Here’s the secret to succeeding in business. Ready? First, make a good product that works well and is delivered efficiently. Second, never forget how important your customers are, or you’ll lose them. Repeat.
It works for almost every industry. A lot of people think Coke tastes great. Why else drink it? Exxon refines crude oil into gasoline. It makes your car run. Sell. Repeat.
But when it comes to healthcare and its delivery, the system isn’t working nearly as well as it could, the products offered don’t provide the results you deserve, and customers – patients – don’t always receive the benefits they should. This was a theme that really stuck for me as I listened to some extremely smart and accomplished people speak this week at TEDMED.
Despite this inconsistent, often frustrating system, there’s a lot of hope and progress being made to fix it, with evidence-based medicine, the effective use of data and mutual accountability leading the way at putting patients first.
Here’s a look at what leaders of the CDC and FDA, the executive health editor at Reuters, President Obama’s chief technology officer and a cancer theoretician and mathematician had to say about improving patient health. See what I mean about extremely smart and accomplished people?
Dr. Thomas Frieden (Director, Centers for Disease Control and Prevention)
In the early 90s, tuberculosis ran rampant in New York City, spreading through hospitals, homeless shelters and resisting multi-drug treatment. It was so bad, Dr. Frieden said, that physicians didn’t want to complete their residencies in New York for fear of contracting tuberculosis themselves.
Dr. Frieden had initial success in bringing tuberculosis under control. But at a chance meeting with a physician who had contracted tuberculosis in a concentration camp during World War II, Dr. Frieden was asked an amazingly simple question that proved transformative: “How many patients did you cure?” Dr. Frieden, “terribly ashamed”, didn’t know the answer.
He began a process called cohort reviews. Traveling to every part of the city, his team reviewed patients one by one until they knew exactly how many had been cured. “Data and information isn’t just statistics, it’s what is locally relevant,” Dr. Frieden said. And if the data isn’t being used with the intention of making patients the VIPs, it’s not being used well. “If you’re not measuring with brutal honesty, you won’t succeed.”
There was one other point from Dr. Frieden’s presentation that’s worth noting. Advertising and media outreach works: Last month, the CDC launched a hard-hitting campaign, Tips from Former Smokers, on what tobacco really does to people. The reason? Media campaigns are “an evidence-based strategy to educate the public regarding the harms of tobacco use.” Did the evidence hold up? You bet. Dr. Frieden says calls to quit lines doubled in the first month.
Dr. Ivan Oransky, Executive Editor of Reuters Health
Dr. Oransky used a simple, and timely, story to demonstrate the situation Americans face with their healthcare. Billy Beane, of Moneyball fame, was himself, albeit shortly, a major league baseball player. Scouts all thought he’d succeed but their predictions were wrong. The healthcare system, Dr. Oransky argues, is as bad at predicting what will happen to people as scouts were at predicting that Billy Beane wouldn’t make it as a ball player. For the healthcare system to work, and work well, its delivery and service must improve. A system where patients feel they’ve received bad care unless they’ve been diagnosed or prescribed medicine doesn’t create good service. Dr. Oransky said:
“We have a system where if you build it, they will come. Billy Beane learned that it wasn’t swinging for the fences, it was watching for the guys who like to walk. We need to figure out, is that a good pitch or should we let it go by and not swing at everything?”
Todd Park, U.S. Chief Technology Officer
Dr. Park didn’t have any gizmos or gadgets. He was just a self-described “fanboy” who said something pretty remarkable is happening in Cincinnati, Ohio. It’s not the chili.
By most measures, Cincinnati was average when it came to healthcare delivery. The city decided it wasn’t content with average. So a few years ago, stakeholders representing many constituencies got together regularly to understand health status in their community and the performance of the healthcare delivery system. They started small, with flu coverage, at which they were, again, “resoundingly average.”
To fix it, first these stakeholders developed a set of common performance metrics and an ongoing measurement system to help achieve goals. Second, they realigned how healthcare is paid for. Insurers and providers wanted to pay for value. Doctors were offered extra incentives and other resources to help them coordinate care more proactively and accelerated deployment of electronic health records and educated clinicians on how to use these new tools. Finally, they put patients at the center. They published a website that gave them much better information on flu. Treatment improved. It’s also working for diabetes, where between 2010-2011, the cohort of patients receiving perfect diabetes care improved greatly.
Dr. Jacob Scott, radiation oncologist and cancer theoretician, Moffit Cancer Center
Dr. Scott thinks of himself as a long-range scout searching the world of biology he’s seen and what is limiting our success in healthcare. If that sounds different than many doctors you know, it’s because Dr. Scott has had a unique experience. He studied physics, served in the U.S. Navy on a nuclear submarine and while studying medicine, decided he should also study mathematics at Oxford University.
Much of what limits success in healthcare, Dr. Scott argues, is medical school. When he arrived, medical school was “like a backstage pass to everything cool about being a human being.” However, medical school, which Dr. Scott says rewards medical students based only on GPA and MCAT scores, is not doing enough to encourage creative thinking and unique partnerships that can look at healthcare’s biggest problems, especially in oncology. Instead, medical school needs to remind students that it’s not the information they leave medical school with, but the ability to face problems critically and step out of their comfort zone, that will make the biggest difference in medicine.
Dr. Peggy Hamburg, Commissioner, U.S. FDA, and Larry Brilliant, president and CEO, Skoll Global Threats Fund
Mr. Brilliant interviewed Dr. Hamburg on a range of issues that are front and center in healthcare right now. Here are some excerpts from the conversation:
Balancing the need for innovation with regulation and safety: Dr. Hamburg said that smart regulation matters if you want to translate science and technology into the products people need. Smart regulation improves the quality and utility of a product while ensuring there’s trust and confidence in it from patients and physicians. She added that a lot of people at the FDA don’t understand the process of innovation and running a business. By reaching out and talking to CEOs and entrepreneurs, the FDA has learned a lot.
On speeding the approval of drugs and devices: Drugs and devices are very different, Dr. Hamburg said. On the drug side, the FDA leads the world in terms of first to market on a majority of drugs and in the time of that review process. Devices are more complicated. FDA is faster the majority of the time compared to European colleagues but slower for pre-market approvals.
The impact of globalization on drug safety: As drug development has moved offshore, so have safety trials, and the challenges of globalization are immense, Dr. Hamburg said. Of the drugs taken in the U.S.,
40 percent are manufactured in another country and 80 percent of the ingredients are manufactured elsewhere. That’s just on drug side.
On drug shortages: Dr. Hamburg said this is a problem that’s increased in recent years in a way that worries all of us. The biggest shortage has been with sterile injectable drugs, many of which are generics or older drugs. They are hard to make and the manufacturing equipment is old. Economic forces are also at play. The FDA is working to learn about shortages much, much earlier, she said, and collaborates with manufacturers to make sure the drug remains available. It also means identifying other manufacturers who can scale up to meet a shortage and those who could make the drug but aren’t, or go overseas and work for an equivalent drug that isn’t approved but could.