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Two Halves to a Puzzle: Blending the "Soul" of Academic Medicine with the New Era of Clinical Serviceby Ron Gilmore
Changing one hundred years of culture means building a fresh new approach to patient care. It's a daunting task, but Steinbauer sees a growing momentum. "There is a definite ‘buzz' about what's happening," he said. "No, we don't have all the answers, and it's not a ‘top-down' decision. This is something that must involve the entire BCM family. We are embarking on a journey of change." "...We are embarking on a journey of change." This journey began when BCM launched a strategic planning process in the summer of 2003. It did so with the sort of introspection one undertakes when considering a life-changing decision. A Task Force on Patient Care and Clinical Quality & Service was established and headed by Larry Bagby and Dr. Stephen Greenberg, department of medicine; Dr. Timothy Boone, department of urology; and Dr. Michael Stewart, department of otorhinolaryngology & communicative sciences. The task force determined that Baylor should become the "premier clinical provider in Houston and the nation." In stating this, they lined out four strategies:
Steinbauer believes that with such changes, the College can finally address the "other half" of patient care - service. Baylor Clinic in its final phases will, for the first time, bring Baylor specialties under one roof and will strive to provide easy access for patients blended with an integrated and highly modernized system of health care delivery - from their first encounter to final follow-up visit. "Individual commitment to a group effort - that is what makes a team work, a company work, a society work, a civilization work." It's neither an easy journey nor a quick one. Changing culture is a "multiyear" endeavor, a lengthy process, said Steinbauer. If the first half of this new health care approach centers on ease-of-use, hightech solutions and patient care focused on the individual and the community, then the second half incorporates the "soul of academic medicine," that is, relying on the timetested triad of academic achievement - research, education and patient care. Indeed, many patients come to Baylor because they believe academicians in clinical practice offer an advantage by being on the cutting edge of medical science, said Steinbauer. It should be no surprise then that the future of patient care delivery consists of both the new and the proven. As Pearl S. Buck wrote, "One faces the future with one's past." Such a marriage of the traditional with the untested can result in trying times, or it can open up windows of much optimism and hope. Or it can do both. Scientist Niels Bohr said, resignedly, that "prediction is very difficult, especially of the future." What is clear in medical academia today, however, is that the future belongs with less invasive procedures, genetic solutions, briefer hospital stays, and more visits in outpatient settings. That such major medical centers as the University of California - Los Angeles (UCLA), Massachusetts General Hospital, and Washington University Medical School in St. Louis have already constructed new adult ambulatory care facilities is indicative that Baylor is on a futuristic course. "To accomplish great things, we must not only act, but also dream; not only plan, but also believe." In a summary entitled Academic Medicine: The Vision for Baylor College of Medicine, written in October 2004, Steinbauer encouraged colleagues that "the opportunity is now" although the challenge is "enormous." "Patients come to see their academic provider in spite of processes that do not reflect a patient/customer-oriented approach [to patient care]," he wrote. "Patient satisfaction surveys routinely tell us that our patients like their doctor, but dislike telephone systems, appointment availability, parking, waiting times in the office, etc. Academic health centers often have this reputation: good care when you can get it and are willing to put up with the inconvenience. As Baylor academic physicians, we should not settle for this reputation." In an environment that has not traditionally questioned itself nor deigned to consider such anathema as "marketing," "branding" or "customer service," it is nearly historic that one of the nation's leading medical centers is now clearly and irreversibly focused on the patient as an individual.
To think outside the black bag requires physicians to consider the complexities of modern day academic medicine. It requires, more than ever, an integration of patient care, research and education, without which few academic health centers can expect to provide the sort of vibrant environment necessary to succeed in today's competitive health care marketplace. To think outside the black bag must at some point mean that there will be change. The word "change" is one that conjures up varied conflicted reactions, and yet it is change that Baylor is grappling with today - changes in how we heal people. Dr. Peter Traber, BCM president and CEO, has addressed the need for change by embracing the concept of a "social contract" between modern academic medical centers and the public that relies on them. Dr. Kenneth Ludmerer, a professor of medicine at the School of Medicine and professor of history on the Faculty of Arts and Sciences at Washington University, wrote of this social contract in his book Time to Heal. The contract is this: That academic health centers must remember their basic institutional values; that they are public trusts accountable to society for resources they receive. Ludmerer wrote that medical schools must do a better job of "realigning their interests with those of the public." He adds, "...opportunities to influence medical education in a more constructive direction are still present. The lesson of history is that the future is not predetermined and that individuals can make a difference." Ludmerer's social contract calls for academic health centers to address a number of issues if they are to be deserving of public support. This includes "adjusting more fully to the new environment of resource constraints..." and "...becoming leaner, more efficient, more agile, and more cost-effective in the practice of medicine." As Baylor College of Medicine prepares to initiate its new ambulatory care center, what is abundantly clear is that the time has passed for medical schools and teaching hospitals to make decisions about patient care without consideration of what is best for the patient. In Academic Medicine: The Vision for Baylor College of Medicine, Steinbauer wrote that "We must guide our decisions with the question: Will this activity improve the quality of care and provide a better experience for our patients?' Only by keeping the needs of the patient foremost will we achieve a breakthrough in the organization, structure and operation of our clinical practice." In his role as medical director for Baylor Clinic, Steinbauer promotes a mission for the clinic that demands "state-of-the-art medical care and customer service in an environment dedicated to teaching these principles and discovering new ways to achieve them." In a clinic setting, two important criteria determine success: the patient encounter and the office system in place. For patient encounters at Baylor Clinic, there will be increased emphasis on the doctor-patient relationship with the patient's needs coming first. Patients will have access to care and information at all times, will have minimal waiting times and will receive care based on an integration of research and education. Electronic medical records will assure seamless transfer of information and coordination of care. Such effective patient care will be made easier by changes in how the clinic offices operate. The use of "real-time" patient data, a focus on waste reduction, and development of systems to connect individual health to the broader community health will help to provide a more patient-friendly clinical environment. |
Patient CareBaylor Clinic from the Inside Out Oil and Medicine: Profile on Dan Duncan ResearchEpilepsy: Seeking the Cause of a Lonely Disease Epilepsy: A history of stigma and superstition In for a Checkup? Check Out the Research Too EducationAll About the Education Evolution Revolution Community ServiceIntroducing the Problem Solvers College NewsRededication of a Monument to Medicine New BCM Logo Takes Center Stage The Perfect Fit: Putting the Pieces Together
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Volume 1, Issue 1, Spring 2005 |
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| Last modified: October 10, 2008 |
"We don't have all the answers," admitted Dr. Jeffrey Steinbauer, medical director of Baylor College of Medicine's new Baylor Clinic, an adult ambulatory care center due to open in early summer 2005.
The notion of the patient as a customer, although strange sounding to modern-day physicians, is actually rooted in the legend of the horse and buggy physician who defined the very meaning of service to others. These early doctors, carrying their ever-present black bags, were not much different from today's healers in that they entered the profession for the purpose of most symbolizes what it means to be a doctor. Solutions in the 21st century, however, are most likely not found in a simple black bag. Solutions for today's complex medicine require something very different. They require that those in the healing profession occasionally step back and think outside the black bag.