Health policymakers and legislatures have been arguing about the optimal way to finance healthcare for more than two decades, if not longer. The 2010 landmark Affordable Care Act and debate about “Medicare for All” continue to delight some and infuriate others, even now. Those important discussions will continue unabated.
However, we shouldn’t take this apparent lack of agreement on how to finance healthcare as license to ignore other grave issues with the industry. After 32 years as a truth-teller in medicine, I’m going to give it to you straight: We, as an industry, are failing the patients who are counting on us. Despite years of effort, we’ve been unable to solve healthcare’s most pressing and complex problems. One in four patients are harmed in American hospitals, and half suffer because they don’t know how to care for themselves after a hospital discharge. Others wait for months to get the crucial care they need. To make matters worse, more than half of clinicians say they’re burned out in their jobs and many hospitals are going bankrupt, unable to withstand negative economic margins. It’s not surprising that conditions like these poison public opinion about healthcare and make it difficult to develop health policy.
We haven’t made it easy for ourselves in healthcare, to put it mildly. But now, in this nascent political season, is the perfect time to shore up our healthcare system to make it more impervious to the vagaries of politics. We’re learning what can turn this around – and at just the right time. It’s clear that the innovation that will revolutionize healthcare is not a smartphone app. It’s not a new drug or novel use for gene therapy, although those innovations are crucial. No, the path to improvement is something much more basic to the human condition. We will at long last fulfill the promise of delivering exceptional healthcare when we build that most fundamental emotion into our care model -- love.
And we have the data to prove it.
At our institution, we believe the secret of great care is love, defined as the energy that uplifts and connects us all. We’ve put into place a simple model for transformation– believe, belong, build. Our caregivers believe their job is to improve value for our patients, feel empowered to do so, and have a clear inspiring vision of the future that is better because of their effort and is aligned with their values. We’ve created structures and a culture so that people belong to a learning community, a network that supports the free flow of ideas from anywhere they emerge so we can share promising practices and innovate faster. And we’ve built robust management and accountability systems to check how we’re doing. The idea is to cultivate the power of love among our entire staff to improve the care we deliver. Much of this starts from being appreciated and valued. In essence, it’s operationalizing love – the powerful idea that there is wisdom and beauty in every person and all ideas are welcome.
This may seem like “soft” stuff. But the results are worth noting. By building our care model around love, we’ve reduced annual Medicare costs by 33 percent, saving the Medicare program over $100 million over four years. We’ve slashed surgical length of stay from 6.2 days to just 2.5. We’ve reduced our mortality from sepsis by 70 percent and lowered A1C values for 1,000 patients with diabetes mellitus by 1.5 points. And we’ve reduced those patient safety events known as sentinel events – those involving death, permanent harm or severe temporary harm – by 70 percent. With one particular project, we’ve wrapped our most complex patients in what we call a “web of well-being,” with case managers acting as advocates and troubleshooters, helping patients navigate those everyday life challenges that get in the way of achieving optimal health outcomes. Results for this? Reduction in cost of care of $10,000 a year per patient, while tripling their sense of well-being and belonging. All of the above transformation occurred without change in payment policy.
There is, of course, still much work to do. Challenges in healthcare persist that will require everyone’s ingenuity and energy. But at least in our corner of the world, our colleagues say they feel empowered, connected and uplifted to solve problems in a way that’s different than before. Whether you call it love or respect, the bottom line is that when we all feel like we matter and are connected, with all our messiness and majesty, amazing things can happen. Problems seem less daunting, which is a precious and powerful gift. By leveraging that power within and between people, together we can make health care better for all – and stave off any threats to it that may arise.
Peter J. Pronovost, MD, PhD is Chief Quality & Clinical Transformation Officer and the Veale Distinguished Chair in Leadership and Clinical Transformation at University Hospitals in Cleveland.