Robert Pearl, MD, serves as a Physician at Stanford University Medical and Business School.
On May 25th, Dr. Pearl will give the keynote presentation "Physician Culture and How it Kills Doctors and Patients" at Becker's Hospital Review 11th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place on May 24-26, 2021 in Chicago.
To learn more about the conference and Dr. Pearl's session, click here.
Question: When it comes to innovation, what are some common pitfalls you see healthcare organizations making?
Robert Pearl: Healthcare organizations make three key mistakes when trying to innovate:
1. Healthcare “gold” rarely glitters. Each year, hundreds of new and highly touted medical technologies enter the market and dazzle the eye. But they rarely move the needle on quality, service or cost. The most effective innovations are usually ones that are already working on a smaller scale within a healthcare organization. Therefore, the biggest opportunities exist in finding, refining and scaling the approaches that already work well. But leaders should beware that scaling innovation is harder than it sounds.
2. Scaling innovation takes discipline and persistence. There’s no shortage of big ideas for improving healthcare operations. But leaders often discover the hard way that an innovation that proved successful in one department or location is difficult to scale systemwide. That’s because the originators of an idea will always be more enthusiastic about their own innovation than other groups within the organization.
3. Leaders can’t control the innovation process. When I was CEO at Kaiser Permanente, I told colleagues that our motto was to “innovate locally and learn nationally.” So, once a year, I would travel to each medical center and ask the local leaders to present the three most effective and innovative approaches for improving the quality, service, and affordability their facility had put in place. Together, the executive staff and I would then select, among the 100 or so presented, the three we thought could be successfully implemented broadly and would have the greatest impact on our entire organization. Then we’d work with the chiefs and physician leaders at all sites to put the new solutions into practice everywhere. This approach to scaling innovation resulted in year-over-year improvements systemwide, with even the lowest-performing facilities matching the average within two years of implementation.
Q: What is the most important lesson you've learned about delivering excellent patient experience?
RP: More than ever before, patients today value choice and convenience, meaning they want to decide for themselves when and where they receive medical care. In fact, a 2018 study by Virginia Commonwealth University found that 61% of patients would switch doctors to get an appointment quickly while 52% would switch to get an appointment at a convenient location.
These preferences often conflict with the traditional values of doctors, who will move mountains to provide rapid access for emergency care but not for routine problems.
Healthcare leaders must start appreciating and prioritizing the evolving needs of patients. At Kaiser Permanente, we were able to offer outpatients same-day or next-day care for more than 60% of routine problems. Moreover, we offered over half of all patients the choice of whether they wanted to be seen in-person or via telemedicine. Patient data indicated that this service-minded approach allowed us to improve the quality of care while greatly increasing satisfaction scores, particularly for individuals who selected same-day video visits. As a result, our organization achieved a JD Power rating that was nearly 100 points higher than other programs in our area and ranking by the National Committee for Quality Assurance (NCQA) in the top five in the nation.
Q: What do you see as the most dangerous trend in healthcare right now?
RP: Until about a decade ago, physicians rarely if ever had to consider how much a test, drug or procedure would cost an insured patient. They didn’t need to know because insurance blinded both the healthcare provider and the patient to the actual expense. Besides, doctors didn’t want to wade into this problematic area, having been trained to do what is medically best for their patients, regardless of the cost.
However, doctors can no longer ignore their role in the cost inflation crisis. Medical costs now consume 18% of the gross domestic product (GDP) while national healthcare spending exceeds $3.6 trillion annually. These numbers keep rising despite the fact that 8 in 10 Americans live paycheck to paycheck. A century ago, Americans feared a bad diagnosis because it meant having to endure physical pain and suffering. Today, a bad diagnosis often results in a different kind of pain: 62% of bankruptcy filings are now the result of medical bills. The cost of healthcare is now killing the American dream and putting patients in harm’s way. Providers need to find more efficient and effective ways to deliver medical care. Instead, they are consolidating for market control and demanding ever higher reimbursements.
Of the more than 100 companies and industries I’ve examined in my role at the Stanford Graduate School of Business, I have found one universal trend: Every company or industry that is as inefficient, ineffective and inconvenient as American healthcare gets disrupted. If American physicians and hospitals refuse to change, they too will get left behind—perhaps as soon as our nation’s next recession.
Q: What future health IT capability will have the most significant impact on clinical workflows or patient outcomes?
RP: Today, patients living in rural and underserved communities receive a lower quality of care than those living in high-population areas. Likewise, patients who get sick during nights and weekends find themselves with fewer options than those who get ill during weekdays. And getting to doctors’ offices is becoming increasingly difficult and inconvenient. Therefore, I believe video (telemedicine) will be the technology to have the greatest impact on the future of healthcare. No other medical technology more fully overcomes the barriers of time and distance. Video allows patients to receive optimal medical expertise regardless of when or where a problem arises.
Video doesn’t just connect doctors with patients. It also allows physicians to connect in powerful ways. For example, today there’s a stroke-trained neurologist who provides immediate expertise to all 20 Kaiser Permanente emergency rooms in Northern California. When deciding whether a patient may need a powerful clot-busting drug, time is of the essence. Giving the drug to the right patient, quickly, can both save a life and preserve brain function. Giving it to the wrong patient, or waiting too long, could result in death. Across the country, the average time from (hospital) door to needle is above one hour. Thanks to the use of video, that time is under 30 minutes within The Permanente Medical Group.
Video visits, offered in conjunction with a comprehensive electronic health record, enable our organization to provide patients with the highest quality care in the most convenient way at the lowest cost possible. That’s why I predict that at least one-third of all visits currently provided in the doctor’s office will be delivered via telemedicine in the future.
More than ever before, patients today value choice and convenience, meaning they want to decide for themselves when and where they receive medical care. In fact, a 2018 study by Virginia Commonwealth University found that 61% of patients would switch doctors to get an appointment quickly while 52% would switch to get an appointment at a convenient location.
These preferences often conflict with the traditional values of doctors, who will move mountains to provide rapid access for emergency care but not for routine problems.
Healthcare leaders must start appreciating and prioritizing the evolving needs of patients. At Kaiser Permanente, we were able to offer outpatients same-day or next-day care for more than 60% of routine problems. Moreover, we offered over half of all patients the choice whether they wanted to be seen in-person or via telemedicine. Patient data indicated that this service-minded approach allowed us to improve the quality of care while greatly increasing satisfaction scores, particularly for individuals who selected same-day video visits. As a result, our organization achieved a JD Power rating that was nearly 100 points higher other programs in our area and ranking by the National Committee for Quality Assurance (NCQA) in the top five in the nation.