Islands of Greatness in a Sea of Risk

June 14th, 2011
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In the U.S., we pay more than $800 billion a year for healthcare yet the World Health Organization (WHO) ranks us 37th out of 191 countries in terms of healthcare “performance.”  This is what Charles Denham, M.D., chair and founder of Texas Medical Institute of Technology (TMIT), was talking about when he spoke of “islands of greatness in a sea of risk” during the Cleveland Clinic Health Care Quality Innovation Summit I attended last month.
As Dr. Denham explained: In the U.S., we have access to the best technology. Doctors and nurses come here from all over the world to train because we have several institutions of excellence where they learn to perform special procedures with precision and care. At the same time, we have a failed and fragmented healthcare system with extreme variations in quality of care.

Not just in Dr. Denham’s talk, but also throughout the Cleveland Clinic conference, I learned of several different approaches that might help correct this poorly running system.  But, given the layered and complex problems in the system, there is no one “right” solution.
Some key points from the conference that seemed to be essential in order to create change and improvements are:


  • Patient-centered care is imperative
  • To improve patient outcomes, safety needs to be THE top priority
  • Hospital readmission rates are an important outcome measure for assessing performance of a health care system
  • Hospitals should measure a patient’s experience: If a patient is depressed, he may not be motivated to comply with therapy (for example, he may not manage his diabetes appropriately, which can lead to readmission)
  • We must recognize that system failures are endemic due to:
    • Lack of investment in systems
    • Lack of full disclosure when an error occurs
    • Punitive payors if a hospital admits they have high rates of hospital acquired infections (HAIs)
  • Innovation can be used to disrupt the status quo:  It may not be a new system that will facilitate change, but a system that has been borrowed and adapted from other successful organizations
  • We need to listen to those outside of the healthcare industry to learn how we can provide better and safer ongoing patient care

What ideas do you have to create an improved healthcare system with fewer dollars spent?   How do you picture a patient centered healthcare system? What health care institutions are living examples of successful change leading to improved care? How can we surround the islands of greatness with a sea of efficiency and improvement rather than of risk? Please share your thoughts with us here.

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About the Author:

I have 20 years experience in clinical research, including leading diagnostic and pharmaceutical clinical studies in disease areas ranging from cancer to infectious disease to cardiology, diabetes, and autoimmune disorders. Send me an email.