Jim Conway
One of the ways Picker Institute supports patient-centered care is by recognizing people in healthcare who have made significant contributions to achieving patient-centered care worldwide. “Conversations with Leaders in the Field of Patient-Centered Care” is a regular feature that highlights people who have promoted patient-centered care in their work or through their organization. This Conversation is with James B. Conway.
Jim Conway is an adjunct lecturer at the Harvard School of Public Health in Boston, principal of the Governance and Leadership Group of Pascal Metrics in Washington, D.C., and a Senior Fellow at the Institute for Healthcare Improvement (IHI) in Cambridge, Mass. He was Senior President of IHI from 2006 to 2009 and Senior Fellow from 2005 to 2006. From 1995 to 2005, Jim was Executive Vice President and CEO of Dana-Farber Cancer Institute in Boston.
Prior to joining DFCI, he was at Children’s Hospital, in Boston, for 27 years in radiology, administration and finance and as assistant hospital director. His areas of expertise and interest include governance and executive leadership, patient safety, change management, and patient- and family-centered care. He holds a Master of Science degree from Lesley College, which awarded him the Community Service Award.
Jim is the winner of numerous awards, including the 1999 ACHE Massachusetts Regents Award. In 2001 he received the first Individual Leadership Award in Patient Safety from the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. In 2008 he received the Picker Award for Excellence® in the Advancement of Patient-Centered Care, and in 2009 the Mary Davis Barber Heart of Hospice Award from the Massachusetts Hospice and Palliative Care Federation.
A Fellow of the American College of Healthcare Executives, Jim is a member of the Clinical Issues Advisory Council of the Massachusetts Hospital Association and is a Distinguished Advisor to the Lucian Leape Institute for the National Patient Safety Foundation. He is board chair of the Partnership for Healthcare Excellence; a board member of Winchester Hospital and the American Cancer Society, New England Region; and a board advisor to Medically Induced Trauma Support Services (MITSS). In government service, he served from 2006 to 2010 as a member of the Commonwealth of Massachusetts Quality and Cost Council.
You have such an extensive résumé that it’s hard to know where to start. However, your focus for the Institute for Healthcare Improvement at this moment is raising HCAHPS scores. How is IHI involved in this?
At IHI I’m working with the team on three areas: Governance and Executive Leadership of Quality; Respectful Management of Serious Clinical Adverse Events; and Patient- and Family-Centered Care. Specifically re the latter, a few years ago IHI picked up a very strong message from the field: How do we dramatically improve the inpatient experience as measured by HCAHPS? This is being driven by increased use of this measure in reimbursement as well as aspiration and competition. IHI commenced first with a research and development project on the topic and then more recently released a “White Paper: Achieving Exceptional Patient Experience in Inpatient Hospital Care.” (Click here to read the IHI White Paper.) In fact, the financial award I received when I was honored with the Picker Award helped underwrite this R&D.
Patient- and family-centered care has been an area of interest for you for a very long time. Looking back over the last two decades, what progress do you see?
Over the last 20 years we had a small number of organizations of great leadership taking this journey, showing us the potential of partnership, and providing us an example to draw courage and learning from. Today, patient- and family-centered care is “busting out all over.” It is what patients and families want. It is also what staff wants—it’s why they went into healthcare. National and international interest in the concept is extraordinary, and some of the organizations making the greatest innovations are also newest to the journey. In my state, Massachusetts, as of 2010, every hospital by law must have a patient and family advisory committee reporting directly to the board. That’s very exciting.
We are also seeing the concepts of engagement and partnership being brought to all care settings, communities, states and countries.
You were with Dana-Farber for 10 years after an unfortunate incident in which a patient died because she was treated incorrectly, and PCC measures seem to have been put in place there very quickly after that happened. Is the healthcare industry moving toward PCC as the norm as fast as you would like? Do you think every institution needs a wake-up call?
Terrible tragedy often provides the burning platform or creative tension for an organization to take a dramatic leap, as in the case of the Dana-Farber Cancer Institution. Fifteen years later it is clear that patient- and family-centered care isn’t an “if” discussion but a “when” and “how” discussion. Of course I would like it to be faster, but I also want it to be effectively integrated, supported and sustained over time. This is not a time for “tokenism” or “PFCC lite.”
What piqued your interest in healthcare, in which you are involved as an administrator, not a clinician?
I joined healthcare in 1966 at Children’s Hospital in Boston when I filed X-rays for 30 days to get money for Christmas—in short, a temporary job. What awakened my interest was the children, their amazing parents and families, hard-working colleagues, the possibilities for an individual to grow and contribute. There were people who were willing to take a chance on and invest in me as I embraced lifelong learning. Today I talk about the stories and mission, vision, values, outcomes and the exceptional privilege of being part of care and a caring team.
We hear a lot these days about the “triple aim”: better care, better health, lower costs. How does HCAHPS fit into that equation? It would seem that improving services would increase costs. Is that not true here? If not, why not? Does it have to do with fewer readmissions?
There is extensive research that points to an inverse relationship between cost and quality: the higher the cost, the lower the quality. The high cost is made up of the cost of poor quality; rework, duplication of effort, barriers and much more. Preventable readmissions are a perfect example of the cost of poor quality. Fixing that lowers cost and improves the patient experience. HCAHPS is a sophisticated measure to help us celebrate accomplishment and prioritize areas for improvement. It specifically helps us identify the things that are “driving patients crazy,” assess the costs of poor quality and improve the experience of care, the health of the population and the per capita cost of care.
Picker Institute ran across an interesting situation the other day in which a well-known hospital received an award for improvement in its clinical care, but its HCAHPS scores were mediocre at best. Does the patient experience, which HCAHPS measures, have as much clout as clinical performance?
I’ve been there as a leader. Many years ago, Dana-Farber was in a collaborative to improve outpatient experience. We were shocked to find out that in one of our programs we had the highest levels of patient satisfaction and the lowest levels of staff satisfaction. Despite the barriers, staff were killing themselves to produce an optimized experience for the patient and family. The end result was frustration, turnover, long days and more. Research from Picker and others is making it very clear: Clinical, financial, service and satisfaction/experience outcomes are in an exquisite dance together, playing off each other.
What do you want to add that you think is important? Your Picker Lecture from 2008 is remarkable. (Click here to see Jim Conway’s Picker Lecture.)
A few weeks ago I gave grand rounds on patient- and family-centered care at one of the nation’s premier healthcare institutions. While the organization was exceedingly busy, with many things going on, the audience in the very large auditorium was standing room only. The level of engagement and energy of the patients, family members, staff, leaders and executives was amazing—this was a journey they all wanted to go on, and it was why they got into healthcare. Governing boards and executive leaders must set the expectation, position people for success and then hold them accountable. When that is achieved, unleashed will be a gift that never stops giving.