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The Medical Professionalism Blog

Forum 2011, Day 2: Memorable Moments

Many thanks to Leslie Tucker who helped with this post.

On day two of the Forum, attendees offered an abundance of rich ideas on how to advance the agenda to build a sustainable health care system. I will write more about that in future posts, after the dust settles and I’ve had more time for reflection. For now, two moments in particular really stood out to me:

In the context of a conversation about partnering among stakeholders, a national physician thought leader offered the profound wisdom that “wise restraints can set us free.” These “constraints” he describes can be thought of as a type of guidance system for clinicians and patients that operates at the national, community and practice levels.

  • At the national level, this guidance system entails providing evidence-based parameters for societal expectations about quality and cost-effectiveness within which clinicians are free to optimize clinical decision-making with and on behalf of their patients.
  • At the community level, it requires agreement on the reasonable allocation of resources by local stakeholders who recognize that excessive health care expenditures require sacrifice in other areas such as education and infrastructure.
  • At the practice level, it involves the use of shared decision-making tools to incorporate patient preferences and utilities into care decisions, and understanding when it is appropriate to use those tools.

Another physician leader challenged us to be more frank and forthright about the need for greater clarity in leadership and learning around the issue of sustainability. According to this attendee, we need to speak honestly about what we mean by sustainability, and to acknowledge the inescapable need to make health care cheaper.

Sustainability is a euphemism for a concept that makes us uncomfortable – illustrated by the fact that in conversations about the triple aim (patient experience, population health, and per capital costs), cost is often not discussed. Some physicians still don’t believe resources are finite. Patients recognize that costs of care are huge problem.

This same speaker also reflected that leaders of specialty societies and other medical professional organizations need to do the brave and hard work of speaking the truth to their constituencies and help them accept and traverse this challenging ground. In effect, they need to see themselves as leaders of a social movement, not dissimilar from the early champions of environmental sustainability.

Fnally, he sharpened the challenge of developing a learning network in healthcare in America.  “We have isolated islands of innovation with very few mechanisms to promote spread to different environments… We can’t continue to live in this world where everything has to be vetted locally all over again.”

These two memorable moments punctuated a day in which a diverse group of health care leadership applied itself to developing and owning actionable strategies to advance the “wise choices” agenda. But with the urgency of health care and nation’s economic stability in the balance, there is definitely still more to say and even more to do.

1 Comment to Forum 2011, Day 2: Memorable Moments

  • martin sepulveda md's Gravatar martin sepulveda md
    August 3, 2011 at 2:16 pm | Permalink

    transformation is really hard work, and like excellent patient care, begins at the level of people who do the work at the site where the work gets done, sitting down together and

    1-talking, understanding where they are, making individual mental models explicit, embracing where they need to be, and accepting that in their personal work and behaviors they contribute to the perpetuation of the current state– yikes, “it aint just others, it’s me 2”
    2- identifying and acknowledgng what is and what isn’t under their personal control to change—discarding the latter and all its baggage, and focusing narrowly on the former.
    3- committing to and making personal change and executing every day, every time, no exceptions—“walk the talk”
    4- setting specific targets in our daily work, measuring and holding each other acountable for the results in our personal behaviors

    payment methods, information systems, policy changes etc are all important but secondary to changing “what i do, what we do where we work”—this is where real change happens—if all of us at the Forum start by changing what we do each day to display and demand a new level of medical decision making, the train will have left the station.

    this was for me the most important potential outcome of the Forum. we should find a way to measure it so that we can hold each other accountable. otherwise, we will have met the enemy and found it was us.

  1. By on August 10, 2011 at 9:30 am

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