Alumni Profile
Brody’s Paradox
Johns Hopkins University president William Brody says improving patients’ hospital
experiences will cut costs at academic medical centers
By Amy Adams
Photograph courtesy of Johns Hopkins University
William Brody, MD, PhD, suspects that health care is overdue for a switch
to some form of universal coverage, but until that day comes he is improvising
as fast as he can to keep Johns Hopkins hospital one step ahead of the
red. “I don’t know exactly where health care is going, but
if you aren’t a survivor at the end you can’t be around to
participate in whatever the new order is,” Brody says. “My
goal is to survive.”
Brody, who is president of Johns Hopkins University, has taken an unusual
approach to survival. “I decided that we aren’t going to focus
on cost,” Brody says. At a time when university hospitals around
the country are struggling, Brody decided to turn the hospital’s
focus to quality. “If you drive quality up, costs will go down on
their own.”
Brody is prone to taking the unusual path. While at Stanford he juggled
medical school (class of 1970) and an electrical engineering PhD program
during a time when the fields of medicine and engineering had little
discernable overlap. Brody went on to become a professor of both radiology
and electrical engineering at Stanford before his combined interests
led him to co-found three medical device companies. He became president
of Johns Hopkins in August 1996.
Johns Hopkins faces some of the same challenges as other university
hospitals around the country, Brody says. These hospitals provide care
to a disproportionate number of people without insurance and therefore
have fewer patients paying in full for their care. The only way to bring
in enough money to fulfill the hospital’s education and health-care
missions is to lure patients with comprehensive health insurance.
Wooing those patients, Brody says, comes down to little things like
better food and a smoother hospital stay, in addition to the specialized
services that academic hospitals such as Johns Hopkins and Stanford excel
at.
“Until now nobody has optimized the hospital’s operation from
the patient’s perspective,” Brody says. Instead, many cost-cutting
efforts strip money from individual departments, which cope by making
internal changes. Each individual department might end up more cost-efficient,
but unless those departments work efficiently together the changes only
make the patient’s stay more prone to glitches, he says.
Take prescriptions, for example. Brody found 107 steps that a prescription
must go through between a doctor’s pen and the patient’s bedside.
With so many steps comes many opportunities for errors, which are expenses
that negate any cost-cutting gains. By optimizing hospital operations
from the patient’s perspective, he reduced the ways medications
could go astray.
Brody likens a patient’s usual hospital stay to a car in an old-fashioned
assembly plant. In the past, each stage of assembly acted independently
with no person taking responsibility for the final product. “It’s
an assembly line with units optimizing their own function,” he says.
Except that in his case the units provide specialized health care rather
than install transmissions. Car manufacturers dramatically improved quality
and cut costs when they put more responsibility in the hands of the assembly-line
workers.
Mimicking this advance seemed like an obvious step to Brody’s engineering
mind. “The way you do that in a hospital is you assemble a team
of doctors and nurses and identify key safety issues,” Brody says.
His team has started evaluating each step in the patient’s hospital
stay to look for ways to improve care. “We are now empowering the
doctors and nurses to stop the assembly line and say, ‘We have a
problem.’ ”
Encouraging doctors and nurses to take personal responsibility for a
patient’s care has already paid off. Infection rates in the cardiovascular
ICU have gone down significantly since Brody began his tenure. “If
you can reduce infection rate, which you can, you can drive cost down,” he
says.
Helping nurses spend more time with patients is one thing Brody sees
as essential to improving care. Brody says nurses spend 60 percent of
their time tracking down information, looking for equipment, answering
the phone and doing other activities that have nothing to do with patient
care. His team looked for low-tech solutions to eliminate these distractions.
One such solution was voice mail. Nurses complained that they were constantly
updating patients’ families rather than taking care of the patients.
Now, each patient has a voice mailbox where nurses can leave status reports
at the beginning of every shift. “Now if all the family members
want to know how Aunt Matilda is doing, they can call in and get that
information from the message,” Brody says, leaving the nurses free
to make sure Aunt Matilda gets the best possible care.
“You do a hundred little things like that and you’ve made
an enormous difference,” he says. “It’s empowering because
people responsible for the care can come up with the ideas.”
Although Johns Hopkins and many other university hospitals are innovative
enough to hold their heads above the financial water, Brody thinks eventually
the system will break. When that day comes, he thinks universal health
care will be the only long-term way to keep costs in line. “It’s
definitely coming either through the government or through the private
sector,” he says. “It’s just a matter of when we will
hit the tipping point.”
Brody has a hunch that the growing ability to predict disease risk is
what will finally usher in universal health care. “If I say that
you have low risk of breast cancer or heart disease, you would maybe
not buy much health insurance,” he says. That leaves only high-risk
people seeking insurance, causing insurance premiums to skyrocket. “The
idea of insurance is that everybody is in the pool so it is an average
risk. The only way to get costs in line is to make sure everyone is insured.”
Even if universal health care does eventually ease the financial burden
on hospitals, Brody says that improving the patient experience will continue
to pay off with better quality care—a worthwhile end result, even
without the associated cost savings. SMD
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