AMCs: Off target and lacking a sense of urgency

As noted in a previous post, I was impressed negatively by a Mt. Sinai hospital paid op-ed that extolled the virtues of academic medical centers while making no reference to the role that such centers could play in improving the quality of care delivered in America.  While acknowledging the attributes of AMCs, I said:

But these statements fail to tell the story of how academic medicine, in many institutions, is failing the American public.

It does not, for example, explain why many AMCs have been slow to adopt proven tools of process improvement to reduce harm to patients and improve efficiency. 

It does not explain the  persistent lack of transparency in many such institutions with regard to clinical outcomes, notwithstanding the documented value of such transparency in improving quality and safety. 

It does not explain why the medical schools that own or are affiliated with many AMCs have failed to train their students in how to use the scientific method to improve the delivery of care.

It does not explain the huge variation in practice among residents and attending physicians, giving lie to the concept of evidence-based medicine.  

It does not explain the reluctance of many AMCs to engage patients and families in the design and delivery of care.

A friend referred me to a summary of TEDMED talk by Daniel Kraft, which reinforced these points:   

Notably Daniel spoke about how when he finished his training at Massachusetts General Hospital 15 years ago the hospital still functioned, from an delivery standpoint, in about the same way as it does today, with specialty silos, defined training hierarchy, etc.

I am guessing that Daniel's talk was mainly on how to leverage new technologies in the health delivery system, but his observation applies more generally, too.

Ironically, one of those Mt. Sinai op-eds (John Morrison and David Muller, "Science and Medicine in the Service of Society," September 10, 2010) made related points:

Historically, medical schools emerged within universities primarily to educate physicians, yet Master’s and Ph.D. programs centered at medical schools now produce the vast majority of the scientists trained in biological arenas relevant to medicine.

All too often, these programs simply co-exist, isolated by different curricula and cultures. If we are to maximize our capacity to impact clinical practice through scientific discovery, we need to produce leaders in biomedicine and health care who see themselves as members of large, interactive teams committed to clinically relevant breakthrough science.

Meanwhile, Michael Nielson in the Wall Street Journal notes that networked science uses "online tools as cognitive tools to amplify our collective intelligence. The tools are a way of connecting the right people to the right problems at the right time, activating what would otherwise be latent expertise."

He notes, though, that this is not rewarded in the field:

Even if you personally think it would be far better for science as a whole if you carefully curated and shared your data online, that is time away from your "real" work of writing papers. Except in a few fields, sharing data is not something your peers will give you credit for doing.

How interesting that people in academic medicine are able to see the need for a more integrated, cooperative, and collaborative approach to medical training, research, and work flows when it applies to the advance of basic science and technology, but they have yet to modify the structure of their academic centers to allow such behavior to thrive.  And, beyond that, they remain blind to the idea of applying those same concepts to the actual delivery of care.  Were they to do so, we could be saving thousands of lives right now, well before the next great cures to disease are developed.

Example:  At a recent meeting of medical academic leaders, the president of one center proudly reported over the growth in faculty, in enrollment, in buildings, and so on at his institution.  Someone asked him about systematic quality improvement.  He cited improvements on Press-Ganey results, acting as though this was the surrogate for quality improvement.

Off track and too slow, folks.  Too slow.  As we have seen, if you don't start to define the important clinical improvement issues and make progress, the government will do it for you and do it wrong.

Recall what Captain Sullenberger said, ""I wish we were less patient. We are choosing every day we go to work how many lives should be lost in this country."

"We have islands of excellence in a sea of systemic failures. We need to teach all practitioners the science of safety."