Let patients grade us and post the scores online, the good, bad and ugly? Are you crazy? This wasn’t the verbatim response of doctors to University of Utah Health Care’s push to publish patient satisfaction data on its Find-A-Doctor website. But it’s pretty close.
“A basic principle of health care is that everyone strongly favors transparency – for everyone but themselves,” wrote Thomas H. Lee in the Harvard Business Review, extolling the virtues of the U.’s pioneering move. Doctors worry colleagues might game the system by cherry-picking patients, that data aren’t risk-adjusted or that they’ll lose patients if they look less than perfect, wrote Lee, M.D., Chief Medical Officer at Press Ganey Associates, the nation’s leading provider of patient surveys. But he said, the U., the first academic medical center in the U.S. to publish its Press Ganey scores, complete with patient comments and an accessible five-star ranking system, was “richly rewarded for its creativity and courage.”
In 2008 the university ranked in the 18th percentile in outpatient satisfaction nationally. Last quarter we ranked in the 85th percentile. Nearly half of our 1,300 plus providers had 30 or more surveys returned. Of those, one of every two ranked in the top 10 percent nationally when compared with their Press Ganey peers. One of four placed in the top 1 percent.
The University of Utah started by privately sharing patient reviews with individual physicians, opening the door to ticklish conversations about how to improve. Then the data were shared internally, allowing doctors to compare themselves to their colleagues. High performers were recognized and lower performers were offered support and personal coaching. In December 2012, the reviews went live at: http://healthcare.utah.edu. “Virtually all, about 99 percent, of comments are unedited, and are only removed in the event that a comment might compromise patient privacy or could be considered legally libelous,” says Brian Gresh, senior director of interactive marketing and web. Initially, Gresh says, the goal was to give consumers a trustworthy alternative to popular consumer portals like Healthgrades.com where it’s impossible to verify if those submitting scathing or glowing comments are actual patients. Instead of allowing a few squeaky wheels to drive the discussion, the U. electronically surveys all patients.
It worked. “Analytics show our web traffic nearly doubled. When you search for a University of Utah doctor, it’s our portal you now see. We own the first position on Google,” says Gresh. Patients are more engaged. About 50,000 patient surveys were returned that first year in 2012. Today the number exceeds 75,000, about 15 percent of our outpatient visits. And though patient volumes have increased––likely due to a mix of factors, including expanded services, an improving economy and Utah’s growing population––we’re keeping costs in check. From 2010 to 2014 health costs nationally grew in pace with inflation, at an annual average rate of 3.5 percent. Our costs grew at just 1.4 percent on average.
Other systems, including, Piedmont Health in Georgia and Wake Health in North Carolina, have since followed the U.’s lead. “University of Utah leaders realized that putting their patient information on the Web wasn’t mere marketing – it was creating a powerful motivation for physicians to give every patient the best, most empathic care. Financial incentives to improve patient experience could never have produced this kind of change,” wrote Lee. “What mattered was physicians’ awareness that every patient visit is a high stakes encounter – the biggest event of the patient’s day or even month. As one orthopedist put it, ‘It forces me to be on top of my game for every single patient.’”
Academia is hierarchical, a space where faculty are judged by the size of their NIH grants and research portfolios. But entrepreneurs can have just as great an impact on patient care and the bottom line – and who better to tinker and dream than students?
Nate Rhodes, a master’s student in bioengineering at the University of Utah, wondered if catheters, which are the leading cause of hospital-acquired infections, could instead be a solution to preventing infection. The thin tubes, used to deliver or drain fluids, are pervasive in medicine. Catheter manufacturers currently use chemical coatings to keep bacteria in check, and providers take care to insert them under sterile conditions and keep them clean. But the coatings aren’t durable; they wear off over time, says Rhodes. “We wanted something that was better at killing bacteria and that didn’t require such close monitoring, something that could be used anywhere in world.”
That is exactly the kind of thinking encouraged by Bench-to-Beside (B2B), an annual competition and incubator program at the U. that coaxes the inventions of medical, engineering and business students into marketable medical devices. “If you can develop a device that’s affordable to most of the world, but built to U.S. standards, you’re benefitting not just developing countries but helping to improve and lower the cost of health care in this country,” says John Langell, M.D., Ph.D., M.B.A., director of the U.’s Center for Medical Innovation.
Catheter-related infections not only compromise patient care, they are also costly. More than $400 million is spent treating the most prevalent, urinary tract variety each year. And now that Medicare is no longer reimbursing health care institutions for care related to preventable complications, such as infections, hospitals must pay the tab.
Rhodes and a team of engineering and medical students started by searching the academic literature for existing technologies but they didn’t find anything that could be adapted to a catheter. Then they stumbled across a study by a group in Glasgow who used visible light—one wavelength of it—to kill bacteria in burn wards. “They used it in the ambient lighting in the ceiling, and we thought, ‘Why hasn’t anyone tried this before with catheters?’” Rhodes said. “We decided, ‘Let’s be the first.’”
B2B is unique in that it’s an incubator for new ideas rather than just a competition. With philanthropic support it provides seed funding for student teams. Its professional and faculty mentors represent diverse fields, from business and law to medicine and biotechnology. “No one else in country offers anything like it,” Rhodes said. His team was coached by experts on 3D modeling and given legal advice on how to file patents. Business faculty gave them crash courses in how to value a company that doesn’t have a sales record, and the optimal time for hiring a CEO.
Their invention: The bacteria-killing LIGHT LINE Catheter is being tested in the lab. Early results show the device, equipped with a high-intensity narrow spectrum light, is harmless to human cells, but kills 99.99 percent of bacteria. The startup company they created, Veritas Medical LLC has secured more than $100,000 in cash prizes and grants from national competitions. They’re in negotiations with a major device maker to commercialize the property and hope to get it FDA approved and to market by 2016. And every penny Veritas earns goes to its founders who were all undergraduate students when they started the project. “This is how we nurture tomorrow’s inventors and speed discovery of life-sustaining technologies while lowering health costs. It’s how we improve health care through innovation,” Langell said.
With nearly 50 teams now competing, up from 14 in 2011, B2B is the most popular program at the 3-year-old Center for Medical Innovation (CMI). Roughly 600 students have gone through the program, producing 87 technologies and 21 spin-off companies. But B2B is just one of CMI’s programs designed to nurture entrepreneurs—students, residents and faculty. BioInnovate is a master of bionengineering degree track attracting dozens of tech venture-minded graduate and post-doctoral students each year. This spring also marked the inaugural Games4Health Challenge, a design competition focused on therapeutic video games. Also under construction is a “gap lab,” or simulation center, where gamers can test their designs on patients. The market for health games and apps is huge; Price Waterhouse Coopers pegs its value at $4 billion. Peruse the app store and you’ll already find a glut of apps that promise to help you lose weight, avoid exerting yourself on “bad air” days, or manage your blood sugar. “Consumers have lots of choice, but they have no real way of determining which game is best, or clinically works. The Food and Drug Administration isn’t regulating them,” says Langell. “We’re studying these games, doing research, which the university is really good at, and giving them efficiency ratings.”
By the Numbers
The Center for Medical Innovation, which has grown five-fold since created three years ago, has a two-year return on investment of 285 percent, based on acquired research grants and philanthropic underwriting. Here’s a recap of accomplishments:
19 faculty patents filed
57 student patents filed
10 University patents licensed
3 clinical trials
25 tech ventures from CMI-facilitated technologies
Suleika Jaouad's future was exceptionally bright. She had just graduated from Princeton, moved to Paris and was on her way to northern Africa to launch her dream of becoming a foreign correspondent. Then came three unexpected and terrifying words: “You have cancer.” After five different opinions during her 22-month medical odyssey, the results of a bone marrow biopsy confirmed the dream-crushing diagnosis for the 22-year-old: Acute Myeloid Leukemia and a rare blood disorder called Myelodysplastic Syndrome.
“No one is ever prepared for those three words,” said Jaouad. “But cancer doesn’t care who you are or how old you are. It doesn’t discriminate,” Jaouad told the audience of medical professionals at the 2014 AAMC annual meeting in Chicago. Instead of reporting on foreign revolutions, Jaouad ended up “reporting from the front lines of a different kind of revolution: one that was taking place inside of me.”
“I thought that I would be behind scenes and tell others stories,” said Jaouad “It never occurred that story would be my own.” But as she begin looking around the waiting room in the oncologist’s office and browsing the cancer section at Barnes & Noble, she felt like nothing addressed her as a cancer patient. Nothing spoke to her. There seemed to be no one like her. She was inspired by broadcast journalist Amy Goodman’s definition of a journalist: “The role of reporters is to go to where the silence is and say something.” Jaouad decided that she could shine a spotlight on a group of people too often voiceless—the 70,000 young adults diagnosed with cancer every year.
At 23, she launched her Emmy Award-winning column, “Life, Interrupted” as part of the New York Times Well blog, reporting from the front lines of the bone marrow transplant unit at Memorial Sloan-Kettering Cancer Center. “Cancer is not something that makes you want to share,” said Jaouad. “It did not come naturally.” Inadvertently, she became a patient advocate, which was a cathartic experience for her personally, and also created a community—online and offline—to combat the intense loneliness she felt.
Jaouad finished her last cycle of chemotherapy in April and says she’s “deeply grateful to say that I’m finally cancer free.” Two weeks ago, she had her port removed and appreciated her doctor’s joke: “Congratulations, you’re being deported today.” She realizes now that she has been deported from land of disease to survivorship, which she admits has not been an easy transition. She references Susan Sontag’s metaphor for illness: “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” She adds that there is a no man’s land between those kingdoms where patients like her—who don't have active disease but feel far from well—live. “There is no map to guide you back to the land of the well,” she says. But she has a new mantra: “Health is about adding life to years, and not years to life.”
Panel moderated by Marsha D. Rappley, M.D., Dean, Michigan State University College of Human Medicine.
How can the field of medicine eliminate waste when students aren’t being trained on the best practices to do so? Vineet Arora, M.D., (@FutureDocs) tells us about the Teaching Value Choosing Wisely Challenge: a contest that involves everyone from medical students to department chairs in improving patient care at lower costs.