Medical Leader Challenges Providers to Meet Challenges

Dr. Jonathan Woodson

“You are making a powerful difference in people’s lives, one patient at a time, by applying your compassion, diligence [and] craft,” the former assistant secretary of defense for health affairs recently told staff at Walter Reed National Military Medical Center.

“There’s no other sort of job like the one you have, and remember, you’re twice the professional – you’re physicians, surgeons and providers, but you’re also military officers, and that’s very, very special,” added Dr. Jonathan Woodson.

A vascular surgeon, Woodson served as guest speaker at the Surgery Grand Rounds, Francis D. Moore Sr. Distinguished Surgical Lecture, held July 11 at WRNMMC.

Woodson led the Military Health System from 2010 to 2016, directing it through a number of initiatives designed to modernize the agency with an annual budget of more than $50 billion and overseeing the care of the nation’s heroes, their families and other MHS beneficiaries.

Following his MHS tenure, Woodson returned to Boston University School of Medicine, where he had been named one of the top vascular surgeons in Boston in 2007 and in 2008, listed as one of the top surgeons in the United States. He currently leads Boston University’s Institute for Health System Innovation and Policy. The surgeon also holds the rank of brigadier general in the Army Reserve.

Woodson explained that the namesake for the lecture at which he spoke at WRNMMC, Dr. Francis Moore, had a career “defined by innovation and leadership.” Moore pioneered numerous experimental surgical treatments, including burn-trauma techniques, development of nuclear medicine, organ transplantation and hormonal therapy for breast cancer, Woodson added. Moore died in 2001.

“The other thing [Moore] did very well was build teams of scientists who could attack problems,” Woodson continued in discussing his topic, preparing surgeons for the future. “[Moore] built environments that could promote excellence and innovation,” said Woodson. This is what Woodson said he wants today’s surgeons and others in health care to do as well.

“It’s about building environments in which people can achieve their potential. [Moore] understood surgeons have a responsibility for exercising leadership and innovation not only in the science of care, but in the larger health care delivery system reforms,” Woodson furthered.

Woodson encouraged the WRNMMC providers to think about how they can use “the challenges of our times in health care and military medicine to make a difference in the care of not only surgical patients, but all patients, through leadership and innovation throughout their careers.”

A number of forces are “reshaping and disrupting traditional models of health care and stressing the system,” including the rise in health-care cost, Woodson said. He added digital technologies are also transforming health care.

“If the Military Health System adopted an enterprise management system, you’d control all of the variables,” Woodson continued speaking to those within the MHS. “You could much more easily than many of the civilian systems, create a highly effective and efficient system lowering cost and outpacing the civilian sector in terms of outcomes, and be the model for the United States, if not the rest of the world, in how to deliver care. [This] does require an enterprise focus.

“When you have a budget control act, [health care cost] competes with equipment, training and modernizing the rest of the force,” Woodson continued. “That’s really the tension – you can’t do the other jobs if in fact health care cost is 10, 12, or 14 percent of the [Department of Defense] budget,” he added.

Woodson said that this is not a “unique issue, [because] on a world scale, every society is grappling with the iron triangle of creating access, improving quality and outcome and creating sustainable systems. It’s the challenge of our times.”

He added some countries are exploring ways to leverage digital technologies to deliver more comprehensive care, particularly in remote areas where practitioners are limited.

The ultimate goal is to have a system that’s safe and does no harm, is effective and that every patient treated gets evidence-based care as soon as possible, Woodson explained. “We want to be efficient in terms of human and fiscal resources. We want a patient-centered care that is personalized,” he continued. “We want a system that’s equitable and everyone who needs care can get it. We want a system that’s high performing, which means that as new information is generated it actually is incorporated into care as soon as possible. We need to create a more connected system.

“Health care is complicated,” Woodson added. He said, “It’s a Gordian knot of historical, economic, legal regulations, politics, cultural, technological and professional issues that have gotten us to this point that needs to be untangled.”

Woodson said many components within the current health care system are operating independently rather than interdependently. “Clearly something needs to be done to better align the stakeholders.”

He added that technology has the potential to connect medical professionals across the continuum of care. This technology includes artificial intelligence, virtual reality, synthetic biology, nanobiology, genomics, proteomics, cognitive computing, robotics and more.

Woodson stated that health care systems “must adapt or die. Industries are being consumed by fast-moving tech companies with innovations in their business DNA.

In an article published in the Harvard Business Review in March, Woodson stated, “In a landmark 2016 study Johns Hopkins researchers estimated that more than 250,000 Americans die each year from treatment-related mistakes, making medical error the third-leading cause of death in the United States. As a former military flight surgeon trained in aviation accident investigations, I know well the hazards of misusing or mistrusting instruments…Pilots who aren’t adept at working with computer interfaces and don’t trust algorithms to help fly the aircraft will not just perform poorly, they’ll crash on takeoff.

“By better teaching [medical] students and practitioners how to fly by instruments and to trust those instruments, we could both improve training and solve many of the problems that lead to those medical errors…,” Woodson added.

“As the authors of the Johns Hopkins study pointed out, medical errors aren’t due to inherently bad doctors but often due to systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability. AI and digitization hold out the promise of addressing those problems — pulling together fragmented networks, coordinating care, standardizing protocols and practices, and providing the ultimate safety net in “fly by instruments” decision support,” he stated.

“Survival is not mandatory, extinction is a possibility,” Woodson said, explaining the importance for those in health care to adapt to meet the challenges within their profession while being innovators and leaders. “I think each of you are up to the challenge,” he concluded.