20 People Who Make Healthcare Better
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We're holding a spot in advance of the election in hopes that the next president of the United States will be the healthcare voice that this country has not had in recent memory. We hope the next president will look back at the ruins of those who have tried to use federal healthcare policy as a reward to friends and a hammer to enemies. We are holding a spot for a purposeful, studied and impassioned driver of ideas that will change fundamental cracks in healthcare funding and quality. We hope this man or woman will understand the inalterable relationship between our future prosperity and our nation's health. We are hopeful our next president understands the urgency.
T. Boone Pickens, philanthropist
Be willing to prove yourself a good steward, and your nonprofit institution might get a sizable donation from T. Boone Pickens, too. The former oil patch wildcatter and BP Capital Management founder has been giving money away for years. But in donating a total of $100 million to two Texas healthcare systems, he wanted to add a dollop of risk to an industry that some feel wastes money like a leaking well wastes oil. Although he may not be around to find out whether the ambitious goals are met, the 79-year-old private equity fund billionaire has stipulated that the University of Texas Southwestern Medical Center in Dallas and the M.D. Anderson Cancer Center in Houston can retain the money only if they're able to grow their respective stakes tenfold in the next 25 years. Both institutions have said in press releases that the goals are reasonable and achievable, but if they can't meet the target, the original money and all its gains will go to fund student scholarships at Pickens' alma mater, Oklahoma State University.
Sen. Chuck Grassley
It's a good thing Chuck Grassley has an "R" after his name; otherwise, party affiliation could easily be forgotten for the dogged populist from America's heartland. In his 33 years on Capitol Hill, including 27 years in the Senate, Grassley, 74, has evolved from a politician that Washingtonian magazine in 1981 ranked as one of the dumbest members of Congress into a tenacious fighter for the little guy in matters ranging from tax policy to healthcare. Grassley's focus on nonprofit hospitals' tax-exempt status has made more than one hospital executive nervous, but the Iowa senator's persistence on a variety of issues has helped shine a light on multiple corners of the healthcare world. As chairman of the Senate Finance Committee in 2001 and again from 2003-06-and now as its ranking Republican-Grassley has been a frequent critic of the Food and Drug Administration, its institutional aversion to whistle-blowers and its relationship with Big Pharma. He has lashed out at the Centers for Disease Control and Prevention for failing to address retention and morale issues that he believes could affect the agency's response to public health challenges. He has spotlighted abuses in nursing homes and called for greater oversight of that industry. He advocates for expanded healthcare coverage, especially the State Children's Health Insurance Program. And, while much of the federal government dithered in the aftermath of Hurricane Katrina in 2005, Grassley and Sen. Max Baucus, D-MT, co-sponsored a healthcare relief package that included immediate access to Medicaid for Gulf Coast refugees and compensation for affected healthcare providers.
Dorothy Wooddell, volunteer
Volunteers who make beds and deliver flowers? So old school. Today's hospital volunteers are serious multi-taskers. They're quality assurance inspectors, patient satisfaction ambassadors, customer service specialists and brand champions. "They are really representing the hospital," says Linda O'Keefe, customer relations supervisor at Huntington Hospital in Pasadena, CA. "It's a friendly face, but it's more that just a friendly face." One of those friendly faces is Dorothy Wooddell, 69, a retired schoolteacher and one of 30 volunteers in the patient relations department at the 525-licensed-bed hospital. "The hospital is very proactive in making sure that they take really good care of people, and that's what my job is-to make sure people are being taken care of," she says. Trash overflowing? Can't figure out the new room service menu? Worried that the nurses aren't washing their hands? Wooddell and her fellow volunteers help uncover problems and find ways to resolve them before patients go home and complain about a negative experience to friends, family and neighbors, says O'Keefe. Going to the hospital can be less than pleasant, admits Wooddell. But as a volunteer, she tries to make it "as pleasant as possible" for patients-and give the hospital's patient satisfaction scores, reputation and word-of-mouth referrals a boost along the way.
Garth Graham, minority health crusader
Multiple studies point to higher chronic disease rates and lower quality of care as just two of the barriers impeding racial and ethnic minorities from receiving the same level of healthcare as many white Americans. But Garth N. Graham, MD, aims to bridge that gap. As deputy assistant secretary for minority health in the Office of Minority Health at the Department of Health and Human Services, Graham leads the federal organization faced with improving care for racial and ethnic minorities by developing policies and programs to end health disparities. OMH has implemented campaigns to both target the disparities and promote prevention, including A Healthy Baby Begins with You, Closing the Health Gap, and Take A Loved One for a Checkup Day. But Graham's work reaches far beyond his governmental role. Graham founded the Boston Men's Cardiovascular Health Project, which seeks to improve African American men's diet and exercise, and is chairman of the American Medical Association/MSS National Minority Issues Committee. He serves on the faculty of Harvard Medical School. And he authored "Reach 2010: Working Together to Achieve the Goal of Eliminating Health Disparities," which appeared in the Journal of Health Care for the Poor and Underserved in 2006.
K.B. Forbes, ally for the uninsured
Muckraker. Shill. Opportunist. These are some of the more tame descriptors that have been lobbed at K.B. Forbes, the enigmatic leader of the Los Angeles-based advocacy group Consejos de Latinos Unidos. Forbes' aggressive tactics may have generated animosity within the hospital industry, but there's no denying the role he played in bringing about a sea change in the way hospitals do business with self-pay patients. Through a series of high-profile, high-stakes lawsuits against some of the nation's largest hospital chains and individual institutions, Forbes and his group have been integral in bringing all the parties to the table to devise a fairer system. "Most hospitals, at least the major chains and big for-profits, have modified their behavior to the benefit of the uninsured and are charging them reasonable and fair rates when you compare it to what the managed care insurance companies are paying," says Forbes. "When you look at the peak in 2003 to 2004, we were getting 300 to 400 complaints a month, and that's dwindled to just a dozen or two a month now. So we've seen a major change."
Charles Ornstein and Tracy Weber, journalists
Given the attention surrounding hospital transparency and the fact that healthcare is possibly the most heavily regulated industry on the planet, it's ironic that it took two newspaper reporters to uncover grave problems with the kidney transplant data from a start-up program at Kaiser Foundation Hospital in San Francisco. On paper, the business plan behind Kaiser's decision to operate its own kidney transplant program made sense. Kaiser Permanente of Northern California had deals to pay University of California hospitals to perform kidney transplants at about $65,000 per operation. But the giant HMO figured it could pocket the savings if it transferred the 1,500 Kaiser members who were waiting for new kidneys to its own program. Less than two years after the doors opened, however, the program came under fire after Charles Ornstein and Tracy Weber reported in The Los Angeles Times that during the program's first full year of operation, Kaiser performed only 56 transplants-and twice as many patients waiting for transplant surgery died. At other transplant centers in the state, more than twice as many patients received kidneys than died. Ornstein and Weber developed a series of investigative reports about administrative mismanagement at Kaiser that resulted in investigations by federal and state regulators and the largest fine on record by the California Department of Managed Health Care. In the end, these journalists may have led to the fledgling program's termination, but they breathed new life into the hopes of Kaiser's kidney patients, who were eventually transferred back to the UC programs.
Whoever at Wal-Mart thought of $4 prescriptions
It's so easy to criticize Wal-Mart for all the right reasons. The retail horde has almost single-handedly scraped mom-and-pop retail off the face of small-town America. And in healthcare, even the company's own numbers show that only 47 percent of its 1.3 million employees are covered under the company health insurance policy. So when Wal-Mart announced in late 2006 that it would sell more than 300 generic drugs for $4-including the diabetes drug metformin, the anticoagulant warfarin and the antibiotic amoxicillin-the healthcare industry responded with a maximum dosage of skepticism. Yes, Wal-Mart and other corporate chains that have responded to the move have their own retail self-interest at heart. Yes, Wal-Mart has 3,810 pharmacies and could use its pricing power to drive out smaller pharmacies. But are we in the healthcare industry so detached that we lose sight of the value of even a few dollars a month to someone who might otherwise choose between prescriptions and food? Can a nation that is seeing its GNP spending on healthcare shoot to 20 percent turn up its nose to any move-no matter what its intent-that saves a few bucks on the healthcare tab?
Sorrel King, activist born of tragedy
Visit any hospital today and you'll likely see signs encouraging patients and families to ask their caregivers questions: Did you wash your hands? What medications am I taking? What's my plan of care? Patient and family involvement has become a lifesaver for many people-and Sorrel King is one of the biggest reasons why. In 2001, King's 18-month-old daughter, Josie, died from medical errors at Johns Hopkins Hospital in Baltimore, just two days before she was supposed to go home. Since then, King has shared her story with thousands of caregivers, using it to educate them on the importance of good communication, involved patients and medication safety. "I wanted to stick it to Hopkins, but I also wanted the healthcare industry to understand that she didn't die from one doctor or one nurse. She died from something so simple as poor communication," she says. Today, through the Josie King Foundation (founded with the Kings' settlement money), King works with Hopkins caregivers to research and promote pediatric care advances. She's been the driving force behind major safety initiatives such as Condition H, which empowers families to activate an early response team if their loved one is in distress. And the Josie King Foundation and Hopkins recently launched the Care for the Caregiver program, which helps medical professionals overcome the emotional stress of being involved with a medical error.
Regina Herzlinger, the face of consumerism
Regina Herzlinger has been a voice crying out in the wilderness for years, but her message is finally being heard. The author and Nancy R. McPherson professor of business administration chair at Harvard Business School is probably best known as an outspoken advocate for consumer participation in healthcare. In the past few years, she has seen a more receptive audience for her ideas-at least among lawmakers and healthcare system reformists, if not hospital or healthcare executives. She's encouraged by the recent proliferation of consumer-driven healthcare plans and has harsh words for naysayers who complain that the plans are just a way to pass cost burdens on to healthcare providers. "People who don't like consumer-driven markets in healthcare say HSA accounts were supposed to be 100 percent of the U.S. population, but only 10 million have them," Herzlinger says. "But they're the fastest-growing financial product we've ever had." She's still not shy about sharing her contempt for the healthcare status quo, and disputes the notion that her goal is simply to achieve a low-cost healthcare system. "There are low-cost systems in the U.K. and Canada, and they're terrific until you get sick," she says. "My goal is for a cost-effective system that gives people what they want at a price they're willing to pay."
Judy Murphy, IT leader
Judy Murphy symbolizes the perseverance needed by clinical IT advocates. Trained as a nurse, Murphy serves as vice president of information services at Milwaukee's Aurora Health Care, a 14-hospital health system that began its EMR odyssey nearly a decade ago. In addition to barcoded patient wristbands, Aurora has implemented systems that handle results reporting, nursing documentation and medication administration across all 14 hospitals. The system is making headway on computerized physician order entry, which is live in two hospitals. An employed group of 680 physicians rely on an integrated electronic chart. And Aurora is eyeing an EMR for its affiliated physicians. Logging 12-hour days is routine for Murphy, a down-to-earth manager who exudes enthusiasm over IT's potential. "This journey has taken longer than anyone expected," she says. "But we really can make a difference in patient care with automation." A well-known speaker at IT trade shows, Murphy has spread that message throughout the industry. "I feel committed to my colleagues doing the same kind of work," she explains. "This work is way too hard to do it from scratch." Murphy cites improved patient care as her second big motivator. Her mantra: The industry needs to remove the "mystique" around clinical and financial documentation that clouds the patient experience. "When a patient checks in, they need to know what is covered. The computer is an enabler to demystify the patient experience."
The reformers in the Governor's Mansion
Governors have handlers-usually they're politically savvy grunts who advise the governor to stay the heck away from anything that could resemble healthcare reform because it is too politically explosive. No way to win, they say. So we have to applaud any governor willing to enter a serious dialogue about fundamental healthcare reform and come up with a plan-any plan. We have to like that Tennessee Gov. Phil Bredesen's Cover Tennessee proposal encourages low-cost plans for workers and emphasizes preventive care. Gov. Arnold Schwarzenegger gets a thumbs up for recognizing that 6.5 million uninsured Californians represent an economic threat that requires a risky proposal. And maybe former Massachusetts Gov. Mitt Romney is finding his plan to cover all workers in the state a bit of a hard sell in the presidential trail, but at least he tried. He could have listened to the handlers.
Eboni Price, New Orleans physician
When Eboni Price, MD, returned to her native New Orleans after years of medical and research training at the Johns Hopkins University Schools of Medicine and Public Health and the Baylor College of Medicine, she had no idea what she was in for. Price arrived in 2005 not long before Hurricane Katrina swept ashore-and soon found herself with a small group of Tulane University physicians in a makeshift clinic on the edge of the French Quarter. The Tulane Community Health Center at Covenant House was originally intended to simply deliver basic care in a time of crisis in the storm's immediate aftermath, but the clinic has since grown into a prototype for a new decentralized neighborhood care model that integrates community services ranging from health education to free Internet access. The center is now "a vital part of community care in the New Orleans metropolitan area," says Price, the associate program director of ambulatory training for Tulane's internal medicine residency training program who doubles as Covenant House's medical director. Despite the immense challenges of providing care in post-Katrina New Orleans, however, Price views her role as a "once in a lifetime" opportunity: the chance to help rebuild-and rethink-a city's healthcare system.
Paul Levy, the blogging CEO
"This is my first blogging experience, so please excuse me if I mess things up." Not the words you might expect from the head of one of Boston's largest medical centers. But that's Paul Levy-executive blogger. Levy launched his "Running a Hospital" blog a year ago because he thought people might be interested in what goes on in a hospital. Since then, the president and CEO of Beth Israel Deaconess Medical Center has shared his salary, his hospital's Joint Commission findings, and the Levy family recipe for Panamanian wedding cake. The blog is unscripted and PR-free, although Levy admits to occasional bragging. He writes casually, links to other blogs, and takes on peers who think his blog is a "worse than crazy" marketing scheme. While he professes to have no promotional intentions, Levy's blog does lend a human voice to a sometimes cold industry. What started as a communication experiment has taken CEO accountability and hospital transparency to a new place-cyberspace. "Running a Hospital" is one of a handful of blogs written by hospital CEOs, but it's Levy's upfront style that has more and more senior leaders thinking about how they communicate. "It's made an impact on the public debate about transparency," he says. "Whether it will be persuasive or not, I don't know, but it certainly has brought the issue more to the forefront of the public debate."
Debra Levin, design champion
Building design advocates often struggle to be heard in discussions about improving the American healthcare system; high-profile players like patient safety champions, clinical innovators and politicians usually dominate the national debate. But Debra Levin has helped give evidenced-based design, a niche of healthcare that emphasizes the physical environment as a way to improve both clinical and economic outcomes, an increasingly louder voice. Levin is president and CEO of the Concord, CA-based Center for Health Design, a nonprofit organization that helps healthcare organizations improve the quality of care through facility design. The center's environmental message is reaching a growing segment of healthcare; the Pebble Project, the center's research program that enables hospitals to compare innovative designs and provides access to consulting and technical resources, now has more than 50 hospitals and product manufacturers participating nationwide. "I think we have moved from the days when just the mavericks were out there on the cutting edge to a place where there are many early adopters," Levin says. Nevertheless, she adds that despite studies showing benefits ranging from improved patient satisfaction scores to a healthier bottom line, many industry leaders still don't recognize design's importance. "We still have a long way to go before all healthcare facilities are built using the knowledge gained from the current available research."
C. Peter Waegemann, EMR advocate
Attend one of the annual TEPR events sponsored by Boston's Medical Records Institute, and you'll be sure to see him-Peter Waegemann is a fixture at the 'Toward the Electronic Patient Record' conference, which he launched in the early 1980s. Back then, crowds were sparse, comprising a few hundred IT wonks. TEPR 2007 drew almost 3,000 people, including the very physicians Waegemann wants to help automate. "If doctors had patient information in front of them, it would make more of a difference than the hundreds of billions we spend on research," says Waegemann, the institute's executive director who emigrated from Germany to the United States in 1975. "No doctor can store the volume of medical knowledge we have between their ears." The institute's programs focus on helping clinicians sort out the vast assortment of vendors' electronic medical record products. "These systems start at less than $1,000 and go up to $80,000," Waegemann observes. "No one is helping the physicians understand the options. We compare price and usability." That nuts and bolts approach distinguishes TEPR from the goliath HIMSS conference, he says-but Waegemann has done more than promote conferences. He has worked for years to promote data standards for electronic clinical information. The work is slow-moving, he attests. But such recent initiatives as the continuity of care record, a baseline of vital patient information, can, he says, "open up the cottage industry of EMR vendors."
Jill Fuller, a voice for nurses
When Jill Fuller, PhD, RN, came to Prairie Lakes Healthcare System seven years ago, the nurses were an unhappy bunch-the hospital had a 65 percent nursing turnover rate on its medical-surgical unit. But no longer. Today, Prairie Lakes' average nursing turnover rate is 10 percent, and the hospital receives at least 10 qualified applications for every open nursing position. Fuller, Prairie Lakes' chief nursing officer, has reduced the "hassle factor" for nurses with initiatives like eliminating overhead nursing positions, downsizing committees and placing medications at the bedside. Empowering frontline staff members is important because they can identify healthcare's many forms of waste, says Fuller. "Managers have to learn how to give up control. You are working in a very complex environment and things don't always go in a straight line from A to B." Fuller is also involved in the Transforming Care at the Bedside initiative, a program sponsored by The Robert Wood Johnson Foundation and the Institute for Healthcare Improvement that aims to improve care quality, create more effective care teams, and increase nursing staff engagement, retention and efficiency. Prairie Lakes, a 70-staffed-bed hospital in Watertown, SD, is the only small rural hospital participant. "The only thing we know about the future is that change is going to continue, and it is going to be rapid and dramatic," says Fuller. "When you are dealing with that type of a future, innovation is critical."
Sister Mary Jean Ryan
Some hospital CEOs misuse the word "journey" when they talk about their hospital's quality program. But Sister Mary Jean Ryan, FSM, president and CEO of St. Louis-based SSM Health Care, can talk about a journey to quality that started almost two decades ago-and includes highs and lows, like all true journeys do. In 1989, she realized that like many organizations, SSM was "quite content with the status quo." Being above the national average on the few indicators available at the time seemed to be good enough. "And yet it just wasn't. We knew that it wasn't," Ryan says. After starting with an aggressive program of continuous quality improvement for a few years, she looked for new ways to energize SSM's quality drive. At the time, there was no Malcolm Baldrige National Quality Award for healthcare, but there were state awards, and she thought the process was just the kind of exercise the system needed. "The feedback that you get from those reviews is better than anything any internal organization could do on its own." Feedback was all SSM got for the first three years; it was only on the fourth try that SSM received the first Malcolm Baldrige National Quality Award for a hospital. "If we had not received it then, we'd still be applying."
Raymond D. Wells, small-town doc
Raymond D. Wells, MD, can't remember a time when he didn't want to be a physician. That calling has led him to a 40-year career providing healthcare to one of the nation's poorest regions: Martin County, KY. Wells' practice, Inez Family Medicine, sits roughly 30 miles from where he grew up in the heart of Eastern Kentucky coal-mining country. Martin County is one of the lowest-ranked counties in the state for quality of healthcare, including obesity, diabetes and lung cancer. Wells has spent much of his career working to prevent these illnesses and improve access to healthcare. He started a telemedicine program with the University of Kentucky to bring healthcare services to coal miners; a nurse practitioner links patients at the mine sites directly to Wells' office or specialists at the University of Kentucky through videoconferencing technology. Wells now performs health risk assessments for the miners, as well. But Wells also devotes time to a challenge facing rural areas nationwide: the shortage of healthcare professionals. "It is hard to get people to come back to Eastern Kentucky or rural areas, so our best bet is to get people from those areas to go to medical school and then come back," he says. Two of Martin County's physicians were mentored by Wells, and two students currently enrolled at the UK College of Medicine will work with Wells for a month next spring.
Cindy Ehnes, managed care watchdog
As the head of the nation's only standalone state agency charged with regulating HMOs, Cindy Ehnes makes decisions that affect the lives of more than 20 million Californians. With so much at stake, it's little wonder that her actions, or in some cases inactions, as director of the California Department of Managed Health Care regularly make headlines across the state. While such scrutiny may be disconcerting to some, Ehnes maintains that it's all part of the territory. "We as policy leaders have to be willing to take on the third-rail issues because a failure to do so leaves the public unprotected." Besides, ready access to the press can be another tool in her regulatory arsenal. "We're working to create a real culture of accountability for everyone in the system, starting with health plans knowing that if they are engaging in bad behavior, there is a greater likelihood that they will be found out, that it will be expensive, and that it will be public."
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