OPINION: How NM health care can exceed patient expectations

I read with interest Journal Executive Editor Jay Newton-Small’s op-ed in the July 27 Sunday Journal. As a board certified internist and having practiced or worked as a medical director in six states, and having been in New Mexico for 26 years, I would like to offer a perspective on improving our health care to meet or exceed patient expectations. I often read that the “problem” with health care in New Mexico is that there aren’t enough doctors because the malpractice premiums are too high due to adverse legislation related to the amount of lawsuit awards. Actually, high insurance premiums and not enough doctors are outcomes of the current New Mexico health care systems. I like to approach this issue with a framework similar to Maslow’s Hierarchy: a triangle with four levels.

Level 1 (the base): Culture. Here there are several cultures at play: A) The national culture around health care access and financing, B) State culture (for example, think Massachusetts, ranked No. 1 in the Commonwealth Fund health care report). Industrial, densely populated, world-class universities like Harvard and MIT, and four medical schools vs. New Mexico, ranked No. 32: agricultural, sparsely populated, predominantly state universities and colleges. And C) Generational culture: Baby boomers and earlier generations prioritized work over lifestyle, Gen X and Y prioritize lifestyle over work.

Level 2: Talent. New Mexico has difficulty recruiting and retaining top-tier talent. Having been responsible for recruiting both medical and administrative professionals to New Mexico, it’s not easy to bring in top-tier talent. For people from the “green” three-fourths of the U.S., New Mexico looks drab. There’s no downtown with a dramatic skyline with glittering skyscrapers. There’s no riverwalk, theater district, Rodeo Drive. The school systems are ranked 50th. The New Mexico violent crime rate is the highest in the U.S. There are no major league sports teams. The No. 1 reason for not accepting a position, in my experience, was the candidate’s family didn’t want to move here. New Mexico isn’t known nationally as having health care centers of excellence that would draw in top-tier health care professionals.

Level 3: Systems. Because of the first two levels, systems of care in New Mexico are not as reliable or efficient as they could be. Most of the systems are provider centric, not patient centric. The term provider here includes any provider of health care services (physicians, hospitals, ancillary services, etc.). Health care systems can be improved, either incrementally or radically, by using time honored, well-tested programs like Lean, Six Sigma, Mistake Proofing and PDSA. Even if these programs are used, the “management system” (oversight, monitoring and accountability), whether in large integrated health care systems or a small medical practice, must be capable of keeping reliable, efficient systems in place. Too often in health care, gains in reliability and efficiency are lost over time, sometimes quickly, because of an inadequate management system.

Level 4 (the apex): Leadership. To achieve excellence in health care there must be strong leadership that can create a vision of excellence and motivate people to reach that goal. Leaders like Brent James, MD, of Intermountain Health in Utah; Quint Studor, former president of Baptist Hospital in Florida and founder of The Studor Group; and Don Berwick, MD, founder of the Institute for Healthcare Improvement. These health care leaders have made substantial impact on health care systems within their own sphere of influence. New Mexico needs a leader who can inspire the various health care entities in New Mexico to collaborate and focus on reliable, efficient, high value patient-centered care.

Not that any of the above are easy to accomplish. It takes time, energy, dedication and steadfastness. As they say, “It’s a journey,” and, “It takes a village.” When is it going to start?