IOM President
Harvey Fineberg

In an article published this week in the New England Journal of Medicine, Harvey V. Fineberg, MD, president of the Institute of Medicine, presented a vision for resolving the pervasive and recalcitrant problems that plague what he “purposefully refers to a ‘health system’ rather than a ‘health care system.'”

But he buried his own personal advice to his colleagues at the far end of the piece. I’ve pulled it up for closer inspection.

Fineburg makes the health-vs-system distinction he says because: “Solutions need to focus on the ultimate outcome of interest…and not on the formal system of care designed primarily to treat illness.”

 A Successful and Sustainable Health System — How to Get There from Here at the New England Journal of Medicine.

Unfortunately his piece then plunges into four pages of distressing med-policy-leader-speak describing what he calls “our remarkably durable health crisis:” statistics, some trending positive, public investments, the much abused Accountable Care Act, agencies and entities in the health system enterprise all hard at work, etc.

If you can work your way through this predictable prose, you will come to the end of the piece and what sounds like Dr. Fineberg’s own personal exhortation to his fellow physicians:

Finally, champion a new ethos of medical professionalism that values accountability above autonomy; supports team-based care and interprofessional education; and accepts responsibility for a system to serve all patients, not only one’s own patients.

To achieve a successful and sustainable health system, we must be able and willing to try many different things. But therein lies a unifying idea: do many things. No single stroke will solve this problem.  A successful and sustainable health system —

  • will not be achieved by supporting prevention,
  • it will not be achieved by championing competition,
  • it will not be achieved by comparing the effectiveness of different practices,
  • it will not be achieved by striking commercial influence from professional decision making,
  • it will not be achieved by changing the way we pay doctors, and i
  • it will not be achieved by just reengineering the system.

It requires all these changes and more.

(I’ve bulleted the preceding points that were originally in a single paragraph.)

Removing the “it will nots” reveals an interesting pro-active prescription for those inclined to advance such medicine:

  •  Support prevention
  •  Champion competition
  •  Compare practice effectiveness
  •  Strike commercial influence from professional decision making
  •  Change the way doctors are paid
  •  Re-engineer the system

Would have loved to see the piece begin with these sentiments and flow outward into steams describing how each should be achieved.