Summary: The American Hospital Association is gathering its members at a Leadership Summit this July, the theme of which is “Hospitals Leading Health Care’s Transformation.” The claim in the title struck me as quite unlikely. Two images came to mind: one of mass seppuku, the other of the artist Christo with his sights on a sprawling metropolitan hospital building much as he once focused his conceptual art on the German Reichstag. Here are some musings on the probabilities of hospitals leading health care transformation, and some intimations about where we might begin to find a leading coalition.
Two images came to mind on reading that the theme of the 2010
Leadership Summit of the American Hospital Association (AHA) is “Hospitals
Leading Health Care’s Transformation.”
The first image was of mass suicide.
Convening hospital leaders around ideas of transformation
More specifically, I imagined a ritual of mass seppuku – harakiri
– among the conferees. The Samurai practice of disembowelment follows some cause
of shame. We know via the Institute of
Medicine of hundreds of thousands of errors and unnecessary deaths each year from
hospital care. From researchers like Dartmouth’s Jack Wennberg, MD we know that
scores of procedures and surgeries are grossly over-performed. Leaders like Obama’s
nominee to head Medicare Don Berwick, MD teach that health outcomes are often worse
when we have more rather than less high tech treatment.
pictured the figurative belly
of the inpatient system cut open
and resources flowing out
Adding salt to such wounds are the analyses of comparative
outcomes between various Western nations that find that all the rest have a
higher investment in out-patient care and also have better health outcomes.
The proud Samurai simply drags a knife blade from one
side of his gut to the other. Hospitals leading health care’s transformation? I
pictured the figurative belly of the inpatient system cut open by the collective
hands of these leaders, and resources flowing out into communities.
This image was entirely uninformed by the contents of the
AHA brochure. I was merely reacting to the title’s disconnection from certain evidence.
First, there are the known, shameful features of US
medicine noted above. Then there is the general rule that the form of capitalism
in our medical-industrial complex focuses public and private investment on the
high cost and lucrative (to those selling services, not to those paying for
them) inpatient environment run by these leaders. AHA’s target audience makes their margins and
multipliers off disease. They sit at the
power-center of our singularly expensive and ineffective complex.
Might that be cause for shame?
Keynoter Gore: Will he offer inconvenient truths?
The second general life rule that shaped my bias is that
when a person or a class of people has a dollar in a fist, it is typically a
challenge to pry it loose. If by “dollar” one is referring to the inpatient
revenue and procedure fees that consume much of the $2.5-trillion spent each
year in the US on medicine as we know it, well, prying such wealth loose would
likely take a blade of some sort.
The third bit of life evidence is the reasonable
assumption that if our focus is dominated by inpatient care and treating disease,
we will not likely spend much energy discovering ways to engage the determinant
s of health to lead us in “health care’s transformation.”
The image of mass seppuku arrived on
reading the AHA
theme alone, without examining the words in the brochure. Perhaps an
of the content would teach me differently.
On reading, I learned that these hospital leaders will be
spending some of their revenues at the Manchester Grand Hyatt, San
they meet. Once present, they will be surrounded
by a political-intellectual royalty: Al Gore, Newt Gingrich, former
press secretary Dee Dee Myers, Freakonomics
co-author Steven Levitt, author and historian Ken Burns, plus leading
from the hospital universe.
Instead of plastic, Christo
the hospital in a
wet paper bag.
Made of Benjamins.
I am sure the talks will be stimulating, especially if
Mr. Gore engages attendees with the inconvenient truth that, when it comes to
health creation, medicine is a fly on the elephant back of determinants like
race, poverty, education, food, stress, opportunity and one’s sense of self-worth.
In the case of over-performed procedures and surgeries, medicine itself is a
Christo’s Reichstag: Would he wrap a hospital in Benjamins?
Perhaps the man from whom the presidency was robbed will
underscore that the transformation in health care and medical investment we
need is to move our human and financial energy out of the high-tech hospitals
and into the high-touch of community-based, out-patient integrative environments
that focus on primary prevention, wellness, health-promotion and social
I searched the conference flier for awareness of the need
to correct this imbalance. Wellness, as a concept, is absent, as are prevention
and health promotion. Primary care exists only as part of integration
strategies with hospital systems. Community health is not to be found.
Integrative medicine and integrative practices merit the same visibility in
this transformational scheme as do public health and the concept of
determinants of health: nada.
The second image began to form. I thought of the artist Christo,
famous for wrapping the Reichstag, the German parliament building, in plastic.
Only in the image that came to me, instead of parliament,
Christo is utilizing one of the castles called hospitals that peak the hills of
municipalities all across the country. And instead of plastic, Christo wraps
the hospital in a wet paper bag. Made of Benjamins.
There are certainly thoughtful leaders of hospitals. But we’ll need a coalition of another sort to
lead health care’s transformation.