At our Spring All Council Conference Tuesday, Dr. Neel Shah recalled hospital higher ups chastising young physicians over some medical procedure or intervention they failed to perform.
“But you never saw anyone get called on the carpet for doing a procedure they should not have done,” he said.
Dr. Shah, our keynote speaker, knows we hurt people by doing too little — but also by doing too much. Dr. Shah is a Harvard Medical School Ob-Gyn and Director of the Delivery Decisions Initiative at Ariadne Labs for Healthy Systems Innovation. He’s one of the smartest people in medicine today.
He focused his talk on the 500 percent increase in C-sections in just one or two generations of mothers. But he largely dismissed the oft-cited culprits, such as fear of lawsuits and varied reimbursement, and instead explored the complex technology and medical systems inside American labor and delivery wards. He explored contrasting management cultures at different hospitals with wildly different rates of surgical births.
He had a simple quest: To understand what drives unnecessary C-sections. He has come up with key observations and best practices but no simple answers to explain why one hospital can have a C-section rate hovering around 50 percent while another across town will have, say, a 20 percent rate.
Joining Dr. Shah on a panel that followed his address were Philip G. Passes, MD, who manages a large physician ob-gyn practice at Monmouth Medical Center, and Suzanne Spernal, an Advanced Practice Nurse who is clinical director of Labor and Delivery at that hospital. The two talked about the hard work and innovative efforts that helped their hospital reduce its C-section rate from 32 percent in 2004 to 15.4 percent in the first quarter of this year.
The announcement sparked a round of applause.
And also on our panel was Deneen Vojta, MD, who is Executive Vice President, Research and Development, at UnitedHealth Group. She talked about how group prenatal care can create emotional and social support for expecting mothers and reduce pre-term deliveries. One study found an astounding 33 percent reduction in pre-term deliveries through group prenatal care.
As I listened to the discussion I thought of a discussion earlier in the day about the Quality Institute’s Conversation of Your Life, a program of our Mayors Wellness Campaign that helps communities come together to talk candidly about end-of-life wishes and advance directives. Here’s another time in life when medicine provides tests, procedures, consultations and interventions that drive up costs without always improving patient satisfaction or outcomes. By the end of the day, it seemed clear that if we want to reduce costs and improve health care we have two places to start.
We’ll continue to keep you informed of our work and look forward to your involvement.