Guest post: Looking inside health care—the reform that's already underway now

By Brad Dodge on September 1st, 2009

Mark Hagland is a nationally recognized health care journalist, public speaker, and author. More information about him and about his work can be found at In the following entry, he shares a few thoughts about the health care reform that is already happening in America.With all the heat surrounding the national health care reform debate this summer, it would be easy to lose sight of the reality that what is primarily being talked about in Washington right now is health insurance reform (though with some elements of reimbursement reform mixed in).And while people of good will might disagree on the best approach to address the enormous health insurance problems in our country, some level of consensus is beginning to emerge on what is sometimes referred to as “internal” health system reform—and that’s a good thing.By “internal” reform, I mean the kinds of operational and incentive-related activities that take place within and around patient care in hospitals, clinics, and integrated health systems. I mean the innovative work being pursued by pioneer organizations across the country with regard to improving patient safety, patient care quality, clinician workflow, operational efficiency, and cost-effectiveness in care delivery.

I’ve described many examples of such work in my writing for health care professional publications, as well as in the two books I’ve written, Paradox and Imperatives in Health Care (which I co-authored with noted health care economist and futurist Jeffrey C. Bauer, Ph.D.), and Transformative Quality: The Emerging Revolution in Health Care Performance. In addition to shorter descriptions of various types of pioneering work in “internal health care reform” mentioned in those two books, I also provided fully 23 case studies of such work between the two volumes, focusing on organizations like Brigham & Women’s Hospital in Boston, Virginia Mason Medical Center in Seattle, Northwestern Memorial Hospital in Chicago, and Geisinger Health System in central Pennsylvania, all organizations that are doing what needs to be done to improve the quality of patient care and make health care more transparent, accountable, and ultimately affordable, for everyone.My case studies in both books range from the very broad to the more specific. On the very broad side was my case study on the 44-hospital Trinity Health system, based in Novi, Michigan, whose clinician and IT leaders are engaged in a truly massive effort to improve care quality and efficiency, with intensive health care IT support.Among other things, the Trinity Health folks have been developing evidence-based order sets that they are standardizing across the entire health system, while also developing standardized clinical process workflows across the health system. Just these two elements alone are remarkable (there are many other aspects of the Trinity Health innovation work), and speak to the vast potential across the U.S. health care system for significant internal reform of the health care delivery nationwide.Meanwhile, at the University of Pittsburgh Medical Center, a 20-hospital health system in Pittsburgh, PA, intrepid physicians have been creating innovations that demonstrate perfectly the kinds of synergies that can result when clinicians, IT professionals, and IT vendors work together to improve the environment around medication ordering, medication management, and overall access to relevant patient information at the point of care. Working with the Pittsburgh, PA-based dbMotion software company, Dr. Bill Fera and his colleagues at UPMC have innovated a kind of semantic interoperability that, since early 2008, has made it possible for physicians at some UPMC hospitals to pull up all of a patient’s medications and other clinical information (also including lab and radiology results) on a single screen, vastly improving physicians’ ability to make the best ordering and diagnostic decisions at the point of care.Both of these case studies, along with nine others, are described more fully in Transformative Quality (available via my publisher’s website at What is strongly heartening for me is that organizations like Trinity Health and UPMC are showing the way forward, even as policymakers debate health insurance coverage and other very important health care policy issues in the coming weeks and months.And, regardless of the final outcome of the comprehensive health care reform debate taking place in Washington right now, a consensus is emerging among all stakeholders that the “internal” reform that organizations like UPMC and Trinity Health are helping to lead is equally vital and important. I, for one, am looking forward to being able to write many, many more articles and book chapters about such innovations going forward. This is the kind of difficult, yet rewarding, work that health care providers face going into the future. In short, when it comes to “internal health care reform,” the future is now.