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David Judge

Patients Driving Innovation in Primary Care

In the spring of 2005, a group of innovators came together at Massachusetts General Hospital (MGH). We agreed that the primary care system was failing and wanted to design a care model that would better support both providers and patients. We heard the Institute of Medicine’s charge to make our care model “patient-centered” but weren’t sure about how best to hear and understand the patients viewpoint.

Around this time I met Dr. Paul Uhlig, a cardiac surgeon who had done his surgical training at MGH. He learned of our work and wanted to hear more. I knew that Paul was interested in redesigning care processes but what I didn’t know was that one lunch with him would forever change my understanding of the patient’s role in the delivery of healthcare.

Paul explained that he had been working at a hospital in New Hampshire a few years prior to our meeting when he and other members of his team began an experiment in the post – surgical ICU. He asked the SICU team that was rounding on post-operative patients to join him at the bedside and to engage the patients and their family members in the decision-making discussion that sets the care plan for each day. Typically, doctors would discuss a patient’s case without including the patient or family. Paul believed that deeper involvement of patients and families could build more trust and assist the hospital in tackling some concerns around quality and safety. While some of his fellow surgeons and staff members were very resistant to this idea, pulled them along with him and what he observed was remarkable.

Patients and their families readily asked probing questions and brought insight to rounds that positively influenced the plans. Patients now had a say in decisions which impacted the pace of their recovery such as when to remove lines and tubes, mobilize them out of bed and begin physical therapy. The simple act of inclusion seemed to bring an energy and accelerated pace to their recovery. Paul also observed a positive shift in the medical team’s spirit and morale. Beyond that, he tracked data that indicated steady improvements in quality and safety including patients leaving the ICU quicker than before and with reduced rates of line infections or readmissions for surgery-related complications. As Paul spoke, I knew that what he was sharing would be transformative for me. I was beginning to understand where our primary care system needed to go and what “patient-centeredness” really means.

Perhaps as remarkable as the sustained success of this experiment over a few years, was the twist on this story that he then shared. Despite the rewards that his patients and immediate team experienced and the measurable improvement in the care, Paul’s department and his entire organization remained quite uncomfortable with this approach. Eventually Paul was dismissed from his position and fired from the hospital staff.

Many of us who have tried to redesign health care have experienced similar barriers to innovation due to our physician-centric view of the world. My own journey at MGH was heavily influenced by Paul’s story and other similarly remarkable examples of patient involvement and patient-driven care around the world. Our own group of innovators eventually designed and opened a primary care practice based largely on the idea that patients are the most important member of their care team and when empowered by a supportive culture that embraces them, they will indeed increase their engagement and this can lead to much better outcomes — better than we have ever achieved in the traditional care model.

We have a path forward away from our broken and failing care system. This pathway will be defined most successfully by organizations that understand that when we welcome patients to manage their own health, much of what we have assumed about delivery of care must be questioned and redesigned entirely, especially our culture. Iora Health has created the culture that provides this opportunity for patients and I believe this is largely why Iora will lead the way in defining the future of primary care. It is also one of the most important reasons that I feel so fortunate to have joined Iora on this journey.

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