Archive for: April 2009

Engineering Errors Out of Health Care

Apr 30, 2009, 11:58 AM, Posted by Ari Kramer

In my first month as a new communications associate with the Foundation’s Pioneer team, one of the many glaring items on my task list has been to gain a solid working understanding of the power of disruptive innovation and what it takes to achieve it. While this may take a while, thankfully Susan Promislo has given me a stack of project briefs and proposals that illustrate different aspects of this equation in a pretty straightforward way.


In one intriguing new effort, a team led by Peter Pronovost– professor of anesthesiology and critical care medicine at Johns Hopkins and renowned patient safety expert – is looking to a collaborative model that has yielded huge improvements in commercial aviation safety, and testing whether the application of a similar method could do the same for hospital patients.

Hospitals have engaged in noteworthy work to improve quality and safety, but other approaches are needed to accelerate improvement. Pronovost’s project is honing in on a public/private partnership model that has been highly successful in preventing aviation deaths and disasters.

Between 1995 and 2003, 2,261 people died in “controlled flight into terrain” (CFIT) plane crashes. Based on recommendations from the White House and Congress, the formation of Commercial Aviation Safety Teams (CAST) has drawn on the knowledge of key leaders from all sides of aviation – major manufacturers and airlines to the FAA and DOD. One of CAST’s first major recommendations led to the commercial adoption of a “terrain awareness and warning system” for all airplanes registered in the United States, and an altitude warning system for ground radar. In 2004 there were no CFIT airplane crashes, and all such accidents since then have involved planes without the warning system. 

The CAST model – in essence a targeted convening at which a bunch of really smart and influential people from key stakeholder groups have at the problem – has provided the aviation industry a vehicle to identify and prioritize major safety hazards and design and implement strong systemic fixes. They have essentially engineered the problem out of air flight to the greatest extent possible.

Pronovost has similar goals in mind for health care through the Public Private Partnership to Promote Patient Safety (P5S), whose charge is to identify and select a single patient safety hazard and test methods to dramatically reduce it in hospitals across the country. Stakeholders representing the Agency for Health Care Research and Quality, U.S. Pharmacopeia, Joint Commission, FDA and chief medical offices of large health systems have expressed interest in joining this effort.

One safety area that appears ripe for this kind of intervention is the use of hospital defibrillators. As Pronovost and other co-authors point out in a recent Health Affairs article, “Under time pressures, and often with limited hands-on experience, doctors often fumble to set defibrillators accurately. What is needed is a yoke-type solution that redesigns the defibrillator controls to be intuitive to eliminate the potential for mistakes… However, device redesign requires a coordinated effort among manufacturers, clinicians, human-factors engineers, and regulators.”

The hope is that P5S can create a vehicle for such high-return and breakthrough thinking that doesn’t now exist in health care. In a recent Health Affairs blog post, Pronovost discussed this project along with some obstacles P5S is likely to face – such as the “myth of perfection” among doctors.

photo by Allen Rockwell from Flickr

From Health 2.0: Re-Imagining the Doctor-Patient Relationship

Apr 27, 2009, 8:03 AM, Posted by Elizabeth Dickson

Several themes and memes emerged from the Health 2.0/Information Therapy conference over the last several days. One theme is the need to re-imagine the relationship between patient and doctor in order to prepare for a Health 2.0 world. In the past, doctors were the primary, if not the only, source of health information. Doctors defined what was relevant to patients' health (e.g. blood pressure, blood tests, height and weight), and they were responsible for collecting it whenever the patient came to their office. In the Health 2.0 world, patients seek information that is relevant to them ("given the pollen count today, do I need to take an extra dose of my allergy medication?"). This new dynamic views patients as sources of health-relevant information, much of which is collected outside of the clinical setting. Patients are no longer passive subjects, but "info-mediaries," as some attendees called them, in their own right.


Paul Wallace of Kaiser Permanente  and the Center for Information Therapy and Jamie Heywood of PatientsLikeMe debated the question during the session entitled "What is the Future Role of the Doctor?". Certain ideas and phrases -- in other words, "memes" -- filtered throughout the discussion, shaping the participants' efforts to rethink the relationship between patient, doctor and data. In order to get their minds around what this new relationship might look like, the panelists and members of the audience employed a few metaphors. These analogies quickly morphed into memes, and conference attendees referred back to them to summarize and simplify their perspective on the future relationship between doctor and patient. Here's a sampling:

  1. Football: The doctor is the quarterback. She is the leader of a team, calling the shots. Perhaps she gets direction from the care coordinator (the coach). Where is the patient in this model? The patient is the all-important ball -- the object of coordination among different health care providers as they move it up the field.

  2. Banking: The health care system is the banking system. Patients can access and control their health data via an online health management portfolio. The portfolio includes myriad tools, geared to different types of patients. In this model, the doctor is like a financial planner - she helps patients navigate the system.

  3. Organization: The patient is the CEO of her body, and her doctor is a hired consultant.

While similar in that they place increased importance on the patient, these metaphors also reveal very different visions for the future role of the doctor.

Meme/metaphor number one recognizes that the patient is the central focus (there "wouldn't be a game with out the ball" according to one Health2.0 attendee), and yet it portrays patients as passive participants in a system over which they have no control and little input. As Jamie Heywood pointed out during the panel, he "wouldn't want to be the patient who gets punted."

The wealth management metaphor implies that health providers and health consumers will interact within a highly organized and interoperable health care system. Few patients will wind up being the health equivalent of "day-traders," and they will still rely on their doctors as trusted advisors. But, doctors will not be patients' only resources. In order to stay relevant, doctors will need to acquire new skills - like how to locate, interpret and translate the most relevant information for their patients (another Health2.0 theme!).


The organization model defines the patient as the source of information and the locus of decision-making. It suggests that patients will navigate an open marketplace of health care providers, and that doctors will compete with one another on cost and value (i.e. better health outcomes).


Which of these metaphors resonates with you? Are there different analogies that pick up on other important features of this relationship? Can they exist in combination, or are they mutually exclusive? Are there implications in these analogies for the future roles of doctor and patients that the Health 2.0 attendees missed?

Reporting Live from Health 2.0

Apr 22, 2009, 9:48 AM, Posted by Elizabeth Dickson

I arrived at the Health 2.0 Conference bright and early this morning. At the urging of this very tech-savvy community, I joined Twitter and issued my first-ever Tweet. (For complete coverage of the conference, check out the 600 + following at #heatlh2con). Next, I popped into the Health2.0 Accelerator pre-conference meeting, where (among other things), we learned about how the Accelerator and Project HealthDesign will collaborate going forward. Afterwards, I spent some time fielding questions about the next round of Project HealthDesign at our expo booth. All before the conference officially kicked off at 1:30pm!

The first session initiated the debate over whether Health 2.0 and Information Therapy (Ix) are in tension or in synergy. We heard from Don Kemper, CEO of Healthwise, that Health 2.0 and Ix are the yin and the yang of translating data into information, information into knowledge, and knowledge in to behavior change. Matthew Holt, founder of Health 2.0, countered that a “shared understanding is not necessarily enough to support a marriage between Health 2.0 and Ix.” Given the candid format and the diversity of the crowd here, we can expect more “great debates” to follow.

Check back for reflections on tomorrow’s sessions, including “The Future Role of the Doctor,” and “User-Generated content vs. Expert: What’s the best approach to Knowledge Creation?”

The Landscape of Health, Green, and Everything in Between

Apr 21, 2009, 11:34 AM, Posted by Elizabeth Dickson

Last May we introduced grantee Health Care Without Harm in a feature on Gary Cohen, Director of HCWH, as part of our “Conversations with Pioneer” series. You can also check out this new short video highlighting Health Care Without Harm and its mission to build the evidence for green interventions in the health care system.


The video also illustrates what is truly pioneering about Health Care Without Harm: their vision for sustainable improvements that also result in direct benefits to patient health and safety. For example, substituting hospital disinfectants for “greener cleaners” can arguably improve the long-term health of the population through indirect environmental effects. But these environmental advantages accrue incrementally over long stretches of time. 

Health Care Without Harm sees the momentum behind the Green Movement as the catalyst for direct and immediate improvements for patients and nurses. In the case of greener cleaners, this could mean reduced rates of asthma and other respiratory illnesses for patients, nurses, and hospital staff.

The Pioneer Team has a keen interest in this concept of the “triple win” – for the planet, long-term population health, and direct benefits to patient health. We recently conducted a field-mapping exercise to explore the intersection between Green and Health. Our purpose was to uncover similarly innovative and effective projects, and to examine the contours of the intersection itself. This discussion raised some interesting questions. Each team member had their own take, and now we would like to hear from you:

  1. Is the union of green and health just a fad? The Green Movement has expanded into many new fields in recent years. Is its foray into health and health care substantial, authentic, and pioneering, or is it just an outgrowth of a short-lived trend?

  2. Creating real-time benefits for patients through green initiatives is a key component of the “triple-win”. What ideas or opportunities for improving patient outcomes are out there for pioneers working in this space?

  3. Broadly speaking, what does the common path of Green and Health look like for the foreseeable future?

We look forward to receiving and reading your comments.

RWJF's Expanding Social Media Presence

Apr 20, 2009, 11:09 AM, Posted by Susan Promislo


You can now follow new content from the Robert Wood Johnson Foundation via multiple social media platforms.  We've launched a new YouTube destination, where you'll find more than 30 video stories on the work of the Foundation and its grantees.  The featured story posted now is Pioneer's own Health Care Without Harm-- check out the ways in which Boston's Brigham & Women's Hospital is adopting more environmentally sustainable practices that have meaningful benefits in terms of worker and patient health and safety.  Lots more will be coming online from our Broadcast Health Series and other video efforts.

RWJF also has an active Twitter stream that just topped 600 followers - it issues near-daily updates on reports, announcements and new developments happening across the Foundation and its universe of grantees and interest areas.  Click here to sign up.


And, we're happy to announce that Pioneering Ideas now has a sibling with the launch of The User's Guide to the Health Reform Galaxy, RWJF's blog providing insights on key things driving today's reform debate.  The blog is part of a dedicated section of our Web site that goes in depth on issues that shape reform prospects: health care coverage, improving the quality of care, strengthening public health, etc.  Interesting posts have been published on health IT, the impact of the nursing shortage, social determinants of health and so on, and you'll hear from a range of staff and grantee voices.  Check it out and take us up on our sincere and open invitation to add your thoughts to the conversation.