIH, the structure of graduate medical education, or other general policy matters, PHS is the only Massachusetts hospital system with the resources to make a persuasive and consistent case before Congress and the Executive branch. Gary will be catapulted in his new role to the national scene, and I am confident he will carry out this task very well.

Second, if there is any organization in the state that has the potential to demonstrate the potential for an integrated health care delivery system, it is PHS. But, it will come as no surprise to participants in that system that this has not yet happened. The long-standing rivalry between the two flagship hospitals has meant that rationalization of tertiary and quaternary clinical service between the Brigham and the MGH has often been deferred. Previous Partners CEOs have focused their efforts on integration of back-office and other business aspects of the system, leaving clinical integration essentially untouched. Gary will face an interesting and important choice as to how and if he will address this unachieved potential benefit to the region. If the Partners system first sets an internal example, it might then be possible to achieve a broader rationalization of care in cooperation with the other academic medical centers (BIDMC, Boston Medical Center, and Tufts). We all need to garner these economies to control costs in the over-served Boston marketplace.

Third, my favorite topic. The Partners hospitals are full of well intentioned, dedicated people. But there has not been a corporate public commitment to reduction of harm and to transparency of clinical outcomes that could help build broad public confidence in the quality and safety of patient care -- and with this a confidence that we are also attempting to control costs. I would love it if Gary were in the position of challenging me and the other hospital leaders in this arena, rather than vice versa. Ironically, some of the world experts in these matters are faculty members in his hospitals. The Partners system should be a world leader in the science of health care delivery, along with the fields in which it already holds prominence.

Fourth, like all of the Boston hospitals, the Partners hospitals face the promise made by the SEIU that it intends to organize its health care workers. To date, Partners has walked a tightrope -- giving the impression to politicians and others of congeniality with this union, while actually not agreeing to any of the union's proposals. The day of reckoning will surely come on this issue, and Gary will have to decide whether to wait for the union to decide on the terms of public engagement or whether to help frame the issue in the public eye. His decision will have ramifications for the entire industry.


Anonymous said...

Paul, Well said. Co-opetition is Porter's term for it and your prose provides great color and pragmatic realities of Boston's medical community. Hopefully your salutations stimulate a beneficial dialogue with your colleagues. Good Luck

jessica lipnack said...

Califdream, Michael Porter does indeed use the term co-opetition but alas did not come up with it. I first learned of it when doing research for a book pub'd in 1993 - at that time found first use in 1984 in regard to Japanese auto industry but since there was no Wikipedia or Google Books then I wouldn't have known the first cited use is 1913. A bunch of other authors, myself included, have used it prior to Porter but good for him for making it popular.

Nice post, btw, Paul.

Anonymous said...

Paul - I've been a fan of the blog since inception and do admire your commitment and vision- but can't hold my tongue on this one. Is this what my Bubbie would call a left handed compliment? Are you really congratulating Gary or pushing Partners buttons and challenging him to be as perfect as you? I don't know, but this one didn't sit well. Maybe too much ego?? Think about it!!

Anonymous said...

Not a left-handed compliment at all. I think Gary is a spectacular choice, and I admire him greatly personally and professionally. I'd be hard-pressed to imagine a better person for the job.

The issues I raise about Partners' actions and performance are real and will have an effect on the whole industry. To leave them unstated is like ignoring the elephant in the room.

I don't consider myself perfect at all, and wonder where you get that idea. A blog, by nature, reflects the opinions of the writer. By putting them out there, I welcome disagreement and commentary -- something consistent with academic and political discourse. I hold no punches, for sure, but I sign my name on everything I write and can be held to account for the same.