It’s Going to Take a Village


Screen Shot 2014-06-26 at 11.41.49 AMI gave a talk for the 14th Annual Population Health Colloquium, organized by the Jefferson School of Population Health, which happens to be the very first school of population health in the US. I invite you to take a look at this video of my talk—I tried to make it a little entertaining, but it also makes a point: To keep patients healthy, we’re going to need a different, friendlier, and more collaborative kind of doctor. We’re going to need to develop measurable population health strategies. And we’re going to need to make lifelong learning fun. Those innovations will help us all.

View the video of my talk here.

I hope this video conveys to you my optimism about the future of healthcare. Being wildly optimistic about academic healthcare in 2014 earns me strange looks from colleagues. I get it, I understand why. The difficulties are stark: Revenues supporting academic medicine are not keeping pace with expenses, and even falling below what it costs. But I’m optimistic because the need for transformation is building new energy to create a new future.

I see that energy across the full spectrum of health: From how we select the young people who will provide care, to the new tools we will give them.

Start at the beginning: How we select.

All schools of health (medicine, nursing, pharmacy, etc.) are able to pick the most accomplished applicants. For medical schools, this means selection based on science GPA, MCATs and organic chemistry grades. Then sadly we’re all surprised when doctors are not more empathetic, communicative and creative.

My research with friends at the Wharton School indicates that doctors have a pattern of bias toward competitiveness instead of cooperation; toward hierarchy instead of teamwork. These biases begin in medical school admissions, where a candidate with great emotional intelligence may lose out in favor of someone who scored a couple points higher on the MCATs.

But I also see energy building to change that. Thomas Jefferson University has pioneered the Jefferson Empathy Scale to test and encourage doctors who can see themselves in the patient’s shoes. A lot of credit goes to several of our leaders, including Sal Mangione, who has brought humanities into the curriculum, and Mark Tykocinski as dean of the medical college. In changing the way we train and view doctors, we have a chance to transform our health system and improve the lives of our patients.

Next: Population Health.

A cascade of initiatives center around doing a better job for populations – targeting and measuring population health strategies. We are responsible for the healthcare of hundreds of thousands of people in our geographic area, and many more who visit from far away or reach us through telemedicine. Population health means doing what it takes to get a defined population healthy and collecting data about the results so that we really understand our successes and failures and can adjust our clinical care and our community health. As Jefferson moves from a volume based financial model to a value based model under the Affordable Care Act (e.g., the government rewards us for getting patients healthy, not how many procedures we do on them), we’ll be relying on effective population health strategies.

We won’t be able to keep this population healthy just by using hospitals and go-it-alone doctors — we’ll need a bigger tool box. There are big tools, like creating new teams of caring professionals for lifelong primary care. And there are more specific tools, like phone calls to find out how sick patients are doing, and sometimes even SEPTA passes for those who can’t afford to get here on their own. We’ll have new technology that allows patients to conduct a virtual visit on a cell phone from home, or talk to the team from a computer monitor by the bed. And we will be collecting and analyzing data so that our decisions are based on current information, not on the way things have always been done.

And beyond: Lifelong learning.

It’s time to bring the same energy and enthusiasm to lifelong learning for providers, as we do for beginning students. We can make learning cool, we can simulate complex real life surgery, and we can assess behavior as well as competence. That sounds like an obvious thing to do, but right now, all health professionals, including surgeons, only have to take a short class and a written test and fill in the blanks to renew their licenses.