I am one of those people who played competitive sports way past the time when more cautious (read: sensible) souls had retired to simply reading the sports pages. My main sport was hockey, in which I absorbed thousands of what I am sure were unintended hits from other players. I was also a runner, logging thousands of miles, and not long ago I took up rollerblading. As a result of all this activity, I became very fit, which is a good feeling. After decades of feeling good, however, my body began to react very differently, in the form of achy joints, which led to extremely painful joints. That, in turn, led to surgeries-two hip replacements and a recent knee replacement.
My encounters with the business end of the medical profession have been painful, but all in all, I have been lucky, with no unforeseen complications. As of late, a friend of mine also had a hip replacement, and therein lies the point of this column.
My hip surgeries and the one done on my friend couldn't have been more different in technique and outcome. My surgeries were done by an orthopedic surgeon who mastered a minimally invasive procedure that avoids cutting through muscle and excessive blood loss. A few hours after the surgery I was walking through the hospital's halls and even climbing stairs. I was on a fast recovery track--at home that night and doing rehabilitation the next day.
Compare that to what my friend went through. He had the traditional hip surgery at a fine hospital in the Chicago suburbs. He was told he would be in the hospital for at least four days, which was accurate. What surprised me was what didn't happen his first day after the surgery. I called his wife and asked her if they had gotten my friend up to walk. "Oh no," she replied, "he's too drugged up to do anything. He just wants to sleep."
On the third day of his stay I was able to reach him and ask if he was OK. He said he was and then said that was the day he was going to try to get up and walk around. Hopefully, my friend will recover shortly and be back in the swing of things such as his job, playing golf and all the things he loves, but I believe that his rehabilitation period is going to be longer than mine was.
The differences in approach came to mind when I read Donald Berwick's book, Escape Fire: Designs for the Future of Health Care, which I highly recommend to anyone interested in the future of healthcare. The book is a collection of the impassioned speeches Berwick gives each year at the National Forum on Quality Improvement in Health Care. That's the annual meeting of the Institute for Healthcare Improvement, the Boston-based group he founded. In his 1996 address, "Sauerkraut, Sobriety and the Spread of Change," he talked about the slow pace of change in healthcare. He used the saga of the great sailor James Cook who in the 1700s sailed all over the world, making discovery after discovery to drive home the importance of searching for new and better healthcare treatments.
Part of what made Cook so great was that he was a first-rate scientist who frequently made innovations that helped his work and paved the way for others to explore. "He tested new clocks for measuring longitude and new telescopes for navigation and astronomy," Berwick said. "His personal observations of the transit of Venus were the best in the world. His surveys of the St. Lawrence River were the most reliable for over a century. And he beat scurvy," Berwick said.
Hundreds of sailors died every year from the dreaded disease. "The problem of scurvy-obsessed Captain James Cook. He did not focus on citrus as a cure (a mistake that actually delayed Navy action), but on a combination of good hygiene and sauerkraut, which contains quite a bit of vitamin C," Berwick noted. "Cook made it his business to ensure deployment of sauerkraut in the diets of everyone on his voyages and even once flogged a sailor for refusing to eat his sauerkraut. More important, Cook ordered his officers to eat it also, writing in his journal words that all senior executives should have emblazoned in their minds: `To introduce any new article of food among seamen, let it be ever so much for their good, requires both the examples and authority of a Commander.' When it comes to healthcare innovation, many healthcare executives and clinical leaders seem to lack Cook's success in getting people to `eat the sauerkraut.' "
Berwick's speeches always center on the discovery of ways to more safely and effectively treat patients. There are new surgical techniques and drug therapies being tested all the time, and there are multiple adjustments being made to give patients a quality experience. But some resist change, as evidenced by what has occurred with the advent of information technology in many systems; no one really likes change but when something comes along that can benefit a patient's experience, I think it should be mandatory to at least explore the possibilities.
Berwick is right. We need more James Cooks in healthcare who have the courage to explore new worlds of care, while ensuring that the science is right, and help make patients well.
Change must be our ally,