How Leah Binder’s Call for Transparency is No Longer
Falling on Deaf Ears
Welcome to the first edition of SwipeSeries, our new content series that features leaders in healthcare and their unique perspectives and experiences. Through exclusive, one-on-one conversations, we’ll talk with inspiring leaders about their outlook on innovation, policy, trends, their personal stories as patients and healthcare consumers, as well as their journeys working in healthcare, and any insight they have on how we can all work to improve healthcare in our country.
To kick off SwipeSeries, Mert Iseri, CEO of SwipeSense, spoke with Leah Binder, President & CEO of The Leapfrog Group, an award-winning national nonprofit based in Washington, D.C., representing employers and other purchasers of health care calling for improved safety and quality in hospitals. She is a regular contributor to Forbes.com and other publications, and consistently cited among the most influential people and top women in healthcare and patient safety.
Mert Iseri (MHI): Leah, it’s very nice to connect with you today. I want to start by first introducing you.
Leah Binder is the CEO of The Leapfrog Group, the most noteworthy organization in quality and safety today. Under her leadership, the organization created The Leapfrog Hospital Safety Grade, which is the single largest invention when it comes to patient safety and transparency. I’ve personally used the The Leapfrog Hospital Safety Grade to help choose physicians, and I want to encourage everyone to do the same as well. Leah, you're extremely thoughtful and passionate about an area we all care deeply about, and you’re someone that I have learned a great deal from, on this journey of patient safety.
To get started, is there a particular story or critical moment you can recall, that really brought your attention to patient safety?
Leah Binder (LB): Great, thank you for that very complimentary introduction, Mert. I really appreciate that! I don’t often get such positive feedback for our work in patient safety, simply because there’s some controversy around our willingness to point out the problems. I appreciate that you recognize our passion for patient safety, which includes sometimes pointing the finger at an actor who is not performing. At the same time we’re also very very happy to recognize achievements in patient safety. For too long, we’ve had a fee for service system where we pay providers regardless of how well they’re doing and we need to change that. The first step to that is to differentiate and recognize achievement and the lack thereof.
There’s two critical moments I’ll share about my motivation. Let me begin with the one area in my life that first paved the way for my interest in patient safety, though it didn’t directly create it. I was in second grade and I was sitting in the back of the class and could not understanding what was going on. I remember everyone else was talking and seemed to understand. The teacher kept coming up and yelling at me because I wasn’t on the right page in the book or I wasn’t doing anything right. They wanted to put me in special education, which at the time was before the American Disabilities Act, which meant I would be in a totally separate classroom with kids who had a whole variety of cognitive issues. I would have been completely separated out and my parents fought for that not to happen.
So there I was, sitting in the classroom, mostly being ignored, I was very quiet anyway, believe it or not, (laughs) and I didn’t know what was going on. It was demoralizing. In third grade the school system took an assessment of students to see how we were doing in all subjects. I took the standardized test and scored the highest in the school. That got the principal, teachers, and everyone asking “what is going on here…. We were wrong about this kid.”
Eventually, they figured out that I had been clinically deaf, and no one had diagnosed it, which happens a lot, actually. (Doctors were able to correct it fairly quickly.)
What that experience taught me at an early age is how devastating it is to be ignored. It goes against human nature. There’s a lot of research in management literature that says if you ignore your employees, it’s actually worse than constantly criticizing them. I’m not saying constantly criticizing your employees is a good thing, but surprisingly studies say it is worse to ignore them.
Fast forward many years and my father was in the hospital. He had a heart attack and he was only 42. I was visiting and one of the nurses referred to him as the ‘heart arrhythmia in bed 3.’ I just remember being upset by that. I was in my early 20’s, and my precious father, who I was so scared about his life, would be treated as this non-human entity. He did unfortunately die a couple weeks later. That memory is kind of meshed with the grief and the tragedy of his young death.
From these experiences I’ve derived a passion for fighting forces that ignore or dehumanize people. Fundamentally, when you don’t pay attention to patient safety, when you don’t think it’s important to wash your hands every single time you touch a patient, you are ignoring their humanity on a very fundamental level. Following rules to protect patient safety is really about respecting the experience of the patient at its most basic human level. And even though washing your hands might be a mundane, everyday thing to people who work in healthcare, it’s not an everyday thing for the patient in that bed. For them one single exception in hand washing can mean the difference between life and death.
MHI: I’m so sorry to hear that. Thank you for sharing such powerful stories. Your passion really shines through and I think it’s absolutely fantastic how you were able to take something as painful and difficult, and turn it into the work that inspires so many people, including myself today.
LB: Thank you. It’s really a pleasure to be with you and to talk a little bit about why I am so passionate about my work in patient safety and the possibility that we may give the next generation of Americans a far better healthcare system. It’s time for us to report on and give people the information they need to make good decisions about their healthcare and that’s what we’re all about at The Leapfrog Group.
MHI: That’s exactly what the American people deserve and the standard we want to set, not just in the U.S., but for the rest of the world. So I’m very thankful, for what it’s worth.
I want to change gears a little bit here. You’ve been in this world for a number of years now and you’ve seen healthcare change, slowly, but it does change. What are some of the particular technology trends you’re seeing, that you’re excited to see emerge as it relates to patient safety?
LB: I’m seeing some really innovative technologies for disinfecting rooms, or areas of the hospital that are quick and less time consuming and less labor intensive. I’m excited to see those in place because they’re fairly new and not as heavily adopted as we had hoped.
We’ve also been extremely frustrated at Leapfrog about the total lack of progress in hand hygiene. If you have to name the number one process or action a hospital can take to reduce its infection rate, it’s washing your hands. The lack of progress is emblematic of the lack of progress that the entire patient safety movement has to grapple with. I’m excited about some of the technologies coming out to better monitor hand hygiene, making it possible to improve efforts and the effectiveness of a hospital, not only in monitoring it, but more importantly, in enforcing improvements for hand hygiene. We’re watching these technologies closely.
MHI: That’s awesome to hear. Of course we know lasting change doesn’t always come from technology, but also through a solution that educates and enforces prioritization for those types of behaviors.
The deadline for hospitals to submit data for the next Leapfrog Hospital Survey has just passed in November. I know hospitals really care about this and their Leapfrog Hospital Safety Grades and as you mentioned, not every hospital gets an A. It’s a difficult thing to achieve and certainly real change must take place. What advice would you give to a health system looking to make significant improvements, knowing that every health system is unique? What are general rules of thumb that you’ve seen work, in most, if not all health systems, to improve scores?
LB: The number one thing I say-- and I realize this sounds simplistic, but it’s fundamentally the answer to your question-- is you have to make patient safety the priority and that takes absolute commitment from the C-suite on down. The C-suite has to start that process, and that means nobody gets punished for putting patient safety first. that means safety is first on the agenda at a board meeting. That means safety is the first thing we think about when we wake up in the morning and when we go to bed at night: Is this really safe?
In the hospitals that get an A all the time, patient safety is their priority, period. It’s really hard to do, by the way. The financial incentives are not aligned in this country toward patient safety so those hospitals are not necessarily following financial incentives to run their hospital, they’re following the incentives of their heart, which is we’re going to make this hospital patient safety focused.
We also see the ‘break out the champagne’ problem, which is where hospitals will say, “let’s really focus on central line infections this month.” They get their central line infection rate down to zero, the champagne comes out, and the next day they’re on to something else. Infections go up the next week, because the minute they stop putting the priority on this effort, they go back to where they were. Patient safety is in fact difficult because it’s not about breaking the champagne open. It’s about everyday vigilance. That’s more mundane than champagne, but extraordinarily important to people’s lives.
MHI: Absolutely. Mundane is perhaps the correct word. I make the analogy here that if you want to get in shape, you get a gym membership, you come up with a meal plan, you decide to eat healthy, cut down on carbs or whatever it is. You hit your weight goal and that health goal that you’re trying to achieve. Once that’s achieved, you don’t just go and order a pizza. You have to keep going.
What are some key milestones ahead for The Leapfrog Group?
LB: I would say our work around policy making. We want to push for more and better measures and we are really pushing against the tide on that. There’s a lot of effort to reduce the number of measures used to compare quality and safety. Some of that effort is good, because some measures are not very useful, but unfortunately, we’ve seen efforts to get rid of important measures including infection measures, which we fought for so long to have data on. What could be more important to anyone than to know the various infection rates of hospitals that you’re choosing between? We’ve had to really battle that one, and we want to stop battling defensively, and focus on offensively pushing for even more and better ways to measure providers.
The other thing we’d really like to see, are more opportunities to assess patient reported outcomes and their perspective on quality and safety in an organization. Right now there’s very little we can go on. Many hospitals will assess that for themselves, but they don’t typically make that public, and it’s not something we can compare one organization to another, which is what all of us consumers will want.
Finally, we have launched surveys to rate outpatient surgery and ambulatory surgery centers. Next year we will publicly report these options for consumers.
MHI: That’s fantastic and we look forward to hearing more about those initiatives. As we wrap up the conversation, can you recommend a podcast, book, or lecture for healthcare consumers, to help them make better choices for their healthcare, and also to simply learn more about patient safety and transparency?
LB: To be self-serving, I’m going to send readers to one of our two websites. Hospitalsafetygrade.org. I would encourage people to take a half hour to go through the information on our Hospital Safety Grade. I think it’s presented in a way that’s simple so you don’t need a PhD in clinical science to understand how we calculate the grades. It’s really interesting to understand all of the things that can go wrong in a hospital, but to also look at hospitals that are doing a great job in preventing those types of things, which can be encouraging as well.
In terms of books, I’m a bookworm, so I usually pull out a library for you. One book that I strongly recommend is When Doctors Don’t Listen: How to Avoid Misdiagnosis and Unnecessary Tests. It’s by Leana Wen and Dr. Joshua Kosowsky. It’s a very useful book on how to make your case and make sure you’re avoiding misdiagnosis.
MHI: I’ll be sure to add that to my reading list. That’s a perfect note to end on. Thank you so much for this delightful conversation. It’s a pleasure as always. I have certainly learned a lot and I think folks have a lot do dig in on, from this conversation.
Want to join the SwipeSeries conversation? We’re looking to connect with interesting people who are passionate about healthcare, technology, innovation, entrepreneurship, you name it! Want to share your story or have an idea for a great interview? Get in touch.