Wachter not afraid to challenge status quo

In the fall of 1996, the telephone began ringing nonstop in Dr. Robert Wachter's office at the University of California San Francisco. Though relatively new to the school's department of medicine, Wachter and his supervisor at the time, Dr. Lee Goldman, had just co-authored a widely read article in the New England Journal of Medicine.

Their editorial predicted a boom in hospitalists—a term they coined to describe a new medical specialty emerging as facilities across the country sought greater efficiency in the increasingly costly healthcare landscape. The hospitalist model challenged many existing principles of patient-care management, and the looming shift struck a chord among providers.

Wachter was surprised by the volume of calls he received from physicians and hospitals, all expressing varying levels of curiosity or concern. But the most memorable call came from his father, a retired business owner who had just finished a tennis match with a physician in Florida.

“I knew my dad was proud of me,” recalled Wachter, who beamed as his father announced about his tennis partner: “He'd heard of you!” into the receiver. But then, after a short pause, his dad added with a little less enthusiasm, “He hates you.”

Wachter tops Modern Healthcare's 50 Most Influential Physician Executives and Leaders ranking for 2015.

For nearly two decades, Wachter, 57, associate chairman of the department of medicine at UCSF, has tackled topics that challenge the status quo. “To me, that's part of the gig,” he said. “If you're going to take on topics that involve policy and money, some people are going to be unhappy with you.”

He has flagged major trends affecting hospital quality and value and pointed out serious, often unreported, safety concerns. He has authored hundreds of studies, examining such issues as medical mistakes, poor physician communication and discrepancies among hospital rating sites. His most recent book, The Digital Doctor, to be released April 7, delves into the hype of medical technology and highlights what Wachter calls “an El Niño of electronic despair and anxiety.”

Though the topics he addresses may be knotty, his dedication to improving patient safety has made him a well-known leader in the field and the face behind one of the fastest-growing specialties in healthcare. Colleagues say Wachter's accomplishments reflect a combination of perseverance, people skills, not taking himself too seriously and a genuine interest in getting all perspectives.

Goldman, now the dean of health sciences and medicine at the Columbia University Medical Center, said he couldn't have picked a better person for the job. When he hired Wachter to run the medical service department at UCSF's Moffitt Hospital in 1995, he assigned him to develop an innovative model to boost quality, patient satisfaction and value while simultaneously reducing hospital inefficiencies.

“He's a 'can-do' type,” Goldman said. Amid roadblocks—including resistance from hospital staff and physician fears about a loss of autonomy—Wachter always maintained a “we can do this” approach, Goldman said. “It takes a good cheerleader to do that,” he added.

Perhaps Wachter's experience as a school mascot prepared him for the challenge. During his senior year at the University of Pennsylvania in 1979, he was the Penn Quaker, firing up the crowds during a March Madness tournament that featured future National Basketball Association Hall of Famers' Magic Johnson and Larry Bird.

He continues to apply that entertaining approach to the field of healthcare. In March 2014, for example, Wachter donned an Elton John costume and sang in front of several thousand attendees at the annual conference of the Society of Hospital Medicine. He converted the lyrics of John's “Your Song” into a song about the rise of the hospitalist profession in the U.S.

“That's part of why he's effective,” said Dr. Lucian Leape, founding chariman of the National Patient Safety Foundation. Since Wachter was appointed as a member of the NPSF Lucian Leape Institute in 2012, Leape has had the opportunity to work one on one with him regularly, and appreciates Wachter's whimsical approach. “What we're really talking about are the best ways to influence people,” Leape said. “You can be serious about a subject, but not take yourself too seriously. I think he's very good at that.”

Among the many people who called Wachter and Goldman after their NEJM hospitalist editorial was published in 1996 was the co-founder of the Society of Hospital Medicine, Dr. John Nelson. At that time, he worked at the Columbia North Florida Regional Medical Center in Gainesville and was one of a very few hospitalists in the country. He was excited that an academician had finally recognized the trend. While conservative estimates from the American Hospital Association show there are as many as 28,000 full-time hospitalists on staff today, there were fewer than 3,000 in the mid-1990s.

“I was impressed with how accessible he was,” Nelson recalled of his 45-minute conversation with Wachter. He networked broadly and recognized the valuable contributions that community doctors were making to the field, said Nelson, who continues to practice hospital medicine at Overlake Hospital in Bellevue, Wash. Even more, “Bob was genuinely interested in what I was up to and found value in exchanging information back and forth,” he said.

Wachter said his path to professional prominence has been serendipitous, the result of factors including the increased focus on value in the U.S. healthcare system, the emerging role of hospitalists and the release of the Institute of Medicine's landmark 1999 report To Err Is Human, which called out high rates of serious medical errors.

In his new book, Wachter also points to inspirational medical leaders from the past who took on controversial issues, thought deeply about them and fought to change the system. Two examples he cites are Dr. Ernest Codman, criticized by colleagues in the early 1900s for wanting to increase transparency in patient outcomes, and Dr. Ignaz Semmelweis, a 19th-century obstetrician who was seen as a quack when he observed a link between hand hygiene and hospital-acquired infections.

How does Wachter pick his issues? “I wake up one day and say, 'Hey, this issue is really important,' ” he said. “And then I dive into it pretty deeply.”