HL20: John E. Wennberg, MD—Variations in Care and the Constant Search for a Better Way

Such variation is important because it is wrapped around essential elements of healthcare that can be expensive and also wasteful. That waste includes frequency of visits to physicians, the number of hospitalizations, how often people are sent to ICUs or get an MRI, Wennberg says. "There are variations associated with overall capacity, how many doctors you have, how many beds," he adds.

Not only do health systems need to have "better organization," but also it is increasingly important to provide a shared program with patients themselves, Wennberg says. "Getting patients engaged has been one of our principle goals, and we are seeing some progress in reducing variations in elective surgery." Wennberg refers to findings in a study by Group Health Cooperative in Seattle that showed a 39% reduction in knee replacement spending once health systems adopted the concept of shared decision-making about what is medically necessary. Wennberg was not involved in the study.

A graduate of Stanford University, Wennberg received his MD at McGill University, and also took post-graduate training in internal medicine and nephrology at Johns Hopkins University. While there, he became increasingly interested in epidemiological principles in the healthcare system, so he pursued a master's degree in public health.

That led him to study the tonsillectomy variations in Vermont as director of a northern New England medical program. Wennberg recalls how he and his colleague tried to shop around their findings, but were roundly rejected. "They weren't ready for it, that's for sure," Wennberg has said. The journal Science published the study.