Suzanne Delbanco acknowledges that hospitals face economic and operational challenges in meeting the Leapfrog Group's stringent patient-safety standards that aim to reduce the number of medical errors occurring in healthcare settings. But she continues to reach for the stars in raising the bar for provider quality as the Washington-based coalition's effort to save lives gains increased recognition and momentum.
"Probably the most life-changing event I ever experienced was when my cousin died from a preventable medical mistake when we were both 14," Delbanco says, reflecting on how that event affected her. A commitment to change the system has since led her to come full circle as a rising young leader in healthcare.
As the first executive director of Leapfrog, Delbanco, 35, is steering the group's powerful Fortune 500 members and other large private and public healthcare buyers, including a growing number of providers, to mobilize their employer purchasing power to initiate breakthrough improvements in safety in healthcare for consumers.
Since its launch in November 2000, Leapfrog has grown from 60 to 140-plus members, all agreeing to educate their employees, retirees and dependents on how quality can vary in healthcare. Each member further agrees to reward hospitals that meet significant safety standards, starting with Leapfrog's three proven hospital safety measures: computer physician-order entry; evidence-based hospital referrals; and intensive-care-unit staffing by physicians trained in critical-care medicine.
"If we treat all providers the same whether their care is free of mistakes or fraught with mistakes, it's going to be very hard to drive breakthrough improvements in quality," Delbanco says. "If we start to reward it, we're more likely to see quality increase rapidly."
Leapfrog fields a voluntary nationwide hospital survey to gauge facilities' progress toward implementing the group's guidelines. The ongoing survey was completed by 557 hospitals of the 949 invited to participate to date. Leapfrog recently updated its standards for evidence-based hospital referrals and will look beyond the volume of procedures to collect more sophisticated data about how patients really fare, including outcomes information for some procedures.
Hospitals have until 2005 to implement computerized physician order-entry systems under Leapfrog's refined recommendations (April 14, p. 18) in part because of "how slowly the vendors' products are evolving," Delbanco says. While only 5% of hospitals responding to the survey said they had fully implemented order entry, another 22% said they would have the systems in place by 2004. "Even if they're optimistic in terms of timing, we're about to see a massive adoption of a practice that, to date, has been extremely rare," she says.
Leapfrog's consortium of companies-frustrated with hospitals' slow adoption of patient-safety practices after the Institute of Medicine's landmark 1999 report on the startling number of often fatal, preventable medical errors-spend more than $56 billion on healthcare annually to provide health benefits to some 33 million employees, retirees and dependents. Delbanco says hospitals are increasingly expressing appreciation for the purchaser-driven movement spurred by organizations that finally are paying attention to the quality of care in their facilities.
"Frankly, I think it's frustrating for providers who go into their jobs to make people's lives better to not be judged on that," she says. "Certainly for progressive hospitals there's a sense of relief that they'll be judged on more appropriate measures and not just cost."
Of course, there are hospitals that don't understand why business should be interested in quality at all. Delbanco is forthright in her response about Leapfrog's core mission, which closely resembles her own.
"In the changing environment we're all in, there's a growing recognition and acceptance on the part of hospitals that they will be held accountable in a way they haven't before in terms of their performance on a variety of measures," she says.
Delbanco says her real passion in leading Leapfrog is helping consumers make more informed choices so they receive better healthcare.
"I'm looking to help the consumer become part of the solution by creating an environment where it's possible for healthcare providers to go the extra mile and protect patients and operate in an environment that rewards them for doing that," she says.
A family matter
Delbanco's caring nature is frequently cited by her colleagues in their reflections on her decade of work in public health.
"Suzanne has a real seriousness of purpose," says Arnie Milstein, medical director at the Pacific Business Group on Health, the largest employer healthcare coalition in the U.S.
The daughter of a general internist physician, Delbanco says she grew up watching her father, Tom Delbanco, show his concern for the patient's experience in getting needed healthcare services. Formerly chief of the division of general medicine and primary care at Beth Israel Deaconess Medical Center, Boston, where he has worked for 32 years, he holds the first endowed professorship in primary care at Harvard Medical School. He's also a founder of the Picker Institute, renowned for developing survey standards that measure healthcare performance through the patient's eyes.
"I always found his work fascinating, and it occurred to me that as a daughter of a doctor, I had such easy access to information and to great healthcare," she says. "But I always wondered what people would do if they didn't have a doctor in the family. How would they navigate this incredibly intimidating and complicated system we have?"
Building on that early ingrained interest, which developed alongside a desire to explore how underserved populations access healthcare, Delbanco traveled overseas after college and volunteered in a refugee camp in Thailand for four months with the Save the Children program.
"It taught me how resilient people can be," she says. "It was a great experience."
An internship requirement at the University of California-Berkeley, where she completed degrees in public health and public policy, landed her at the Kaiser Family Foundation in Menlo Park, Calif. Delbanco remained at Kaiser for five years in various research positions.
"She came to us as a smart, hard-charging young person and quickly took on dramatically more responsibility than we ever intended because she was so talented and we had some gaps to be filled," says Drew Altman, president and chief executive officer of the Kaiser Family Foundation. "She stepped up on a lot of major studies."
Delbanco devoted much of her energy at Kaiser to navigating reproductive health policy, taking on controversial issues and getting the facts straight to prepare policymakers to make informed decisions. Altman recalls one occasion when he and some colleagues asked Delbanco to make a presentation at a Kaiser board meeting on the results of a foundation-conducted study on the quality of abortion. Her presentation resulted in the board chairman at the time, William Richardson-then president of Johns Hopkins University and now CEO of the W.K. Kellogg Foundation-running down the hall after Delbanco to tell her how terrific he thought it was. She moved on to work with Kaiser's initiative examining managed care and the underserved.
"Kaiser was rebuilt in 1991, and we think of Suzanne as an important part of that history," Altman says.
Delbanco also has consulted on health insurance coverage in the temporary employment industry, the first survey of beneficiaries of California's Medicaid program, Medi-Cal, and worked as a community liaison for Kaiser Permanente during the establishment of Medi-Cal's managed-care programs.
The employer solution
It was during her years at Kaiser that Delbanco says she realized that access to care was only one pressing issue facing consumers. With limited resources to bring to the healthcare system, pursuing higher-quality care "would spread the resources more broadly" to enable more people to receive care. "I realized that it's really the employer in this employer-based healthcare system we have, with the opportunity to drive change," she says.
That realization brought her to a senior manager position at the PBGH, one of the nation's best-known healthcare purchasing coalitions that includes 50 companies that provide healthcare for 3 million people in California. As a manager on the quality team at the PBGH, Delbanco helped build some of California's first comparative performance scorecards for medical groups, hospitals and health plans, while pushing plans to begin varying their reimbursement to providers based on quality.
"We were a pretty good training ground for Leapfrog," says the PBGH's Milstein, a founding member of Leapfrog who remains on its board. He said he immediately suggested Delbanco for the Leapfrog leadership position. "Based on everything she'd done so far, she deserved a chance," he says.
Altman, recalling an early morning in Leapfrog's infancy when Charles Buck, a founding member of Leapfrog who was in charge of healthcare for General Electric Co., called him in Washington to ask Altman's thoughts on Delbanco for the executive director position.
"It was a bold step to choose a young person ... but she's been extremely successful and is unusual in her ability to bridge the private sector, the policy world and also the research world," Altman says.
"She's turned Leapfrog into a real force to be reckoned with in American healthcare," says Mark Smith, CEO of the California HealthCare Foundation, Oakland, and Delbanco's first supervisor at Kaiser.
For Delbanco, the next challenge to extend Leapfrog's reach will come at the physician level. The group is working with the Centers for Medicare and Medicaid Services and the federal Agency for Healthcare Research and Quality to devise a "leap" that measures the degree to which physician offices are set up with clinical decision-support technology, including electronic access to patients' laboratory results, computerized physician-order entry and practice guidelines.
"We're dealing with some tough issues here, but I think everyone will be better off facing the truth," she says. "We still have a long way to go in how to make information usable by consumers, but there's a portion of consumers out there who have an appetite for the kind of data we're bringing them now. The trick is going to be how to engage the rest of them and give information to a broader array of people in a way that's usable."
Birthplace: New York
Family: Husband, Sachu Constantine
Education: Bachelor of arts in social studies, 1989, Wesleyan University, Middletown, Conn.; master's of public health, 1994, University of California-Berkeley; doctorate in public policy, 1999, University of California-Berkeley.
Previous jobs: Senior manager, Pacific Business Group on Health, San Francisco; consultant, California HealthCare Foundation, Oakland; program officer and program consultant, Kaiser Family Foundation, Menlo Park, Calif.; consultant and community liaison, Kaiser Permanente, Oakland.