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.

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.

A Surgeon’s Touch: Q&A with Carla Pugh

Carla Pugh spent her childhood tinkering with appliances and electrical outlets. Quite fittingly, she spoke in TEDMED 2014’s “Play Is Not a Waste of Time” session. Now a surgeon and the Clinical Director of University of Wisconsin’s Health Clinical Simulation Program, Carla shared why haptic skills training matters so much in medicine. Eager to learn more about what she sees for the future of medical education, we reached out to her for a Q&A session.

Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].
Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].

What impact do you hope your talk will have?

I want to spark a serious conversation about need for elite, high-end, mastery training in the healthcare profession. Healthcare is at a critical juncture where there are huge opportunities for major information exchanges that can empower physicians and patients. Both patients and physicians will benefit from clinical skills performance data. For example, what if we all knew which haptic techniques place physicians at risk of conducting poor clinical examinations?

Outside the measurement of haptic skills, are there other gaps that you believe exist in medical education?

I think the future of medical education is about the global improvement of all skills. The soft skills – like interpersonal communications, and the promotion of tolerance – are definitely the most difficult to achieve. As educators, I think there are gaps in knowing how to be the best teachers we can be, and understanding the limitations of observational learning. When my students walk away from watching a video, I have no idea who’s learned what and who hasn’t. Traditional learning hasn’t fully recognized that, and still hasn’t made strategic efforts to change. Watching videos is helpful because it does give students a certain level of instruction, but at some point it’s important to have that team conversation where you face your colleagues. Also, if you are doing a procedure, at some point you have to pick up an instrument and use it. Videos and observation can only get you so far. Applied learning doesn’t take place until action happens.

Could you paint us a picture of your dream patient simulation lab?

Integration is key. Our whole education system isn’t where it could be; I still dream of something that’s full service. The dream simulation lab would have a central facility, where people come to train and discuss a wide variety of clinical skills. It wouldn’t only be about haptics – it would include communication across professions, and improving patients’ communication with their healthcare providers. Beyond that, it would also be a place where patients could come to learn important techniques – like how to give themselves a shot, take care of a wound, or think of creative ways to remember to take their medication. We would educate using broad, hands-on heuristic techniques.

Standard measurement of a physician’s skill is through the board exam. If you were designing the board exam for surgeons, using all of your haptic technology, what would it be like?

The way that the board exam is administered is highly centralized – we have to go to a board designated location to get tested. Ideally, there would be maintenance of professional certifications, where doctors are given relevant lifelong learning opportunities that are ongoing and well integrated into their daily clinical practice. This is something that the board is working on.

I would like to see decentralized opportunities where doctors are able to practice clinically relevant scenarios.   As doctors, we need to maximize our use of local social capital. For example, I have a few experts working down the hall from me, but I don’t have access to their knowledge, their haptic and communication skills for example. We need more information sharing, and the opportunity for shared practice. I want to compare their performance to my performance, and the ability to choose a training paradigm that directly matches the mastery level that I want to achieve. It’s about mastery, not skills – when we talk about skills, we tend to think of them in terms of “you either have them or you don’t.” Mastery is about constantly improving and working towards better performance. That’s what we should focus on.

Are there any actions items you want your viewers to take?

Make sure to read my research article about using sensor technology to assess clinical skills, which will be published in the New England Journal of Medicine on February 19!

It’s smart to design simple: Q&A with Josh Stein

On the TEDMED stage, serial entrepreneur and CEO & Co-founder of AdhereTech Josh Stein shared what he’s learned about designing ‘smart’ devices and the internet of things as they relate to positively influencing patient behavior. We caught up with Josh to learn more.

The Internet of Medical Things
Connected Medical Devices Will Revolutionize Healthcare… If Patients Actually Use Them. Josh Stein at TEDMED2014. (Photo: Sandy Huffaker for TEDMED)

Why does the talk matter now? What impact do you hope the talk will have?

The Internet of Medical Things is going through a period of incredible growth, which is absolutely fantastic for patients! However, there’s an enormous design hurdle in regard to user adoption, and this hurdle is largely ignored. In short, there is too great a focus on what these devices can do, and not enough focus on how these devices will actually do it.

The Internet of Things, (IoT), or ‘smart’ devices, can be separated into two distinct categories: devices that users purchase and devices they don’t purchase.

Most IoT devices fall into the former category. Users will pay a lot of their own money for a gorgeous new smart phone, TV, or fitness tracker because these gadgets provide an immediate benefit to the user (they are awesome and fun to use). In these instances, consumers are willing to go through a reasonable set up and learning process for these devices.

In contrast, a large percentage of smart IoT medical devices actually fall into the latter category: users don’t buy these devices, and they are provided to users by a third party. This occurs because: 1) other parties subsidize these tools in order to improve patient outcomes and thereby decreasing overall costs or increasing revenue, 2) consumers typically don’t like to pay for medical devices, and 3) consumers typically don’t see a tangible immediate benefit from these devices.

The reason why this distinction is so important is that most smart medical devices are designed as if they fall into the former category, at least from a user-experience perspective, when they actually fall into the latter category. Thus, these smart med devices are designed as if patients will go through a long and complicated set up process to use said devices, when in reality the patient will not perform such tasks. Patients are simply expected to do way too much in order to use most smart med devices.

I shared this thought at TEDMED 2014 with the hope that this notion will resonate with other smart medical device creators. This could potentially lead to improved devices and better patient health.

What kind of meaningful or surprising connections did you make at TEDMED?

I met Jim Madara, the CEO of AMA; he and his team spoke about the innovative ways in which they are revolutionizing how medicine is taught. I met Marc Koska; his syringe is one of the most ingenious medical devices that I have ever seen. It solves a huge problem through simplicity and understanding its user. I built a relationship with an individual who is innovating clinical trials at one of the most innovative companies in healthcare. I don’t want to mention this person’s name because, though this introduction, my company is now planning an engagement with his incredible organization. Stay tuned for updates on this collaboration – we’ll keep TEDMED in the loop!

I also met one of my favorite stand-up comedians, Tig Notaro. Her TEDMED talk was awe-inspiring, and it was amazing to see a whole other side to her. I can’t say enough great things about her and her work!

I had the pleasure of speaking with Jay Walker. His wisdom and advice has directly impacted product and vision of my company. I genuinely attribute a great deal of our success to the conversations I’ve had with him.

What is the legacy you want to leave?

I want to be known as someone who has a net positive benefit on the world. Professionally, I believe I’m on the right track with the innovative work that my team and I are doing –  our product has been improving the adherence and outcomes of patients since 2013. We work long hours, but seeing improved patient health and traction continues to motivate us.