Monday, December 16, 2013

As we look back at the history of Partners Healthcare System (PHS) in Massachusetts, it is useful to consider what it is and what it might have been.  What it is is an extraordinary collection of extremely dedicated and talented people--clinicians, researchers, and teachers--who do their best to serve humanity.  What it is also is an incredibly successful business enterprise, carrying out a series of strategic plans that have led to market dominance in Eastern Massachusetts.  What it is not is a leader in quality, safety, process improvement, and transparency.  As I noted in March 2009:

The Partners hospitals are full of well intentioned, dedicated people. But there has not been a corporate public commitment to reduction of harm and to transparency of clinical outcomes that could help build broad public confidence in the quality and safety of patient care -- and with this a confidence that we are also attempting to control costs. . . . The Partners system should be a world leader in the science of health care delivery, along with the fields in which it already holds prominence.

I'm not the only person to notice this.  As I have traveled throughout the country, I often find people curious as to how a health care system that has comprised people like David Bates, Atul Gawande, and Tejal Gandhi has failed to adopt the principles espoused by, and to utilize the guidance of, these world-class experts.

I believe--although there is no way to prove it--that if founder Richard Nesson had lived longer and had thereby been able to exercise a lasting influence on the heart and soul of PHS, that this would have occurred. As noted in this obituary, Nesson had a deep connection to community service and to people's well-being, as well as a thoughtful sense of business matters. In the absence of his social conscience, the leadership of PHS has focused on influencing the body politic and building its business presence more than on the leadership role it might have taken in quality, safety, process improvement, and transparency.

But a recent announcement has given me hope.  Gregg Meyer, MD, is joining the system as Chief Clinical Officer in January.  Most recently, Gregg has served as Chief Clinical Officer and Executive Vice-President for Population Health at Dartmouth-Hitchcock and as the Senior Associate Dean for Clinical Affairs and Paul B. Batalden Professor and Chair at the Geisel School of Medicine. While he was formerly at PHS, it was in a more limited role at MGH. Now, he is moving up to a system-wide position.

This has the potential to be the most significant single appointment at PHS in many years.  Gregg has substantial expertise in the matters I have discussed, but he also has an insider's view of how to achieve change and deal with the many political jurisdictions within this spreading healthcare system. I believe that he is not the kind of person to take on the assigned task without having received assurances from the top leadership that they will support his efforts--and without a personal belief that he can succeed in helping to transform this system.

But it is late in the game, if the goal is to offer PHS to the world as a leader in quality, safety, process improvement, and transparency.  Other systems--including but not limited to Ascension, ThedaCare, and MedStar--have head starts.  Each of them intends to be "the best at getting better." Importantly, too, each of them approaches the task with modesty, being unafraid to admit where they need to improve and learn from others. PHS has been a bit short on the modesty front over the years. I'm hoping Gregg's arrival not only is a sign of corporate commitment to a quality and safety agenda, but is also a sign that the arrogance characterizing this system is on the wane.


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