10.10.2008

A Passionate Doctor Cries Out for Change

For those promoting change, few if any attributes are more valuable than passion. In a lean transformation, for example, a change agent who is passionate about what lean can accomplish can inspire and motivate others.

Dr. Thomas F. Lansdale III, a Cleveland doctor with fierce passion for his profession, has caused a bit of a stir with an
article in the Cleveland Clinic Journal of Medicine. Lansdale, currently in private practice and also an assistant professor at Johns Hopkins, spent more than 20 years working at three hospitals, including serving as chairman of a department.

Lansdale, as far as I know, is not a lean guy. But in the article, he laments the ways he believes hospitals have changed over the years and makes a strong case for the kinds of changes being sought by those applying lean to healthcare.

Somewhere along the way, I became increasingly aware that teaching clinical medicine to students, interns, and residents was getting harder and harder. The patients were sicker and stayed only 3.2 days in the hospital. What we were teaching wasn’t how to diagnose and treat diseases, but how to manage only their most serious complications—the respiratory distress from pneumonia, the ketosis of uncontrolled diabetes, the septic shock from infections. The wards became intensive care units, and the critical care units the province of “intensivists” who were more adept than we were at taming all the machinery and technology…

Worse, though, was the ebbing of the lifeblood of the hospital. Now the medical center, riddled with “centers of excellence” instead of departments, answered only to administrators who cared nothing about medical education, except for the Medicare dollars they would lose if they cut the training programs. They spent enormous amounts of money marketing the centers of excellence, and they cut everything else to manipulate the bottom line.

We remain absurdly complacent about rising iatrogenic infection rates, knowing all too well that we are allowing immunocompromised patients to die unnecessarily in our intensive care units. There are alcohol-based hand-washing gels everywhere, but no police or policy with teeth in it to enforce handwashing. We lurch toward physician computer order entry, clinging to the false belief that software programs will prevent adverse drug reactions and delivery of the wrong dangerous drug to the wrong patient.

We understaff our pharmacies so that they can’t get the medications to the patients on time or alert us to our own prescribing errors. We burn out our nurses despite years of loyal service. And worst of all, we capitulate to the for-profit insurance industry that informs us they won’t pay for day 4 of Mr. Jones’ hospitalization because he has failed to meet some arbitrary criteria in their manual.

That’s the kind of passion we need in the lean movement. Does anyone have an opening for Dr. Lansdale?