There has recently been debate on these pages regarding optimal expertise for biomedical leadership, precipitated by Roy Poses’ posts “Health Care Leaders: Don’t Know Much About Health Care” and “NY Times Proclaims Anyone Can Run a Health Care Organization with a Little Studying Up“.

I’m resurfacing a post I wrote in Jan. 2009 entitled “Pfizer/Wyeth Merger And Sacrificing The Future: Laying Off Scientific Staff All Over The Place” that I believe succinctly states the problems with ‘management by amateur.’

Read the entire post, but here are the highlights:

… Those in charge [and who lack domain credentials -ed.] can’t see that which the domain specialist sees.

They cannot see because they lack the training, experience, and what’s described as ‘meta-competence’ (in this brilliant article on competence [the Dunning-Kruger effect - ed.]) essential to seeing that which is obvious. Obvious, that’s, to those who don’t lack these characteristics. In addition, I have also observed that some lack the fundamental analytical capabilities essential to understanding and managing the complexities of biomedical R&D.

Why those without domain expertise are in charge of organizations whose long term viability depends entirely on the most advanced and creative pursuit of biomedical ‘miracles’ is another matter. I will not address this here, other than saying it reflects the adverse consequences of a bias that has evolved in management “science.”

That bias is the belief that all the world consists of faceless labor resources performing easily definable processes upon interchangeable widgets, and that management can therefore be done by generic managers, exclusively. Some of the world is like that [i.e., fast food chains - ed.], but some is not, such as biomedical R&D. [And clinical medicine as well - ed.]

Management in the absence of domain expertise in this industry is, in fact, mismanagement.

There is nothing here to spin, there is nothing to debate. There is nothing to discuss. This is a first principle.

Failure to accept this reality results in corporate failure.

Those who believe otherwise are engaging in magical thinking.

Further, those without biomedical domain knowledge who disagree should be prepared to discuss how their lack of domain knowledge might affect their insights and thoughts on such complex matters, compared to those with both domain knowledge and leadership experience. A question is this: based on the same Western traditions of inquiry and critical thinking that led to modern biomedical science and its achievements, whose thought is prone to be more valid?

– SS

[Source : Health Care Renewal]

I have written on these pages about a cross-occupational invasion of medicine by IT personnel, wherein the IT personnel seem to forget that they’re facilitators of healthcare, not enablers, with a primary purpose of serving the needs of clinicians.

[Source : Health Care Renewal]

Our current post about health care organizations recruiting executives with no experience in or knowledge about giving health care or biomedical science has attracted some attention. Some people suggested that letting some people from the “outside” into health care leadership might lead to fresh thinking and new ideas. My concern wasn’t about that. However, I do believe that to be succesful, the leadership of health care organizations ought to collectively be knowledgeable about health care, and understand its context, culture, science base, and values. My concern was not about a few “fresh thinkers,” but that the preponderance of health care leaders this day know little about what it’s like to actually take care of patients, have little understanding of biomedical science and health care research, and don’t comprehend, much less share the values of clinicians.

To illustrate with some admittedly anecdotal data, I looked up the official biographies of the CEOs of some health care organizations that have recently been mentioned in Health Care Renewal. I selected the most recently mentioned examples of the following types of health care organizations: hospitals and health care systems, managed care organizations/ health care insurers, pharmaceutical companies, device companies, biotechnology companies, and health care information technology companies.

Here are the results.

Hospitals/ Health Care Systems

Example: Sutter Health

CEO: Patrick Fry

Biography:

Mr. Fry joined the Sutter organization in 1982 as an administrative resident at Sutter General Hospital in Sacramento. Over the ensuing years he held increasingly responsible administrative positions both at the local affiliate level and region level, with responsibilities covering the breadth of Sutter Health’s services.

After serving as regional president for Sutter Health’s affiliates in the greater Sacramento region, Mr. Fry became president of the organization’s eastern operations. He later assumed leadership of Sutter Health’s Western Division and in 2000 became Sutter Health’s second-in-command, serving as chief operating officer and executive vice president. In 2005 Mr. Fry became President and CEO.

Mr. Fry earned a bachelor’s degree in public health administration from the University of California, Davis in 1979 and earned a master’s degree in health services administration from George Washington University in Washington, D.C.

Managed Care Organizations/ Health Care Insurers

Example: WellCare

CEO: Heath Schiesser

Biography:

Heath Schiesser assumed the role of president and chief executive officer in January 2008. He originally joined WellCare in 2002 as senior vice president of Marketing and Sales and focused most of his effort on the growth of the Company’s Medicaid and Medicare businesses. As president of WellCare Prescription Insurance, he led the Company’s successful national entry into Medicare prescription drug plans. Between mid-2006 and the assumption of his current position in January, he served in a part-time role as a senior advisor, focusing on WellCare’s rapidly growing Medicare products.

Mr. Schiesser brings extensive experience in improving operations, developing strategies and growing businesses in several sectors. Prior to joining the Company, he worked at the management consulting firm of McKinsey & Company, co-founded an on the internet pharmacy for pharmacy benefit manager Express Scripts and worked in the development of new ventures.

A cum laude graduate of Trinity University, Mr. Schiesser received his Master of Business Administration from Harvard University.

Pharmaceutical Companies

Example: Johnson and Johnson

CEO: William C. Weldon

Biography:

William C. Weldon is Chairman of the Board and Chief Executive Officer of Johnson & Johnson, the world’s most comprehensive and broadly based health care products company.

Mr. Weldon assumed his current responsibilities in April, 2002. Previously Mr. Weldon served as Worldwide Chairman, Pharmaceuticals Group, and a Vice Chairman of the Board of Directors. He was elected to the Board in February, 2001.

Mr. Weldon joined Johnson & Johnson in 1971 in the sales and marketing department of its McNeil Pharmaceutical subsidiary. In 1982 he was named manager, ICOM Regional Development Center in Southeast Asia. Mr. Weldon was appointed executive vice president and managing director of Korea McNeil, Ltd., in 1984 and managing director of Ortho-Cilag Pharmaceutical, Ltd., in the U.K. in 1986. In 1989, he was named vice president of sales and marketing at Janssen Pharmaceutica in the U.S., and in 1992 he was appointed president of Ethicon Endo-Surgery.

In 1995 Mr. Weldon was named a company group chairman of Johnson & Johnson and Worldwide Franchise Chairman of Ethicon Endo-Surgery, the Johnson & Johnson affiliate that develops new procedures for minimally-invasive surgery and designs related products. In 1998 Mr. Weldon was promoted to the Executive Committee and named Worldwide Chairman, Pharmaceuticals Group.

Among his outside activities, Mr. Weldon is a member of the Board of Directors of JPMorgan Chase & Co. He’s also Chairman of the CEO Roundtable on Cancer, Vice Chair of The Business Council and a member of The Sullivan Commission on Diversity in the Health Professions Workforce. Mr. Weldon also serves on the Liberty Science Center Chairman’s Advisory Council and as a member of the Board of Trustees for Quinnipiac University. He previously served as Chairman of the Pharmaceutical Research and Manufacturers of America (PhRMA).

Mr. Weldon was born in Brooklyn, NY, and is a graduate of Quinnipiac University in Hamden, Connecticut. He and his wife have two children and one grandson.

Device Companies

Example: Medtronic

CEO: William A. Hawkins

Biography:

Bill Hawkins assumed the role of Chief Executive Officer of Medtronic, Inc. in August 2007 and became Chairman of the Board in August 2008. He was named President and Chief Operating Officer in May 2004 after joining Medtronic as Senior Vice President and President of Medtronic’s Vascular business in January 2002.

Bill joined Medtronic from Novoste Corp., where he’d been President and Chief Executive Officer since 1998. Previous positions included Corporate Vice President and President of the Sherwood Davis and Geck organization of American Home Products; President of the Ethicon Endo-Surgery organization of Johnson & Johnson; President, Devices for Vascular Intervention and U.S. Operations, for Guidant Corp.; and several increasingly responsible executive positions culminating in the presidency of the Ivac organization for Eli Lilly & Co. He began his medical technology career with Carolina Medical Electronics in 1977.

He received his bachelor’s of science degree in electrical and biomedical engineering from Duke University in 1976 where he also conducted medical research in pathology. Bill also earned a master’s degree in business administration from the Darden School of Business, University of Virginia, in 1982.

Bill is a member of the Board of Visitors of the Engineering School of Duke University and the Guthrie Theatre Board.

Biotechnology Companies

Example: Dendreon

CEO: Mitchell H Gold, MD

Biography:

Dr. Gold joined Dendreon in 2001 as the vice president of business development. He subsequently was appointed a director in 2002 and was named the chief executive officer of the Company in 2003. Dr. Gold has led the Company’s corporate development, acquisition and financing efforts in current years, completing transactions valued at approximately $225 million, including the acquisition of Corvas International, and raising approximately $350 million in capital. Prior to joining Dendreon, he served as the vice president of business development for Data Critical Corporation, a company engaged in wireless transmission of critical healthcare data, now a division of GE Medical. He also served as the co-founder, president and chief executive officer of Elixis Corporation, a medical information systems company. Dr. Gold is a former urologist at the University of Washington and currently serves on the boards of the University of Washington/Fred Hutchinson Cancer Research Center Prostate Cancer Institute and the Washington Biotechnology and Biomedical Association. Dr. Gold received his B.S. from the University of Wisconsin-Madison and his M.D. from Rush Medical College in Chicago.

Health Care Information Technology Companies

Example: Allscripts

CEO: Glen Tullman

Biography:

Glen E. Tullman joined Allscripts as Chief Executive Officer in August 1997 to lead the Company’s transition into the Healthcare Information Sector. He led the Company’s Initial Public Offering and Secondary Offerings of the Company, which is now traded on NASDAQ (MDRX) and has driven the Company to becoming the leading provider of clinical software, connectivity and information services to doctors.

Prior to joining Allscripts, Mr. Tullman was Chief Executive Officer of Enterprise Systems, Inc., a leading healthcare information services company providing resource management solutions to large integrated healthcare networks, from October 1994 to July 1997. Mr. Tullman led the company’s Initial Public Offering and secondary offerings. HBO and Company of Atlanta acquired Enterprise in 1997 in a stock transaction valued in excess of $250 million. From 1983 to 1994, Mr. Tullman served in a number of management roles including President and Chief Operating Officer of CCC Information Services, Inc., a provider of information systems to the country’s largest property and casualty insurers. Under his leadership, the company grew from $17 million to more than $100 million and is publicly traded.

Mr. Tullman graduated from Bucknell University Magna Cum Laude, with a double major in Economics and Psychology. Upon graduation, he joined the Executive Office of the President of the United States in Washington, D.C. and later accepted a fellowship to study social anthropology at St. Antony’s College, Oxford University, England. Mr. Tullman serves on the International Board of the Juvenile Diabetes Research Foundation and on the Board of Trustees of the Certification Commission for Healthcare Information Technology (CCHIT). He also is Co-Chair of the National ePrescribing Patient Safety Initiative (NEPSI), a $100 million campaign, led by Allscripts and Dell Personal, to deliver free electronic prescribing to each physician in America. In 2006, he was named CEO of the Year by the Illinois Information Technology Association.

So there we have the leaders of seven important health care oganizations. Only one is health care professional (even though he is described as a “former urologist.”) Only one of them claims any biomedical science experience, and that was in college. One has bachelors and masters level degrees in health administration, and another has a bachelors degree in electrical and biomedical engineering. That seems to be the sum total of the group’s experience, expertise, and formal training in health care and biomedical science. Only one claims any experience directly taking care of patients. Only one has training in any health care profession. Only one is a (?”former”?)doctor, nurse, therapist, or biomedical scientist.

Of course, there are at least thousands of health care organizations in the US alone, each with its own often massive (and some might say top-heavy) management teams. But I would wager that if there was a systematic survey of these leaders, the majority would turn out not to be health care professionals, not to be biomedical scientists, and not to have much direct health care experience. I would further wager the more massive the organization, the less health care experience, knowledge and training would be found among the leadership.

I repeat, to really reform health care, we need health care leaders who actually comprehend health care, and support its values. But the bubble might have to burst before many people learn that lesson. For now, there’s too much money to be made.

[Source : Health Care Renewal]

A somewhat remarkable new book will be released in Nov. 2009 by the American Health Information Management Association (AHIMA), of which I am an associate editor. It is aimed at the non-medical- informatics IT and healthcare management professional. I express thanks to AHIMA for their forward thinking in accepting and publishing this material.

Books such as this were difficult to get into print just a few years ago, likely due to resistance to their publication by the powerful trade organizations of the health IT vendors:

H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations

In H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations, the editors—all of whom have led successful electronic health record (EHR) and Health Information Technology (HIT) projects—have collected case studies of HIT implementations that didn’t go as planned, offering expert insight into key obstacles that must be overcome to leverage IT and modernize and transform healthcare.

… the adoption of effective HIT—now a national priority with the passing of President Obama’s American Recovery and Reinvestment Act of 2009 (ARRA)—remains at a fairly primitive stage compared with IT adoption in every other major industry. In fact, healthcare is the only trillion dollar industry that remains primarily in the paper stage, although most healthcare data are available electronically.

By studying HIT implementations that failed, the editors are able to document, catalogue, and share key lessons that all project managers of HIT, health system leaders in informatics and technology, hospital executives, policy makers, and service and technology providers must learn in order to succeed with HIT.

H.I.T. or Miss presents a model to discuss HIT failures in a safe and protected manner, providing an chance to focus on the lessons offered by a failed initiative as opposed to worrying about potential retribution for exposing a project as having failed.

Authors

The editor and associate editors all served on the 2007 leadership board of the Clinical Information Systems Working Group of the American Medical informatics Association (AMIA).

Editor: Jonathan Leviss, MD

Associate Editors:

Brian Gugerty, DNS, MS, RN
Bonnie Kaplan, PhD
Gail Keenan, PhD, RN
Jonathan Leviss, MD
Larry Ozeran, MD
Eric Rose, MD
Scot Silverstein, MD

This book follows the anonymized case study approach I used in my website on HIT difficulties, started in 1999, itself based loosely on the style of the introduction of the 1994 book “Managing Technological Change: Organizational Issues in Healthcare Informatics” (ed. 1) by sociotechnical issues pioneers informaticists Nancy Lorenzi and Robert Riley.

One can talk about “healthcare transformation” via HIT all one wants, but until the current inadequate approaches to HIT (per the National Research Council, 2009) are themselves transformed, doing so is largely wide-eyed utopianism.

I am quite pleased to see this new book appear. (Note: I will not receive any royalties for sales).

– SS

[Source : Health Care Renewal]

Bloomberg reports that White Home advisers say the H1N1 swine flu virus could kill 90,000 and hospitalize 1.8 million people this year. Swine flu has hospitalized about 8,000 and killed over 500 so far this year so the bulk of the deaths and hospitalizations would come in the last four months of the year. That would be around 22,000 deaths per month and 450,000 hospitilizations per month if this does indeed occur.

Swine flu might infect half the U.S. population this year, hospitalize 1.8 million patients and lead to as many as 90,000 deaths, more than twice the number killed in a typical seasonal flu, White House advisers said.



In a report by the President’s Council of Advisers on Science and Technology, President Barack Obama today was urged to speed vaccine production and name a senior member of the White House staff, preferably the homeland security adviser, to take responsibility for decision-making on the pandemic. Initial doses should be accelerated to mid-September to vaccinate as many as 40 million people, the advisory group said.

If that many people get sick there are going to be lots of people out of work and possibly a lot of confusion. If hospitals get overwhelmed then we’ll run into extra problems. The HHS has said that even the high priority groups will not be fully immunized until Thanksgiving. If the vaccine had been made available by August 1st and immunizations were already underway then you probably would not have this concern about 90,000 potential deaths. Unfortunately, that’s not what happened. The vaccine is not coming in time to beat the return of students to schools and cooler fall temperatures. This means a lot of people will probably be exposed to the virus before they receive their first of two immunizations.



You can find a list of H1N1 swine flu resources here.



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[Source : HealthNewsBlog.com]