(as of July 2006)
Q. How did the idea for Remaking American Medicine begin?
A. The project began with a phone call in July 2001 from representatives of The Robert Wood Johnson Foundation® and Dr. Donald Berwick, president and CEO of the Institute for Healthcare Improvement (IHI). They asked my colleagues and me if we would consider making a documentary on quality improvement. To be candid, I had no idea what quality improvement was. It was very hard to understand what they were talking about from the language they used. But like many people who have come face to face with health care issues, I was very interested in the opportunity to help make positive change.
Q. What support did you receive from The Robert Wood Johnson Foundation?
A. We were fortunate to receive a 10-month planning grant from the Foundation that allowed us to learn about the complexities of health care and to interpret the language used to describe how many people across the country were working to improve the quality of health care.
Q. How did the series evolve from your planning and research?
A. After talking with many health quality experts and reviewing what was already available, we decided on a two-pronged strategy. First, we proposed producing a four-part primetime series intended for PBS. We felt that PBS would be the ideal venue for a thoughtful and compelling exploration of health care quality. We also decided that the television series had to change the way the public and the medical community think about the quality of health care. To that end, we knew we needed to do something more than develop the traditional PR campaign that public television producers rush to create at the last minute. So, we engaged Devillier Communications, Inc. to plan a multi-year, multi-million-dollar communications and public engagement campaign to complement the series. The goals are to build momentum for supporting quality improvement efforts across the country, while at the same time attract viewers to watch the programs.
Second, we believed that a series of videos designed to motivate health care professionals to think differently about the care they deliver could be a powerful tool to spread the quality message. We proposed to the Foundation that these videos be based on the experiences of the seven health care institutions that received a grant as a part of the Pursuing Perfection initiative, funded by The Robert Wood Johnson Foundation.
Q. What observations did you make while talking with various health care providers around the country?
A. For anyone reading the newspapers or watching TV, it is easy to become alarmed by the stories of harm and death caused by a system that is intended to provide care. The people we met put a human face on the alarming statistics of medical error reported by the Institute of Medicine and others. Like many, we are concerned by a health care system that is not prepared to cope with the dramatic increase in chronic diseases. We address that topic in one of the series programs. Likewise, we were puzzled by why the health care industry lags so far behind other industries in the use of information technology and evidence to make decisions about treatment.
But rather than just blaming individuals for medical errors and inconsistent health care practices, we also need to acknowledge our own role in improving the quality of care we receive. Our access to people on the front lines of health care provided us a remarkable opportunity to look behind the curtain, and we have had incredible access to tell compelling stories for the PBS series. We have gained the trust of a wide variety of institutions and individuals, and they have shown us their problems and the solutions they are working on to repair the flaws in their systems of care. Ultimately, Remaking American Medicine focuses on the successes of those pioneers who are committed to making health care better for all of us.
Q. How do you envision the Remaking American Medicine outreach campaign working?
A. We have already recruited 49 national organizations (as of August 2006) representing health care providers, patients and consumers, purchasers, government and regulatory groups and health care quality experts throughout the country to become our National Partners in this effort. National Partners are communicating with their members and constituents about the series. We are providing them with products and tools to generate grassroots activities in conjunction with local PBS stations.
Anchoring much of this work at the local and regional level will be the Medicare Quality Improvement Organizations (QIOs) who are forming coalitions of like-minded organizations. QIOs were among the first organizations to understand how they could use Remaking American Medicine and the public engagement campaign as a vehicle to further advance the work they are already doing to improve health care quality. We are extremely grateful for their engagement.
We also created an incentive grants program to help PBS stations establish coalitions or participate in coalition activities already being initiated by QIOs and local members of our National Partners. Twenty-two grants were provided through this process, and there are some exciting community-based activities underway that will help consumers become more active in taking control of their own health care.
Q. What are some of the products and tools being created to support the campaign?
A. Among the tools we are creating is www.RAMcampaign.org, which serves as the nerve center of this effort. The Web site went live in March 2005 and provides an opportunity for QIOs, National Partners and their constituents to receive the latest information on the series and download various promotional and organizing tools, including a Leadership Guide that we created. A very important aspect of the site is a searchable database that includes contact information for organizations throughout the country working to improve health care. The database allows groups and individuals to learn about others interested in this issue and to provide contact information that will help them link up with each other. Through the database, we help groups connect with each other, stimulating further coalition development and grassroots activities. The Web site is an important way to connect groups who don't normally work together. In the long run, we think the site can help create sustainable relationships among people who are committed to championing continuous improvement in the quality of health care.
We are also developing tools to help coalitions work effectively with their PBS stations and promotional materials to help them spread the word in the health care community. In spring 2006, we'll be launching a media campaign and providing turnkey materials to QIOs and National Partners that they can use with their press contacts.
Q. How is production work for Remaking American Medicine and the educational videos progressing?
A. We've completed 18 months of production in the seven Pursuing Perfection health care institutions, videotaping over 400 hours of footage. This has been edited into seven 20-minute motivational videos designed for health care professionals. The series is called Pursuing Perfection in Health Care, and was premiered at the Institute for Healthcare Improvement (IHI) National Forum in December 2004.
Remaking American Medicine, intended for broadcast on PBS, builds on what we learned while developing the educational series, but frames the issue of quality improvement from the perspective of consumers. In the series we tell the story of Sorrel King, whose 18-month-old daughter was taken to Johns Hopkins Hospital after a bathtub accident left her with second degree burns over 60 percent of her body. Josie was on the mend, but just a few days short of discharge, Sorrell began to notice a change in Josie’s condition. She alerted hospital staff to her daughter’s declining condition, but her pleas were dismissed by the child’s care providers. Two days later Josie died of dehydration. We follow the story of Anna Terrano, an 89-year-old woman admitted to Hackensack University Medical Center, who, like patients all across the country, was a victim of a medication error. For two days, Anna did not receive her pain medication due to a transcription error, and she suffered increasingly debilitating withdrawal symptoms. But our goal is to also show the work of pioneering leaders, like Dr. Donald Berwick, who through IHI’s 100,000 Lives Campaign are attempting to reverse the tragic consequences encountered by Sorrell, Anna and millions of other patients and their families.
Throughout this process, we've relied on an Advisory Panel of some of the leading experts in quality health care. People like Dr. Donald Berwick, IHI; Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality; Dr. Ed Wagner at the MacColl Institute for Healthcare Innovation; and Dr. Brent James, vice president of medical research and continuing medical education at Intermountain Health Care are providing excellent guidance on the series content.
Q. How would you sum up Remaking American Medicine?
A. At the core of Remaking American Medicine™...Health Care for the 21st Century is our effort to tell stories, to allow the words of those on the front lines - providers and patients - to create the language that will communicate to us all the power of the transformation that is taking place across the nation.
But we would not be able to tell any of these stories if it were not for the courage and moral conviction of visionary leaders of health care institutions who are cooperating with us. They have embraced the concept of transparency and breathed life into it. They have shown us their problems as well as their struggles to pursue perfection in the care they deliver.
As a filmmaker, this has been one of the most challenging yet equally rewarding projects I have ever worked on. I believe this series and the public engagement campaign will highlight the work of hundreds of organizations that are creating an environment where quality of health care is a goal for all of us. It's a goal well worth working toward.