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This topic isn’t directly in our wheelhouse here in the e-patient movement (“empowered, engaged, equipped and enabled”), but as I continue one patient’s odyssey in learning about healthcare, a discussion on Paul Levy’s blog has taught me a lot. So I’m posting it for other interested patients.

It’s on his post What does it take? The original post was about why Boston hospitals aren’t agreeing with Levy’s offer to share knowledge to reduce hospital-acquired infections etc. But it’s shifted to being largely about the use of checklists, which has led to some profound comments about cultural and human issues when change is in the wind.

One comment, from Brent James of Utah’s Intermountain Health Care, is so informative I want to share it here.

Paul, you have put your finger on what I regard as THE core task of the present generation of the healing professions. It is very clear that we are in the midst of a transition. The term of art that is usually used to describe the present state – and which Don Berwick so eloquently explained (at least, at the level that an individual physician would experience it) – is “the craft of medicine.” It’s the idea that every physician (or nurse, or technician, or administrator, etc.) is a personal expert, relying primarily on their personal commitment to excellence. In a very real sense, every physician occupies his/her own universe, with its own reality, truths, physical constants. As a physician I might say to a colleague, “What works for you, works for you. What works for me, works for me. Let’s both stay focused on the patient – our core fiduciary commitment to put the patient first in all things – and that will guarantee the best possible results.”

David Eddy said it most eloquently: This core assumption of the craft of medicine is scientifically untenable.

As a direct result of some solid research around this fact, the healing professions are in the midst of a major sea-change, a once-in-a-century shift: We’re moving from “medicine practiced as individual heroism” to “medicine as a team sport.” The kinds of tools you’re talking about make perfect sense in a team setting, but almost no sense within the craft of medicine.

Don is right in calling it culture change. However, we are well past the tipping point. There is strong evidence that the professions have committed to a new course and are actively moving. It’s the difference between 5% of the profession “getting it” (where we are now), and moving to a point where it is standard, accepted, background business essentially all of the time.

The key change concept was perhaps best expressed by Winston Churchill: “People like to change; they just don’t like to be changed.”

I am also deeply impressed by Roger’s classic text on change: Diffusion of Innovation. He describes bottom-up change, by sharing results (both data and word of mouth) from initial thought leaders (his “early adopters”). That has worked very well for us, and makes the change fun – rather than something that a bunch of external “know nothings” are trying to do to you.

There is an e-patient tie-in, though.

Brent first appeared on Levy’s blog last March. Shortly after, on another post, our Gilles Frydman commented, ending with this:

“It is possible, even probable, that in the end, the only solution to overcome the problems mentioned by Brent James will require a deeper paradigm shift than what can be achieved by the LEAN management philosophy, applying to healthcare entities some of the ideas developped in Eric Von Hippel’s Democratizing Innovation. The sooner you’ll involve the end-users of your system (the engaged and informed patients we call e-patients) to help in the innovation process necessary to solve some of the failures of modern hospitals the faster you’ll be able to produce profound results, IMHO.”


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