Can we tackle the health care system’s ills with learned optimism?

by Nurjana Bachman on February 10, 2011

You’ll almost never hear innovators say, ‘Can we do something?’ You will sometimes hear them say, ‘How can we do something?’

I heard this last week from Kim Smith, a founding team member of Teach For America and founder/CEO of Bellwether Education Partners, at MIT’s Innovation in Healthcare Symposium. It reminded me of the innovators at our hospital, whose problem-solving visions we try to push toward real products.

Solving problems in the health care system itself seemed a far more daunting task. I arrived at the symposium thinking about the entrenched interests keeping current systems in place — the way doctors are trained, the way companies in health care create competitive barriers to information sharing, the pharmaceutical industry’s business model, the fact that insurance companies are incentivized not to cover sick people. The list goes on.

But I left this gathering feeling uplifted and inspired. Thought-leaders from disparate areas had solutions to propose, not just new problems to describe. I later realized that it was the attitudes and approaches of the speakers, rather than their specific content, that inspired me most. Attitudes embodied in statements like this:

  • Innovation is learned optimism.
  • Innovators embrace failure as a learning experience. Rapid prototyping and not being too attached to an idea is essential to success.
  • Innovators are tenacious. They doggedly pursue a goal until it is achieved, and will not stop there.
  • Innovators connect dots, often applying a basic principle from one field to another.

As for the actual task of improving the health care system, Harvard Business School professor and author Michael Porter made the business case for why better health care saves money in the long run. He offered eloquent and intuitive solutions (also in his book, Redefining Health Care). They included organizing medical teams based on the patient’s needs not the doctor’s, and measuring value (outcome, defined as what the patient considers important, divided by price) as opposed to simply measuring price.

John Mendelsohn, president of MD Anderson Cancer Center, provided a tangible success story. In the early 1990s, MD Anderson completely reorganized the treatment of cancer patients, moving from isolated treatments by doctors organized by discipline (radiology, surgery, oncology), into well-integrated team treatment addressing the cancer type (breast cancer, head & neck, etc.). One impetus for this change was their analysis of the patient experience: they found that a cancer patient walked an average of 1.5 miles from appointment to appointment in a single day, not a structure that puts the patient’s needs first.

The reorganization required not just optimism, but an up-front investment — constructing new buildings and getting team members to think and communicate differently. But there were great benefits. It brought all practitioners in the same room at the same time speaking with one another directly, addressing the patient’s treatment needs together. And the laboratory researchers at MD Anderson began to attend the clinical teams’ meetings, giving them new insights and ideas that they could take back to the lab. Today, thanks largely to this integrated approach, translational clinical trials at MD Anderson are particularly strong, with 11,000 patients currently enrolled in a clinical trial.

Even the panel on drug development was optimistic. After the usual despairing remarks (“Only 1-2 drugs in 1,000 make it through clinical trials. That’s like Boeing making 1,000 planes and they all crash except for 1 or 2.”), the panelists offered potential solutions. These were based primarily in engineering models and systems-based thinking: Do more modeling of clinical trials in silico to avoid late-stage failures. Allow negative data from clinical trials to become public so that we can learn from them.

Clinicians and lab researchers cultivate learned optimism by necessity — without it, they couldn’t stay motivated. It was refreshing to hear the same optimism applied to health care as a system — a strong counterpoint to the vocal pessimism that’s pervasive in the public discourse.


  • chrissy

    Im with you!

  • chrissy

    Im with you!

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