Team efforts touted at Watson event: Shine lecture, Haley’s career embrace collaborative clinical improvement
By Lin Lofley
In delivering the 2013 Patricia and William L. Watson Jr., M.D. Visiting Lecture, Dr. Kenneth I. Shine told members of the UT Southwestern Medical Center community that “21st century health care is a team sport.”
Dr. Shine, who served as UT System Executive Vice Chancellor for Health Affairs for a decade from 2003 until his retirement at the end of August, defined today’s health care team as “a collection of individuals from a variety of backgrounds, disciplines, and professions working together for the purpose of improving the health of the patient.
“A doctor does not always have to be the leader of the team. The patient often is a member of that team and, indeed, the team in the 21st century needs to be patient-centered.”
Citing a clinician who embraces the team concept, Dr. Shine, who now serves as Special Advisor to the UT System Chancellor, praised Dr. Barbara Haley, Professor of Internal Medicine, who received the 2013 Patricia and William L. Watson Jr., M.D. Award for Excellence in Clinical Medicine at the Sept. 11 event.
“In 1925 Dr. Francis Peabody said, ‘The secret in the care of the patient is caring for the patient,’ ” Dr. Shine said. “Dr. Haley has clearly demonstrated that, with the added notion that she actually knows about some things that go beyond care, namely how to improve health and how to deal with problems related to breast cancer.”
Dr. Haley said, “This award confirms the role of the clinical doctor in what is now a very large spectrum of health care in this nation. On a very personal level, I’ve spent almost my entire medical career here at UT Southwestern. I’ve always felt very privileged to be in an environment where I was surrounded by the brightest and best teachers, mentors, and colleagues.”
A renowned breast cancer specialist, she articulated her philosophy of care: “To navigate a patient through the course of their cancer, a disease that I know will profoundly affect their entire life, is truly a privilege. I hope to earn the respect and confidence of the patient, and I hope to offer them the very latest and best treatments.
“So as a clinical doctor, you never close the book on learning, and you continually strive to expand your knowledge so that you can give the patient the very best in personalized care.”
The Watson Award is UT Southwestern’s highest clinical honor and is bestowed upon an outstanding physician whose work exemplifies the medical center’s commitment to patient care.
Dr. Shine’s lecture addressed the continued need to elevate patient care and quality standards, centerpieces of the clinical movement that began with a pair of papers published by the Institute of Medicine while he was president of the organization from 1992 to 2002.
The first paper, To Err is Human: Building a Safer Health System, was funded entirely by the IOM itself after problems arose getting outside agencies to participate in the study.
“Only after we published the study did it become appropriate to really acknowledge that we had lots of problems with regard to patient safety,” Dr. Shine said. The study is accessible on the IOM website.
Dr. Shine talked of the importance of team members being aware of the entirety of a case – creating a possible stopgap against errors – and creating a procedure to deal with errors when they occur.
“At UT, when medical errors occur, we want to not only recognize them earlier, but we also want to deal with them in terms of patients and families,” he said. “The old way was blame/shame, where someone – most likely the junior doctor – was held responsible. We now must embrace problem solving. Errors occur because of system failures; it’s not only about individuals.”
The other seminal report during Dr. Shine’s leadership of the IOM, Crossing the Quality Chasm: A New Health System for the 21st Century, reviewed the quality and effectiveness of the nation’s health care system and assessed its overall safety and effectiveness.
The report, published in 2001 and also accessible on the IOM website, offered 10 rules for redesigning care in the 21st century, and six aims for improvement of health care delivery.
“We’ve got to change,” Dr. Shine said. “Our health care system is a nonsystem. It’s one of the most expensive in the world; close to 18 percent of the GDP (gross domestic product) is now tied to health care. And yet our nation’s life expectancy is 78.3 years, 36th in the world.”
Recent effective health care trends, he said, included health homes, which engaged 24/7 teams to deliver care to patients; bundling, which not only addresses acute care, but also follows patients for years in order to ensure quality of life; and systems engineering, which provides clear measures of quality.
Further improvements, Dr. Shine said, will be driven by the current and future generations of health care professionals.
“One of the things we need to teach in medical school is leadership,” he said. “That seems surprising, because you’re surrounded by people who are highly intelligent. But leadership is a learned skill. Leadership is about engaging individuals around a common goal. We need to do that.”
Dr. Haley holds the Charles Cameron Sprague, M.D. Chair in Clinical Oncology.