Bringing the Healthcare Quality Message to the Masses
A documentary film honoring the AHRQ and the late John Eisenberg, a health systems research pioneer, also aims to promote health policy and patient safety, says his son, the filmmaker. From MedPage Today.
As a high school junior, Mike Eisenberg didn't really appreciate the importance of his father's work -- until his father was dying.
"At that point, I was still figuring out what it was he did and understanding the healthcare field and what role he had in it," Eisenberg said of his father, John Eisenberg, MD, MBA, the health systems research pioneer who died in 2002 at age 55 from a brain tumor.
"As he was passing away, in his final months, I was getting a much clearer sense of the impact he was having, by the people who were coming over to see him [when he was in hospice care at home]. I would shake hands with people and not know who they were and what they did. And at the memorial service there were a lot of people there -- the sheer number of people, that was what really stuck with me."
But prior to that, "he was just my dad; he worked in his office a lot, and had stacks of papers which he'd become relatively famous for, but it was way over my head. It was something I never thought I needed to understand."
Eisenberg later learned that his dad was considered by many to be a world leader in healthcare quality and patient safety, and served as one of the early directors of what is now the Agency for Healthcare Research and Quality (AHRQ). An obituary in Annals of Internal Medicine described John Eisenberg as "a pioneer in health services research and a champion of evidence-based medicine and 'value-for-money' healthcare in the United States and around the world."
The BMJ said that John Eisenberg's death "[left] a void in the international healthcare research and quality movement." The journal praised his launching of AHRQ's evidence-based practice centers: "At the time of his death, 12 centers in the United States and Canada had generated 56 evidence reports ... By making AHRQ the federal leader in quality improvement and patient safety, he made the lives of millions of Americans better in a direct and tangible way. He was a warm and compassionate man who will be missed by all who knew him."
Today, Mike Eisenberg, now a 30-year-old filmmaker, not only knows what his father did, he is also concerned that much of that work is in jeopardy. AHRQ has long been targeted for de-funding by members of Congress who don't think its work is worth the money. It escaped de-funding once again in the last round of budget negotiations, but is likely to be under the microscope in future sessions of Congress.
"It started with an article in The Cancer Letter" last June, he explained. "Somebody had forwarded an article about AHRQ that they had written, about how the House and Senate were working to take the money being used to fund AHRQ and put it toward other resources.
"I thought, 'That sounds ridiculous; they're going to de-fund AHRQ? They're clearly doing a lot of work that's essential.' I knew my dad was facing a similar challenge [when he was the director] so I thought we could make a short documentary about AHRQ and why it's important. But that turned into 'there's a bigger picture here and it's about health policy and patient safety.'"
A Roundabout Route to Filmmaking
Eisenberg came to documentary filmmaking by a circuitous route. After growing up in Potomac, Md., a wealthy suburb of Washington, he enrolled at Marietta College in Ohio because of its strong baseball program -- "Division 3, which I felt I could compete at," said Eisenberg, a pitcher known for his curve ball.
By end of his junior year, Marietta's team had won the national championship. "A week later I got drafted to play with the Cleveland Indians, and I dropped out senior year and spent the better part of 3 years with the minor leagues before being released," Eisenberg recalled. He then played in some independent baseball teams, one of which was located in Chicago, where he now resides. "I found out about a film school here; it was a 2-year program, and that interested me, I didn't want to do 4 more years."
He had a choice to make -- hold onto baseball, or pursue his other passion -- filmmaking -- at Tribeca Academy, now known as Tribeca Flashpoint College. "So I hung up my cleats and went back to Marietta to finish my senior year ... Then I went back to Chicago with the intention to go to Tribeca Academy; I fell in love with what I was learning."
He also met two people who would be pivotal in his life: Kailey Brackett and Matt Downe, who both ended up becoming partners with him in a video and film production company, Tall Tale Productions. Brackett went on to play an even more crucial role: she became Eisenberg's wife.
At first, the trio was trying to pursue the business part-time while they were working at other jobs -- Matt and Mike at ad agencies and Kailey working in TV and film. But they took Tall Tale full time after a couple of years, "and we were sort of looking for next project and that's where we are today with this documentary," Eisenberg said.
"Kailey is our producer and our business manager, so she is involved in almost every aspect of what happens here, and Matt and I are the creative team, handling all the filming and editing and the creative development going on," he explained, noting that they'll hire outside contractors when they need them for things the team does not have expertise in, such as audio recording or music.
An Educational Process
For the documentary, which is tentatively titled To Err is Human, Eisenberg has been learning about his dad's career. "One thing I grappled with understanding was that he was a working physician for almost his entire career," he said. "He still saw patients for a long time past when he was beginning his government work. But when we moved to [Washington], the priority was definitely to begin his work in policy; that's where he began working with [former Health and Human Services Secretary] Donna Shalala, who has since become a good family friend."
Eisenberg remembered one key moment when his father considered accepting a nomination as the Surgeon General. "He chose not to do that because of the work he wanted to continue in policy," he said. "That was something I never forgot, because you get a clear sense of what is important when you turn down something as clearly visible as Surgeon General. I think that was a big decision for him to keep doing what he was doing in policy research at AHRQ."
The team had to think hard about how to approach the documentary, which they're in the process of both making and raising funding for. "Healthcare is such a big topic that you need a small piece of it [to work on]," said Eisenberg. "Our intention was to make a documentary that would not only inform us as subjects but also maybe inspire people to take action, whether on their own independent basis or on a national scale.
Interview subjects so far have included Carolyn Clancy, MD, John Eisenberg's successor at AHRQ who is now with the Veterans Health Administration; Helen Burstin, MD, MPH, formerly of AHRQ and the current chief scientific officer of the National Quality Forum; and Paul Goldberg, editor and publisher of The Cancer Letter. The team also has interviewed Richard Kronick, PhD, AHRQ's current director.
But to do more work on the film, the team needs to raise money. "We've used our resources, and gone out and gotten interviews," said Eisenberg. "We will still be able to do a few things in Chicago, but to really [do this] we need a budget, people who are passionate about the topic and are interested in the success of the documentary, and that's hard to find."
"Ultimately documentaries aren't money-making machines -- they're not Star Wars," he said. But in order for a documentary to affect people, "there has to be an element of [shock]." So Eisenberg and his team plan to interview people affected by medical mistakes. "We're not talking about being able to prevent [physicians from making them] but events the system is influencing, such as whether doctors are being overworked, or there's poor communication between hospitals, or over-testing, all those kind of things.
"That keeps me up at night -- How am I going to tell story about system and make it interesting to people? But step one, is there anyone out there like a group or foundation looking for an opportunity to make a difference using the medium we're good at, which is filmmaking?"
Eisenberg's estimated budget for the film ranges from $100,000 to $500,000 and beyond. "It really depends on scale of where the story takes us," he explained. "That's the most difficult thing about funding a documentary film -- allowing it to guide you to best way to tell story."
"We've submitted grant proposals but ... it's such a niche area; it straddles a fine line between social justice and politics," he continued. "It's not starving kids or people with mental illness ... It's kind of its own world."
Once the documentary is finished, Eisenberg would like to get it shown at a prestigious film festival such as Sundance or AFI. "Ideally, somebody like HBO or CNN or a network that specialized in hour-long documentary specials would want to pick it up -- the best-case scenario would be that they'd see it before we finish it and would help us make it," he said.
In the end, Tall Tale wants to finish the documentary and put it somewhere where people can see it and then help the company get it out to the public, whether that's on Netflix or via a third-party distribution company. "We could put it on YouTube and hope for the best, but that wouldn't make impact we want it to make," said Eisenberg. "Getting it online is not a problem; the problem is letting people know it's there."
Although the film is partially about his father, Eisenberg thinks of it more as an extension of his father's work. "Explaining how AHRQ is what it is, you can't skip over him, but we're using my father's work as a stepping stone and a guideline for how to make this documentary," he added, noting that he has lots of clips of his dad from C-SPAN, from congressional testimony, and from news interviews where he talks about everything from healthcare costs to oat bran and cholesterol.
"He just seems to be the best at explaining the problem and the solution, and his passing was too soon because he didn't get the chance to see through all the work that he had done. On a personal level, there's the element of, 'I can continue that work in my way.'"
"There certainly might be an area of the documentary that honors his work, but I don't want it to be distraction from ultimate purpose for which the documentary exists, and I think he'd be much prouder of documentary that assisted his work than simply praised it," he said.
The upcoming presidential election makes this a good time to work on the documentary, Eisenberg said. "Based on who's running, we're looking at a drastic divide of whether healthcare is going to be a topic or not for the next 8 years."
This article originally appeared in MedPage Today.