JHF is a sponsor of the invitation-only Princeton Conference, a confluence of academic, industry, and government thought leaders who meet to explore critical health policy issues through themed presentations and interactive panels. Dr. Feinstein is part of the planning committee for the conference, which tackled topics including the effect of new payment and delivery models on consumer and provider behavior, cultivating a 21st century healthcare workforce, the future of Medicare in an accountable care world, health system consolidation, and specialty pharmaceutics that could improve health but spike costs.
During her presentation, Dr. Feinstein noted that the U.S. healthcare system has made disappointing progress in advancing safety, reliability, and efficiency. She posited that one of the principal reasons is that there's too much time spent thinking about quality improvement methods, and not enough spent considering the specific context in which those methods are applied.
Using Lean to its fullest potential requires an environment that stimulates system-wide quality improvement, with engaged leadership, a culture of quality and safety, defined targets and measurements, consumer and patient engagement, and incentives for performance excellence.
"Lean isn't a flavor of the month, and it's not for spot repairs," Dr. Feinstein says. "It's an enterprise solution that forces you to anticipate, harness technology, and create an infrastructure for problem-solving. Without those layers of QI, there's no spread or sustainability. It's like planting a turnip in cement."
Dr. Feinstein's panel also featured:
- Michael Millenson, president of Health Quality Advisors, LLC and author of Demanding Medical Excellence: Doctors and Accountability in the Information Age
- Gordon Mosser, MD, MLitt, a senior fellow at the University of Minnesota School of Public Health's Division of Health Policy & Management and co-founder of the Institute for Clinical Systems Improvement (ICSI)
- Neel Shah, MD, MPP, assistant professor at Harvard Medical School, co-author of Understanding Value-Based Care, and executive director of Costs of Care
Millenson also lamented the slow pace of improvement in healthcare quality and safety. He framed the issue in terms of duty versus interest, with a fee-for-service environment creating a divide between what's best for patients and what's best for profits. Healthcare reform has started to bridge that chasm by creating financial incentives that reward providers for evidence-based, outcomes-driven care.
Dr. Mosser examined the role of management in fostering a high-performing health system, stating that leadership falls short unless it considers the context of quality improvement efforts and promotes collaboration. Medical schools could begin to address these management shortcomings by creating a learning experience which emphasizes quality improvement and team-based principles.
Dr. Shah drew upon his experiences as an obstetrician-gynecologist, noting that pre-term births in the U.S. have declined over the past decade due to process improvements (such as reducing non-medically necessary cesarean sections), greater access to maternity care, and efforts to reduce smoking among women. That decline, in turn, has led to fewer developmental complications and lower legacy costs. Other healthcare sectors could similarly benefit by crafting multifaceted solutions to complex problems.
"The Princeton Conference is a one-of-a-kind intersection of health economics and policy, with the audience becoming part of the panel and learning experience," Dr. Feinstein says. "You have leaders from various backgrounds—non-profit, for-profit, Republican, Democrat —analyzing issues through different lenses. The culture is to respectfully listen, but occasionally challenge. There are no polemics here."