Healthcare quality, cost expert shares critical advice

Thomas H. Lee, MD, joined Press Ganey as chief medical officer in 2013. He has more than three decades of experience in healthcare performance improvement as a practicing physician, a leader in provider organizations, researcher and health policy expert.

At Press Ganey, Lee develops clinical and operational strategies to help providers measure and improve the patient experience and the value of care.

LeeLee, a practicing physician at Brigham and Women's Hospital in Boston, frequently lectures on the patient experience and strategies for improving the value of healthcare, and has authored more than 260 academic articles and three books.

In this Q&A with Managed Healthcare Executive (MHE), Lee shares advice and insight regarding what should now be a top priority at every healthcare system and health plan across the country: Improving quality and reducing care costs.

MHE: You've worked with several organizations to help them measure and improve quality while reducing costs. Of those organizations that have been the most successful, have you noticed any common characteristics?

TL: Probably the single most important feature has been willingness to use transparency with quality data-internal transparency, which produces accountability among colleagues; and external transparency, which causes clinicians to raise their game for every single patient.

Of course, it takes more than the intellectual understanding of the impact of transparency before an organization can take that step. There has to be trust within the organization that the leaders really are committed to better quality, and will not be using transparency to humiliate colleagues.

For example, many organizations have an appeals process, through which physicians can make the case that patient comments or data should not be posted for others to see. The goal, after all, is not to embarrass anyone; it is to better care for patients.

MHE: How would you characterize the industry's current ability to measure quality and cost in a productive way? What are some of the biggest challenges?

TL: Our ability to measure quality and cost is better than we think. We tend to point out the problems, and I think that is actually a form of resistance to change (if the data are flawed, then we can ignore them). The fact is that the data will always be flawed, but we have to act based upon what we have, because the imperative to improve is so urgent.

The data situation is much better today than a decade ago. We can use e-surveys to get data quickly and inexpensively from patients, and we also have much more clarity about which variables provide the most important insights into how patients' needs are being met. For example, Press Ganey's analyses show that patients are much more concerned about coordination of care, communication, and empathy than they are about waiting time and practice amenities.

The next big steps are standardizing outcomes measurement, really emphasizing outcomes over processes, and starting the hard work of measuring real costs.

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