Four Thought Leaders Shaping the Future of Health Care

By guest contributor and TEDMED 2015 speaker Thomas H. Lee, MD

For years now, experts have said health care should move “from volume to value,” and the good news is that it’s finally happening. Even within the past few months, the pace of change has accelerated. More and more payments to providers are tied to quality and efficiency, and increasing amounts of data on their performance are being published online.
Empathy suffering health careIn my TEDMED talk, I spoke about how the reduction of suffering was becoming the focus for health care. Today, many health care providers are starting to compete on how well they meet patients’ needs.
As this competition increases, health care providers can look to four key thought leaders whose work influences my own every day: Michael Porter, Leemore Dafny, Ronald Burt, and Nicholas Christakis. Individually and collectively, their contributions provide clarity on what we need to do in health care, why we need to do it, and how to get it done.
Over the last few decades, Michael Porter of Harvard Business School has defined the meaning of strategy for business in general. His work on health care clarifies why an overarching strategic goal is important for every organization, and why that goal should be to create value for patients. He and his colleagues have described how multidisciplinary teams should look, and what kind of information and incentives those teams need to drive improvement.
If Porter’s work describes the “recipe” for what we need to serve in health care, Leemore Dafny helps us understand the heat that is necessary to start things cooking. She is the Harvard economist who has studied payer and provider consolidation and shown how it leads to weaker competition and higher prices. I have long been leery of thinking about health care as a marketplace, concerned about unintended consequences if patients have to act like consumers and make tradeoffs in quality and price. But Dafny and her colleagues are persuasive when they argue that competition in a value-driven market has greater potential to drive improvements in quality and efficiency than the alternatives – and that providers like me should embrace competition and learn to trust market forces.
Porter and Dafny’s work tell us what we have to do, and why we have to do it. But how do we get that work done? Part of the answer is to strive for the creation of social capital.
For the last several years, I have given a book to virtually every new close colleague: Brokerage and Closure: An Introduction to Social Capital by University of Chicago sociologist Ronald Burt. We all know about financial capital (the funds that enable organizations to do things they otherwise could not do), and about human capital (hiring good people). Social capital is about how those people work together. If they are reliable in their coordination, the organization can make leaps in quality and efficiency. Burt provides a clear and useful structure for learning (increasing variation in what is done by brokering ideas) and then converging on best practices (closure).
Then there is the challenge of how do we make collaboration and compassion the norm in health care. Financial incentives cannot get the job done. That is why I think so often of Nicholas Christakis, the Yale social network scientist who has shown how epidemics of values and emotions can spread from person to person. While the work of Porter, Dafny, and Burt define the big picture, Christakis characterizes the nature of the work that needs to be done on the ground.
There are, of course, many more colleagues whose work I respect and learn from, but these four constitute a “package” that I think can accelerate the transition to a new and better health care system.
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TEDMED Speaker Tom Lee, on addressing patient suffering in health careIn his TEDMED talk, quality care pioneer and Chief Medical Officer of Press Ganey, Tom Lee reveals his passionate quest to define empathy as a business asset and patient suffering as an outcome.

What happens when doctors move towards transparency? Q&A with Leana Wen

Physician and public health advocate Leana Wen discussed a highly controversial approach to transparency in the clinical encounter. We caught up with Leana to learn more about her ideas and actions in public health advocacy.

What happens when doctors move toward transparency?

“I want doctors and patients to come together to end the sickness of fear.” Leana Wen, TEDMED 2014. Photo: Sandy Huffaker for TEDMED

What motivated you to speak at TEDMED? I wanted to share a message to doctors, patients, innovators, and all those who are committed to transforming the future of medicine. There is no place better to do that than at TEDMED, in front of people want to learn paradigm-changing ideas and who are already motivated to take action!

Why does this talk matter now? What impact do you hope the talk will have? It’s harder for people now than ever to establish a long-term, trusting relationship with their doctor. There is a growing disconnect between what patients need and what doctors do. I explain in this talk how radical transparency will empower both patients and doctors (and other providers). I hope doctors watching the talk will choose radical transparency and voluntarily disclose both financial conflicts and personal views to their patients. I also hope patients—people—watching the talk will prioritize transparency and choose their doctors accordingly.

What were the top TEDMED2014 talks that made an impression on you? Sonia Shah flipped my conception of cause and effect, and how we may need to change the focus of public health and medical interventions. Eleanor Bimla Schwarz stopped me in my tracks to appreciate how our bodies are made, and how our efforts to interfere with normal body processes can have downstream adverse consequences. Gail Reed and Sigrid Fry-Revere challenged me away from U.S.-centric thinking to consider there is much to learn from how other countries serve patients.

What is the legacy you want to leave? I want doctors and patients to come together to end the sickness of fear. Doctors can take the first step, and let patients into our world. We can ensure patients and their families take part in all bedside rounds. We can embrace open medical records and open disclosure of medical errors. We can show vulnerability and humility with our patients. These are all steps to change the paradigm of medicine from one of secrecy and hierarchy to one that is fully open and engaged. I would love to live in a world where doctors and patients (and all healthcare providers) come together to be equal partners in medical care, without barriers or secrets or fears.

Please share anything else you wish you could have included in your talk. I wish I had more time to talk about how transparency may seem scary, but that research shows openness helps doctors as well as patients. There are studies that show collaborative medical records and open disclosure of medical errors increase patient trust, improve health outcomes, and even decrease malpractice. This will be particularly important as doctors are being measured on quality metrics like diabetes and blood pressure control. Lifestyle changes require trust, and trust requires transparency.