QUALITY: A Stroke of "Genius" for Health Innovators

This year's MacArthur "genius" grants included three extraordinary physician-innovators. All three are practicing physicians, taking care of patients. All three are also showing us how we can improve the whole system, not just for a handful of patients lucky enough to have exceptional doctors. Diane Meier is a pioneer in palliative care, illustrating how we can dramatically improve care for the seriously or terminally ill—and save money while we're at it. Regina Benjamin provides primary care to the poor in unbelievably difficult conditions in rural Alabama. Peter Pronovost is a critical care physician who has shown hospitals simple, inexpensive ways to prevent lethal infections. What's really phenomenal—and different—is that if you try to talk about some of these concepts to policymakers in Washington, at least some of them will know what you are talking about. That wasn't as true just two or three years ago, and I think it shows a growing awareness that health reform has to do more than cover people. It has to cover people in a health care system that is both more efficient and more compassionate.

I got to know Diane Meier though the reporting I've done in the last few years on palliative care. She is a geriatrician and palliative care physician at Mount Sinai in New York and the director of the Center to Advance Palliative Care. (We've blogged about palliative care here, here, here and here, about the potential money palliative care can save here, and I've written about Meier here and here.) CAPC is an interesting model: It promotes research, but it also teaches doctors and nurses and social workers the nuts and bolts of palliative care. Not the medical aspects— there are other CME opportunities to learn about fentanyl vs morphine etc. At CAPC conferences and seminars (I first met Diane at one in Chicago in 2006) she teaches medical staff how to design a business model for palliative care, how to get hospital CEOs and CFOs on board, how to make arcane Medicare billing rules work, more or less, to their advantage. She even shares fund-raising tips {"Wear pearls," she tells the women in her audiences.") But I've also seen Diane, pearl-free and in sensible shoes, spend more than an hour listening to just one elderly patient with hip pain, or explaining to oncologists in training that chemotherapy and opiates aren't the only things their patients need. Empathy, patience, emotional perception and knowing how to work the system are also part of the arsenal.

I met Dr. Regina Benjamin only once but she's not easy to forget. She took the time to travel to Missisippi in the spring of 2007, about 18 months after Hurricane Katrina, to talk to a small group of health care journalists. We weren't writing about her that day, we were just learning from her, and she was fine with that. Dr. Benjamin is a family physician in the tiny shrimping community of Bayou La Batre in southernmost Alabama. It is racially and ethnically mixed, including an influx of Vietnamese who were drawn to its shrimping fleet, probably the only thing in the fictional home of Forest Gump that was familiar to them. (I don't have my notes from that trip handy, but I'll share this post with colleagues and Kaiser Family Foundation staff who were on that trip with me. If they remember anything that I've overlooked, I hope they'll comment.) News articles about Dr. Benjamin's award point out that her clinic was destroyed by Hurricane Katrina, but she rebuilt it—only to have it burn down just as they were ready to reopen. What the articles omitted is that she had to rebuild as well less than a decade earlier, after Hurricane Georges in 1998. Each time, the grateful community rallied around to help her, as she has helped them, putting the bills on her own credit card when she had no other choice. When her clinic is out of commission, she treats patients out of her beat up old pick-up truck (if this sounds like a story of inspiration ready for Readers' Digest, you're right.) She also finds time to serve on all sorts of health-related and nonprofit boards, and in her "spare" time, she mentors and teaches younger doctors how to provide quality care to underserved communities in rural America.

You may have read about Dr. Peter Pronovost from Johns Hopkins in Atul Gawande's New Yorker piece last fall, and my colleague Paul Testa has written about his infection-control work too. Just yesterday—and we think this is a coincidence but who knows—the House Oversight Committee released a report about how hospitals were (or more often were not) preventing bloodstream infections from central lines (or central venous catheters.) It concluded that if all state hospitals were to use the simple checklist that Pronovost helped develop, more than 15,000 lives and $1.3 billion would be saved each year. While other guides for infection-control have 111 steps. Pronovost's has five, and they are rich in common sense but very low in cost:

• Handwashing;
• Full draping of the patient;
• Cleaning the skin with proven cleansers;
• Avoiding catheters in the groin if possible; and
• Removing catheters as soon as possible.

If they can work in strapped Detroit hospitals, they can work anywhere.

(Update: See also our Sept 24 post on Dr. Wafaa el-Sadr, an innovator in public health and HIV/AIDS)