Quality and Integration: A Q&A with Gail Warden

By Cynthia Hedges Greising

Across-the-board quality improvement will occur only when hospitals use sophisticated information technology and share best practices with other organizations.

Cynthia Hedges Greising

Gail L. Warden, president emeritus of Henry Ford Health System in Detroit, is the recipient of the 2006 TRUST Award, presented by the Health Research and Educational Trust (HRET). Warden was one of the first CEOs to understand the value of a seamless continuum of care. He has long championed evidence-based management, well before it was part of the vocabulary of health care leaders.

Warden was CEO of Henry Ford Health System from 1988 to 2003, serving as chair of the AHA board of trustees in 1995 and of the HRET board from 1998 to 2000. In a recent interview, Warden talked about the changes in health care since his AHA chairmanship and the developments he foresees in the coming years.

How has health care changed in the 10 years since you served as AHA board chair?

There are a lot of issues that haven’t changed, such as the uninsured and the lack of access to health care. The financing system still needs to be reformed to create incentives for performance improvement through quality and safety, economic discipline and patient-focused care. We have huge shortages of nurses, technologists, technicians and therapists. It is increasingly difficult to attract people into health professions. In fact, there’s a belief that we don’t have enough physicians for the future. A number of things have not changed despite some of the valiant efforts by AHA and many other organizations to try to do something about such issues.

What has prevented these issues from being remedied?

Access and uninsured issues are moving targets. As soon as you think one thing is fixed--such as SCHIP [State Children’s Health Insurance Program] and Medicaid, which gave more opportunity for children and families to be covered--other forces emerge that reverse the trend. Here in Detroit, the major corporations are backing away from employee health benefits because they can’t afford them. As they do that, they increase the number of people who are either uninsured or underinsured. Consequently, the issue just keeps growing, with no national plan for addressing the gaps that exist.

Also, when one looks at the availability of health professionals, the shortage is critical. Nursing is a good example. We don’t have enough nursing faculty. Therefore, they are not able to turn out the volume of students, despite the fact that there is an increase in the number of individuals who want to go into nursing.

We still have huge work environment issues that impact the satisfaction of nurses. As the technology gets more and more complicated, the care processes are more complex. It’s a challenge for nurses and other health professionals to keep up with all the changes and learn these new processes.

Public expectations have increased considerably from 10 years ago. For instance, the public is starting to understand the importance of quality and safety. The Internet has created a more sophisticated consumer. There’s no sense of limits on the part of the public. Patients have an aversion for rationing and for standing in line or waiting for appointments. They expect a lot more than they did just a few years ago but are not ready or able to pay for all that is expected.

The aging of the population is starting to affect demands on the health system. We have wide gaps in the implementation of evidence-based prevention. We’re doing second and third hip replacements on 85-year-old people. Yet we haven’t really figured out what to do about a lot of the chronic illness issues, despite valiant efforts in disease management.

What progress has been made?

On the quality side, on the one hand, the progress has been substantial. I think we can attribute a lot of that to the [Institute of Medicine’s] Committee on Quality of Health Care in America, which helped redefine quality. Quality has become a function of the interplay between consumers, caregivers and systems that organize care; the purchasers and payers who select care; and the agencies that provide oversight. We just don’t have sufficient coordination across all the sectors. Recently, we had an encouraging event as the National Committee for Quality Health Care came together with the National Quality Forum.

What is still needed to improve quality?

We need mandated performance measures that meet the needs of all the different stakeholders. We still need a social marketing campaign to educate the public to understand their role in the care processes and to establish realistic expectations. We’re publishing all kinds of good information about quality and how institutions compare and how physicians compare. At the same time, the average person consults his friend or family about what hospital he should go to or what doctor she should see, instead of looking at the data. Until we can implement pay for performance or some other incentives so that we reward organizations for quality, that’s going to continue.

You were instrumental in the 1980s and early 1990s in trying to develop integrated delivery systems. Will that be a continued driver for health care in the 21st century?

The health plan working with the health system drives quality and safety. Kaiser, Henry Ford, HealthPartners in Minneapolis and others--where there is real integration and a real continuum of care--are really making a difference. These are the institutions that are the benchmarks in evidence-based care, disease management, managing the chronically ill, improving the continuity between ambulatory care and inpatient care, and promoting and instilling prevention into everything they do.

One of the real measures of how these organizations accomplish that is the sophistication of their IT system and computerized medical records. That’s what makes the difference. Everyone--in the government and the field--seems to understand the need for a common platform for information technology so that organizations and providers can talk to each other and get on the same page. AHA gets some credit for that because of some of its early and continued work on IT with the National Alliance for Health Information Technology.

What is the outlook for health care in the coming years?

It doesn’t matter what a few good organizations do if we’re not impacting the entire system. To accomplish that we must improve the competencies of the managers of the health systems, whether it’s the physician managers, hospital administrators, nurse executives or whoever. We need to get the right competencies identified, get the individuals to share management practices and become more evidence-based in their approach to management. This means basically they have to be willing to take the time to ask themselves the tough questions in their own organization and to share that with their colleagues from other organizations.

We learned a lot about 15 years ago, when HRET did the Community Care Networks. People came together and talked about what they were doing in their own settings and what was working and what wasn’t working. We should be encouraging such collaboration.

Cynthia Hedges Greising is a staff writer at the Health Research & Educational Trust in Chicago.

The 2006 TRUST Award will be presented by HRET on July 13, 2006, at a reception during the Health Forum/AHA Leadership Summit in San Francisco. Created by HRET in 2003, the TRUST Award is given annually to a health care leader who exhibits visionary leadership.

GIVE US YOUR COMMENTS!

Hospitals & Health Networks welcomes your comment on this article. E-mail your comments to hhn@healthforum.com, fax them to H&HN Editor at (312) 422-4500, or mail them to Editor, Hospitals & Health Networks, Health Forum, One North Franklin, Chicago, IL 60606.

If you would like a FREE Subscription to H&HN OnLine, please click here to register.

This article 1st appeared on June 6, 2006 in HHN Magazine online site.

To respond to this article, please click here.