The Coat Check

The Cost of Quality – And The Boundaries of Possibility

Sobering testimony before the U.S. Senate by professors from Harvard and Johns Hopkins has detailed a sobering fact: despite billions in strategic investments and planning, preventable medical errors remain the third leading cause of death nationally with more than 1,000 lives lost every day. This means that 400,000 patients die each year with total costs exceeding $1 trillion. That staggering cost estimate includes more than 10,000 serious complications each day as a result of medical error that do not result in death. This cultural sector-wide challenge is well-known, and many tools such the IHI Quality Improvement Practicum exist to help drive that debate forward using methodologies like Six Sigma/Lean. At the same time, not enough attention is being played to the role that emerging health care leaders can play in driving positive change. 

Take for example the well-known case of TV celebrity Dr. Oz whose sugar pill shenanigans are well known on prime-time television even as he tones down the rhetoric in front of Congress. While the medical establishment has thus far not taken any direct action against Dr. Oz, a medical student continues to wage a highly visible campaign to hold public appearances by licensed medical professionals to the same level of scrutiny as legal testimony. This overarching accountability gap at the institutional level is so severe that some leaders in the health care space have even called for an end to public hospital donations where quality ratings are subpar, and a ruthless yet necessary consolidation of standalone hospitals into larger health systems. While White Coat Checklist is not prepared to advocate for such extreme policy decisions, we do believe these issues highlight one core essential principle:

Accountability must pervasive and ongoing, at the individual level as well as collectively. Take the example of Indiana University Health Saxony Hospital, which enjoys one of the lowest 30-day readmission rates and average length of stay in the nation. IUHSH helps make the point that it’s not star power or a good PR team that make organizations like Kaiser Permanente or Cleveland Clinic such leaders in health care quality; rather, their ability to identify and drive patient-centered discourse toward best practices which are then meticulously executed and maintained is the essential ingredient. If this little-known hospital in Indiana, with a fraction of the resources of these larger renowned systems, can achieve such outcomes, then the yardstick for accountability must become more strict. Another even more extreme example is available: Cumberland Medical Center in Tennessee achieved Meaningful Use Stage 2 Attestation (an exhaustingly complex certification of Electronic Medical Records achieved by fewer than 500 health care systems nationally by June 2014) in JUST TWO WEEKS. 

Why is this relevant for medical school applicants? Many candidates do not realize the degree of leadership vacuum that currently exists, as well as the costs of that current lack and the potential gains of creating an alternative health care paradigm. Having one eye toward the big picture is essential for that conversation, just as being able to discuss the minute details of patient engagement from a close-up perspective will also serve you well. Remember, though, that medical schools are seeking leaders – you may well be told, “No thanks, we aren’t looking for nurses,” if your application’s personal statement and secondaries do not reflect a mindful realization of the current landscape and a commitment to lead the next phase of transformation. If your life plan does not involve directing team members where your ideas drive the day to day clinical interaction in collaboration with multidisciplinary stakeholders, then you should strongly consider walking away. For those more determined than ever to make a difference, a detailed checklist to guard against common application mistakes is also available. Keep up the hard work, everyone!

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