by Thomas H Lee
7. Make the building of social capital as prominent a concern for the organization as financial goals are. Ultimately, the viability of healthcare organizations in a competitive marketplace—and the joy their personnel get from working in them—depends on their ability to create value for patients. To improve—to do more for patients than they currently can do and to do it more efficiently—organizations have to learn, and then they have to standardize around best practices. The themes of Ronald Burt’s framework for social capital—brokerage and closure—matter more than bond ratings. Boards of directors, trustees, CEOs, and other senior leaders should recognize the importance of social capital and approach the work of building it with the same discipline they currently apply to financial capital.
8. Identify the teams that are the real units of healthcare delivery and use social network science to enhance their effectiveness. Almost every patient with conditions of any complexity has a team of clinicians today, but those clinicians often do not know that they are part of a team or function like a pickup team of players who are meeting for the first time. Social network science can be used to help teams function better, resulting in better and more efficient care, greater professional pride, and lower personnel turnover.
9. Use financial incentives for financial issues. Idealistic and optimistic though I may be, I know that money matters to almost everyone. I am completely comfortable with the use of financial incentives for financial issues, including rewarding hard work and the thoughtful work required to make care more efficient.
10. Use nonfinancial incentives for nonfinancial issues, including driving the organization’s epidemic of empathy. Improvement of quality, including empathic care, should not be driven by purely financial considerations. No clinician should ever pause to wonder whether he or she should be empathic. Instead, being an empathic clinician should be a social norm. Clinicians and other personnel should work hard as individuals and effectively as teams to reduce patients’ suffering because it brings them pride and because if they didn’t, they would be ashamed. These intrinsic motivations can produce improvements in quality that financial incentives never will.
The insights of social network science can speed the spread of the norm of empathic care. The most influential clinicians—those who can initiate the process—can be identified just by asking around. A critical mass of empathic clinicians can send the message to everyone else that this is the way we deliver care. Personnel who are isolated can be brought closer to the group so that the norms have a greater impact on them. Peer pressure and transparency can be used to help personnel be at their best not just for special patients but for all patients.
The delivery of healthcare offers an endless series of opportunities for provider personnel to rise to the occasion, meet their patients’ needs, and reduce their suffering. Organizations that can help their personnel do that will be rewarded both with business success and with the pride that can result from an epidemic of empathy.
Notes
Introduction
1. Nicholas A. Christakis and James H. Fowler, “The Spread of Obesity in a Large Social Network over 32 Years,” New England Journal of Medicine 357, July 26, 2007: 370–379. DOI: 10.1056/NEJMsa066082.
2. Nicholas A. Christakis and James H. Fowler, “The Collective Dynamics of Smoking in a Large Social Network,” New England Journal of Medicine 358, May 22, 2008: 2249–2258. DOI: 10.1056/NEJMsa0706154.
3. Empathy: The Human Connection to Patient Care. https://www.youtube.com/watch?v=cDDWvj_q-o8.
4. Thomas H. Lee, “The Word That Shall Not Be Spoken,” New England Journal of Medicine 369, November 7, 2013:1777–1779. DOI: 10.1056/NEJMp1309660.
5. Gina Kolata, “Doctors Strive to Do Less Harm Through Inattentive Care,” New York Times, February 18, 2015. Accessed August 7, 2015, http://www.nytimes.com/2015/02/18/health/doctors-strive-to-do-less-harm-by-inattentive-care.html?_r=0.
Chapter 1
1. Beth A. Lown, Julie Rosen, and John Martilla, “An Agenda for Improving Compassionate Care: A Survey Shows About Half of Patients Say Such Care Is Missing,” Health Affairs 30, September 2011: 1772–1778. DOI: 10.1377/hlthaff.2011.0539.
2. A. McGehee Harvey, Adventures in Medical Research: A Century of Discovery at Johns Hopkins (Baltimore: Johns Hopkins Press, 1974): 158.
3. William Osler, “The Lumleian Lectures: On Angina Pectoris,” Lancet 175, April 9, 1910: 973–977. DOI: 10.1016/S0140-6736(01)14114-0.
4. Tinsley R. Harrison, Paul B. Beeson, William H. Resnik, et al., Principles of Internal Medicine (New York: Blakiston, 1950): 1342.
5. Thomas H. Lee, “Turning Doctors into Leaders,” Harvard Business Review, April 2010: 50–58. Accessed August 7, 2015, https://hbr.org/product/turning-doctors-into-leaders/R1004B-PDF-ENG.
6. Gail Gazelle, Jane M. Liebschutz, and Helen Riess, “Physician Burnout: Coaching a Way Out,” Journal of General Internal Medicine 30, April 2015: 508–513. DOI: 10.1007/s11606-014-3144-y.
7. Christina Maslach and Michael P. Leiter, The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It (San Francisco: Jossey-Bass, 1997): 186.
8. Emily D. Dolan, David Mohr, Michelle Lempa, et al., “Using a Single Item to Measure Burnout in Primary Care Staff: A Psychometric Evaluation,” Journal of General Internal Medicine 30, April 2015: 582–587. DOI: 10.1007/s11606-014-3112-6.
9. Thomas H. Lee and Toby Cosgrove, “Engaging Doctors in the Healthcare Revolution,” Harvard Business Review 92, June 2014:104–111. Accessed August 7, 2015, https://hbr.org/2014/06/engaging-doctors-in-the-health -care-revolution.
Chapter 2
1. Centers for Medicare and Medicaid, National Health Expenditures 2013 Highlights. Accessed August 7, 2015, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf.
2. Amanda Noss, “Household Income: 2013,” American Community Survey Briefs, Washington, DC: U.S. Census Bureau, September 2014. Accessed August 7, 2015, https://www.census.gov/content/dam/Census/library/publications/2014/acs/acsbr13-02.pdf.
3. Michael E. Porter and Thomas H. Lee, “Why Strategy Matters Now,” New England Journal of Medicine 372, 2015:1681–1684. DOI: 10.1056/NEJMp1502419.
4. Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson (Editors), To Err Is Human: Building a Safer Health System (Washington, DC: National Academies Press, 2000). Accessed August 7, 2015, http://www.nap.edu/openbook.php?record_id=9728.
5. Committee on Quality of Health Care in America, Crossing the Quality Chasm: A New Health System for the 21st Century (Washington, DC: National Academies Press, 2001). Accessed August 7, 2015, http://www.nap.edu/openbook.php?isbn=0309072808.
6. Christine K. Cassel, Patrick H. Conway, Suzanne F. Delbanco, Ashish K. Jha, Robert S. Saunders, and Thomas H. Lee, “Getting More Performance from Performance Measurement,” New England Journal of Medicine 371, December 4, 2014: 2145–2147. DOI: 10.1056/NEJMp1408345.
7. Michael E. Porter, “What Is Value in Healthcare?” New England Journal of Medicine 363, December 23, 2010:2477–2481. DOI: 10.1056/NEJMp1011024.
Chapter 3
1. Richard A. Friedman, “Understanding Empathy: Can You Feel My Pain?” New York Times, April 27, 2007. Accessed August 7, 2015, http://www.nytimes.com/2007/04/24/health/24beha.html.
2. Helen Riess, “Empathy in Medicine—a Neurobiological Perspective,” JAMA 304, October 13, 2010:1604–1605. DOI: 10.1001/jama.2010.1455.
3. Mohammadreza Hojat, Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes (New York: Springer, 2007): 80.
4. Eric B. Larson and Xian Xin Yao, “Clinical Empathy as Emotional Labor in the Patient-Physician Relationship,” JAMA 293, March 2, 2005:1106–1011. DOI: 10.1001/jama.293.9.1100.
5. Anthony L. Suchman, Kathryn Markakis, Howard B. Beckman, and Richard M. Frankel, “A Model of Empathic Communication in the Medical Interview,” JAMA 277, February 26, 1997: 678–682. DOI:10.1001/jama.1
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6. Kathryn I. Pollak, Robert M. Arnold, Amy S. Jeffrey, et al., “Oncologist Communication About Emotions During Visits with Patients with Advanced Cancer,” Journal of Clinical Oncology 25, December 20, 2007: 6748–6752. DOI: 10.1200/JCO.2007.12.4180.
7. Laura J. McVey, Donald E. Davis, and Harvey Jay Cohen, “The ‘Aging Game’—an Approach to Education in Geriatrics,” JAMA 262, September 15, 1989: 1507–1509. Accessed August 7, 2015. DOI:10.1001/jama.1989.03430110097036.
8. Helen Riess, John M. Kelly, and Robert W. Bailey, “Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience-Informed Curriculum,” Journal of General Internal Medicine 27, October 2012: 1280–1286. Accessed August 7, 2015. DOI: 10.1007/s11606-012-2063-z.
9. Stewart W. Mercer, Margaret Maxwell, David Heaney, et al., “The Consultation and Relational Empathy (CARE) Measure: Development and Preliminary Validation and Reliability of an Empathy-Based Consultation Process Measure,” Family Practice 21, December 2004: 699–705. DOI: 10.1093/fampra/cmh621.
10. Robert Axelrod, The Evolution of Cooperation (New York: Basic Books, 1984).
11. Thomas H. Lee, “The Word That Shall Not Be Spoken,” New England Journal of Medicine 369, 2013:1777–1779. DOI: 10.1056/NEJMp1309660.
12. AMA Manual of Style: A Guide for Authors and Editors (New York: Oxford University Press, 2007): 416–417.
13. Lisa M. Bellini and Judy A. Shea, “Mood Change and Empathy Decline Persist During Three Years of Internal Medicine Training,” Academic Medicine 80, February 2005:164–167.
14. Sharyn J. Potter and John B. McKinlay, “From a Relationship to Encounter: An Examination of Longitudinal and Lateral Dimensions in the Doctor–Patient Relationship,” Social Science & Medicine 61, July 2005: 465–479. DOI: 10.1016/j.socscimed.2004.11.067.
15. Sunil Dasan, Poonam Gohil, Victoria Cornelius, et al., “Prevalence, Causes and Consequences of Compassion Satisfaction and Compassion Fatigue in Emergency Care: A Mixed-Methods Study of UK NHS Consultants,” Emergency Medicine Journal 32, August 2015: 588–594. DOI: 10.1136/emermed-2014-203671.
Chapter 4
1. Howard H. Hiatt, Benjamin A. Barnes, Troyen A. Brennan, et al., “A Study of Medical Injury and Medical Malpractice,” New England Journal of Medicine 321, 1989: 480-484. DOI: 10.1056/NEJM198908173210725.
2. Michael E. Porter, “What Is Value in Healthcare?” New England Journal of Medicine 363, December 23, 2010:2477–2481. DOI: 10.1056/NEJMp1011024.
3. Douglas Stone and Sheila Heen, Thanks for the Feedback: The Science and Art of Receiving Feedback Well (New York: Viking Press, 2014).
4. Joshua J. Fenton, Anthony F. Jerant, Klea D. Bertakis, and Peter Franks, “The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality,” Archives of Internal Medicine 172, March 12, 2012: 405–411. DOI: 10.1001/archinternmed.2011.1662.
5. Ashish K. Jha, E. John Orav, Jie Zheng, and Arnold M. Epstein, “Patients’ Perception of Hospital Care in the United States,” New England Journal of Medicine 359, October 30, 2008:1921–1931. DOI: 10.1056/NEJMsa0804116.
6. Greg D. Sacks, Elise H. Lawson, Aaron J. Dawes, Marcia M. Russell, Melinda Maggard-Gibbons, David S. Zingmond, and Clifford Y. Ko, “Patient Satisfaction Survey and Surgical Quality,” JAMA Surgery. Published online June 24, 2015. DOI:10.1001/jamasurg.2014.1108.
7. Matthew P. Manary, William Boulding, Richard Staelin, and Seth W. Glickman, “The Patient Experience and Health Outcomes,” New England Journal of Medicine 368, January 17, 2013:201–203. DOI: 10.1056/NEJMp1211775.
8. Tayler M. Schwartz, Miao Tai, Kavita M. Babu, and Roland C. Merchant, “Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications,” Annals of Emergency Medicine 64, May 2014: 469–481. DOI: 0.1016/j.annemergmed.2014.02.010.
9. C. Komal Jaipaul and Gary E. Rosenthal, “Do Hospitals with Lower Mortality Have Higher Patient Satisfaction? A Regional Analysis of Patients with Medical Diagnoses,” American Journal of Medical Quality 18, March/April 2003: 59–65. DOI: 10.1177/106286060301800203.
10. Seth W. Glickman, William Boulding, Matthew Manary, Richard Staelin, Matthew T. Roe, Robert J. Wolosin, E. Magnus Ohman, et al., “Patient Satisfaction and Its Relationship with Clinical Quality and Inpatient Mortality in Acute Myocardial Infarction,” Cardiovascular Quality and Outcomes 3, March 2010: 188–195. DOI: 10.1161/CIRCOUTCOMES.109.900597.
11. Klea D. Bertakis and Rahman Azari, “Patient-Centered Care Is Associated with Decreased Health Care Utilization,” Journal of the American Board of Family Medicine 24, May–June 2011: 229–239. DOI: 10.3122/jabfm.2011.03.100170.
12. Jane C. Weeks, Paul J. Catalano, Angel Cronin, Matthew D. Finkelman, Jennifer W. Mack, Nancy L. Keating, and Deborah Schrag, “Patients’ Expectations About Effects of Chemotherapy for Advanced Cancer,” New England Journal of Medicine 367:1616–1625. DOI: 10.1056/NEJMoa120441.
13. Deirdre E. Mylod and Thomas H. Lee, “A Framework for Reducing Suffering in Healthcare,” Harvard Business Review, November 14, 2013. Accessed August 7, 2015, https://hbr.org/2013/11/a-framework-for-reducing-suffering-in-health-care.
Chapter 5
1. Ronald S. Burt, Brokerage and Closure (Oxford: Oxford University Press, 2005): 15.
2. Melissa D. Phipps and John D. Phipps, “Code Comfort—A Code Blue Alternative for Patients with DNRs,” Harvard Business Review, December 9, 2014. Accessed August 7, 2015, https://hbr.org/2014/12/code-comfort-a -code-blue-alternative-for-patients-with-dnrs.
3. Anna M. Roth and Thomas H. Lee, “Healthcare Needs Less Innovation and More Imitation,” Harvard Business Review, November 19, 2014. Accessed August 7, 2015, https://hbr.org/2014/11/health-care-needs-less-innovation-and-more-imitation.
4. Ronald S. Burt, Brokerage and Closure (Oxford: Oxford University Press, 2005): 93.
5. Nicholas A. Christakis and James H. Fowler, Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives (New York: Little, Brown and Company, 2009).
6. Susan Dominus, “What Happened to the Girls in Le Roy,” New York Times Magazine, March 7, 2012. Accessed August 7, 2015, http://www.nytimes.com/2012/03/11/magazine/teenage-girls-twitching-le-roy.html.
7. Channel 4, The Town That Caught Tourette’s. Accessed August 7, 2015, https://www.youtube.com/watch?v=T4-v5FriLrk.
8. Nicholas A. Christakis and James H. Fowler, “The Spread of Obesity in a Large Social Network over 32 Years,” New England Journal of Medicine 357, July 26, 2007: 370–379. DOI: 10.1056/NEJMsa066082.
9. Nicholas A. Christakis and James H. Fowler, “Social Contagion Theory: Examining Dynamic Social Networks and Human Behavior,” Statistics in Medicine 32, February 20, 2013: 581–590. DOI: 10.1002/sim.5408.
10. Nicholas A. Christakis, James H. Fowler, and Rose McDermott, “Breaking Up Is Hard to Do, Unless Everyone Else Is Doing It Too: Social Network Effects on Divorce in a Longitudinal Sample,” Social Forces 92, December 2013: 491–519. DOI: 10.2139/ssrn.1490708.
11. David A. Kim, Alison R. Hwong, Derek Stafford, D. Alex Hughes, A. James O’Malley, James H. Fowler, and Nicholas A. Christakis, “Social Network Targeting to Maximise Population Behaviour Change: A Cluster Randomised Controlled Trial,” Lancet 386, July 11, 2015:145–153. DOI: 10.1016/S0140-6736(15)60095-2.
12. James H. Fowler and Nicholas A. Christakis, “Dynamic Spread of Happiness in a Large Social Network: Longitudinal Analysis over 20 Years in the Framingham Heart Study,” British Medical Journal 337, December 8, 2008:123–138. DOI: 10.1136/bmj.a2338.
13. John T. Cacioppo, James H. Fowler, and Nicholas A. Christakis, “Alone in the Crowd: The Structure and Spread of Loneliness in a Large Social Network,” Journal of Personality and Social Psychology 97, December 2009: 977-991. DOI: 10.1037/a0016076.
14. Marina Keegan, “The Opposite of Loneliness,” Yale Daily News, May 27, 2012. Accessed August 7, 2015, ht
tp://yaledailynews.com/crosscampus/2012/05/27/keegan-the-opposite-of-loneliness/.
Chapter 6
1. Thomas H. Lee and Toby Cosgrove, “Engaging Doctors in the Healthcare Revolution,” Harvard Business Review 92, June 2014:104–111. Accessed August 7, 2015, https://hbr.org/2014/06/engaging-doctors-in-the-health-care-revolution; Nikola Biller-Andorno and Thomas H. Lee, “Ethical Physician Incentives—from Carrots and Sticks to Shared Purpose,” New England Journal of Medicine 368, March 13, 2013: 980–982. DOI: 10.1056/NEJMp1300373.
2. Eric Goralnick, Ron M. Walls, and Joshua M. Kosowsky, “How We Revolutionized Our Emergency Department,” Harvard Business Review, September 26, 2013. Accessed August 7, 2015, https://hbr.org/2013/09/how-we-revolutionized-our-emergency-department/.
3. Thomas H. Lee, Albert Bothe, and Glenn D. Steele, “How Geisinger Structures Its Physicians’ Compensation to Support Improvements in Quality, Efficiency, and Volume,” Health Affairs 31, September 2012: 2068–2073. DOI: 10.1377/hlthaff.2011.0940.
4. Rosemary Thackeray, Benjamin Crookston, and Joshua West, “Correlates of Health-Related Social Media Use Among Adults,” Journal of Medical Internet Research 15, January 2013: e21. DOI: 10.2196/jmir.2297.
5. David. A. Hanauer, Kai Zheng, Dianne C. Singer, Achamyeleh Gebremariam, and Matthew M. Davis, “Public Awareness, Perception, and Use of Online Physician Rating Sites,” JAMA 311, February 19, 2014: 734–735. DOI: 10.1001/jama.2013.283194.
6. Eric Anderson and Duncan Simester, “Reviews Without a Purchase: Low Ratings, Loyal Customers, and Deception,” Journal of Marketing Research 51, June 2014: 249–269. DOI: http://dx.doi.org/10.1509/jmr.13.0209.