Vineet Arora, MD

The word legacy has been synonymous with death to me. When so and so dies, we discuss their legacy. I had a powerful experience that changed my mind on this word that is befitting for this Legacies column.

Seven years ago, I was sitting in a room of powerful women and I was the youngest one there. I wasn’t sure how I got there, but I was glad I did because it changed my life. At the time, I was panicked. The exercise was called “Craft your legacy statement.”

But, this exercise was different. The ask was to “live into your legacy.” Craft a legacy statement in THREE minutes that summarizes what you want your legacy to be … and then decide the three things you need to do now to get there. So, here is my exact legacy 3-minute statement: I am an innovator pushing teaching hospitals to optimize training and patient care delivery through novel technologies and systems science. Clearly, I did not aim high enough. One of the other attendees stated her legacy simply as “Unleash the impossible!” So clearly, I was not able to think big at that moment, but I trudged on.

Next, I had to write the three things I was going to do to enact my legacy today. Things went from bad to worse quickly since I knew this was not going to be easy. The #1 thing had to be something I was going to stop doing because it did not fit with my legacy; #2 was what I was going to start doing to enact this legacy now; and, #3 was something I was going to do to get me closer to what I wanted to be doing. So, my #1, resign my current leadership role that I had had for 8 years; #2, start joining national committees that bridge education and quality; and #3, meet with senior leadership to pitch this new role as a bridging leader, aligning education and quality.

Like all conferences, I went home and forgot what I had done and learned. I settled back into my old life and routines. A few weeks later, a plain looking envelope with awful penmanship showed up at my doorstep addressed to me. It wasn’t until after I opened it and read what was inside that I realized I was the one with horrible penmanship! I completely forgot that I wrote this letter to myself even though they told me it would come and I would forget I wrote it! So, how did I do? Let’s just say if the letter did not arrive, I am not sure where I would be. Fortunately, it did come, and I followed my own orders. Fast forward to present day and I recently stepped into a new role – associate chief medical officer: clinical learning environment – a bridging leader who aligns education and clinical care missions for our health system. Let’s just say again, had that letter not arrived, I am not sure where I would be now.

• Be bold. Years ago, when I was asked by my chair who they should pick to be chief resident, I thought “This must be a trick question – I should definitely tell him why I should be chosen – and then pick the next best person who I want to work with.” Apparently, I was the only person who did that, and that is why my chair chose me. Everyone else picked two other people. So the take-home point here is do not sell yourself short … ever.
• Look for the hidden gateways. A few years ago, I was asked if I wanted to be an institutional leader by the person who currently had that role. I was kind of thrown for a loop, since of course I would not want to appear like I wanted to take his job. I said everything was fine and I felt pretty good about my current positions. It was only a few weeks later that I realized that he was ascertaining my interest in his job since he was leaving. They gave the job to someone else and the word on the street was I was not interested. I totally missed the gate! While it wasn’t necessarily the job I missed out on, it was the opportunity to consider the job because I was afraid. So, don’t miss the gate. It’s the wormhole to a different life that may be the right one for you, but you need to “see it” to seize it.
• Work hard for the money and for the fun. There are many things Gwyneth Paltrow does that I do not agree with, but I will give her credit for one important lesson: she divides her movie roles into those she does for love (for example, The Royal Tenenbaums) and those she does for money (for example, Shallow Hal). It made me realize that even a Hollywood starlet has to do the stuff she may not want to do for the money. So, as a young person, you have to work hard for the money, but ideally it will help you take on a project you love, whatever it is. You’ve won the game when you’re mostly paid to work for the fun ... but that may take some time.
• Always optimize what is best for you personally AND professionally. While I was on maternity leave, the job of my dreams presented itself – or so I thought it did. It was at the intersection of policy, quality, and education, with a national stage, and I would not need to move. But, I knew I could not accept the travel commitment with a young child. While I wondered if I would have regrets, it turns out the right decision professionally also has to work personally. Likewise, there are professional obligations that I take on because it works personally.
• Figure out who your tea house pals are. A few years ago, I was in San Francisco with two close friends having an epic moment about what to do with our lives as adults. We were all on the cusp of changing our directions. Not surprisingly, we could see what the other needed to do, but we could not see it for ourselves. We still text each other sometimes about the need to go back to the Tea House. Sometimes your “tea house pals” are not necessarily those around you every day. They know you, but not everyone in your work place. This “arm’s length” or distance gives them the rational, unbiased perspective to advise you, that you or your colleagues will never have.
• Look for ways to enjoy the journey. Medicine is a very long road. I routinely think about this working with all the trainees and junior faculty I encounter. You can’t be in this solely for the end of the journey. The key is to find the joy in the journey. For me, that has always come from seeking out like-minded fellow travelers to share my highs and lows. While I tweet for many reasons, a big reason is that I take pleasure in watching others on the journey and also sharing my own journey.

Here’s to your journey and living your legacy!

Dr. Arora is associate chief medical officer, clinical learning environment, at University of Chicago Medicine, and assistant dean for scholarship and discovery at the University of Chicago Pritzker School of Medicine. You can follow her journey on Twitter.

The word legacy has been synonymous with death to me. When so and so dies, we discuss their legacy. I had a powerful experience that changed my mind on this word that is befitting for this Legacies column.

Seven years ago, I was sitting in a room of powerful women and I was the youngest one there. I wasn’t sure how I got there, but I was glad I did because it changed my life. At the time, I was panicked. The exercise was called “Craft your legacy statement.”

But, this exercise was different. The ask was to “live into your legacy.” Craft a legacy statement in THREE minutes that summarizes what you want your legacy to be … and then decide the three things you need to do now to get there. So, here is my exact legacy 3-minute statement: I am an innovator pushing teaching hospitals to optimize training and patient care delivery through novel technologies and systems science. Clearly, I did not aim high enough. One of the other attendees stated her legacy simply as “Unleash the impossible!” So clearly, I was not able to think big at that moment, but I trudged on.

Next, I had to write the three things I was going to do to enact my legacy today. Things went from bad to worse quickly since I knew this was not going to be easy. The #1 thing had to be something I was going to stop doing because it did not fit with my legacy; #2 was what I was going to start doing to enact this legacy now; and, #3 was something I was going to do to get me closer to what I wanted to be doing. So, my #1, resign my current leadership role that I had had for 8 years; #2, start joining national committees that bridge education and quality; and #3, meet with senior leadership to pitch this new role as a bridging leader, aligning education and quality.

Like all conferences, I went home and forgot what I had done and learned. I settled back into my old life and routines. A few weeks later, a plain looking envelope with awful penmanship showed up at my doorstep addressed to me. It wasn’t until after I opened it and read what was inside that I realized I was the one with horrible penmanship! I completely forgot that I wrote this letter to myself even though they told me it would come and I would forget I wrote it! So, how did I do? Let’s just say if the letter did not arrive, I am not sure where I would be. Fortunately, it did come, and I followed my own orders. Fast forward to present day and I recently stepped into a new role – associate chief medical officer: clinical learning environment – a bridging leader who aligns education and clinical care missions for our health system. Let’s just say again, had that letter not arrived, I am not sure where I would be now.

• Be bold. Years ago, when I was asked by my chair who they should pick to be chief resident, I thought “This must be a trick question – I should definitely tell him why I should be chosen – and then pick the next best person who I want to work with.” Apparently, I was the only person who did that, and that is why my chair chose me. Everyone else picked two other people. So the take-home point here is do not sell yourself short … ever.
• Look for the hidden gateways. A few years ago, I was asked if I wanted to be an institutional leader by the person who currently had that role. I was kind of thrown for a loop, since of course I would not want to appear like I wanted to take his job. I said everything was fine and I felt pretty good about my current positions. It was only a few weeks later that I realized that he was ascertaining my interest in his job since he was leaving. They gave the job to someone else and the word on the street was I was not interested. I totally missed the gate! While it wasn’t necessarily the job I missed out on, it was the opportunity to consider the job because I was afraid. So, don’t miss the gate. It’s the wormhole to a different life that may be the right one for you, but you need to “see it” to seize it.
• Work hard for the money and for the fun. There are many things Gwyneth Paltrow does that I do not agree with, but I will give her credit for one important lesson: she divides her movie roles into those she does for love (for example, The Royal Tenenbaums) and those she does for money (for example, Shallow Hal). It made me realize that even a Hollywood starlet has to do the stuff she may not want to do for the money. So, as a young person, you have to work hard for the money, but ideally it will help you take on a project you love, whatever it is. You’ve won the game when you’re mostly paid to work for the fun ... but that may take some time.
• Always optimize what is best for you personally AND professionally. While I was on maternity leave, the job of my dreams presented itself – or so I thought it did. It was at the intersection of policy, quality, and education, with a national stage, and I would not need to move. But, I knew I could not accept the travel commitment with a young child. While I wondered if I would have regrets, it turns out the right decision professionally also has to work personally. Likewise, there are professional obligations that I take on because it works personally.
• Figure out who your tea house pals are. A few years ago, I was in San Francisco with two close friends having an epic moment about what to do with our lives as adults. We were all on the cusp of changing our directions. Not surprisingly, we could see what the other needed to do, but we could not see it for ourselves. We still text each other sometimes about the need to go back to the Tea House. Sometimes your “tea house pals” are not necessarily those around you every day. They know you, but not everyone in your work place. This “arm’s length” or distance gives them the rational, unbiased perspective to advise you, that you or your colleagues will never have.
• Look for ways to enjoy the journey. Medicine is a very long road. I routinely think about this working with all the trainees and junior faculty I encounter. You can’t be in this solely for the end of the journey. The key is to find the joy in the journey. For me, that has always come from seeking out like-minded fellow travelers to share my highs and lows. While I tweet for many reasons, a big reason is that I take pleasure in watching others on the journey and also sharing my own journey.

Here’s to your journey and living your legacy!

Dr. Arora is associate chief medical officer, clinical learning environment, at University of Chicago Medicine, and assistant dean for scholarship and discovery at the University of Chicago Pritzker School of Medicine. You can follow her journey on Twitter.

The word legacy has been synonymous with death to me. When so and so dies, we discuss their legacy. I had a powerful experience that changed my mind on this word that is befitting for this Legacies column.

Seven years ago, I was sitting in a room of powerful women and I was the youngest one there. I wasn’t sure how I got there, but I was glad I did because it changed my life. At the time, I was panicked. The exercise was called “Craft your legacy statement.”

But, this exercise was different. The ask was to “live into your legacy.” Craft a legacy statement in THREE minutes that summarizes what you want your legacy to be … and then decide the three things you need to do now to get there. So, here is my exact legacy 3-minute statement: I am an innovator pushing teaching hospitals to optimize training and patient care delivery through novel technologies and systems science. Clearly, I did not aim high enough. One of the other attendees stated her legacy simply as “Unleash the impossible!” So clearly, I was not able to think big at that moment, but I trudged on.

Next, I had to write the three things I was going to do to enact my legacy today. Things went from bad to worse quickly since I knew this was not going to be easy. The #1 thing had to be something I was going to stop doing because it did not fit with my legacy; #2 was what I was going to start doing to enact this legacy now; and, #3 was something I was going to do to get me closer to what I wanted to be doing. So, my #1, resign my current leadership role that I had had for 8 years; #2, start joining national committees that bridge education and quality; and #3, meet with senior leadership to pitch this new role as a bridging leader, aligning education and quality.

Like all conferences, I went home and forgot what I had done and learned. I settled back into my old life and routines. A few weeks later, a plain looking envelope with awful penmanship showed up at my doorstep addressed to me. It wasn’t until after I opened it and read what was inside that I realized I was the one with horrible penmanship! I completely forgot that I wrote this letter to myself even though they told me it would come and I would forget I wrote it! So, how did I do? Let’s just say if the letter did not arrive, I am not sure where I would be. Fortunately, it did come, and I followed my own orders. Fast forward to present day and I recently stepped into a new role – associate chief medical officer: clinical learning environment – a bridging leader who aligns education and clinical care missions for our health system. Let’s just say again, had that letter not arrived, I am not sure where I would be now.

• Be bold. Years ago, when I was asked by my chair who they should pick to be chief resident, I thought “This must be a trick question – I should definitely tell him why I should be chosen – and then pick the next best person who I want to work with.” Apparently, I was the only person who did that, and that is why my chair chose me. Everyone else picked two other people. So the take-home point here is do not sell yourself short … ever.
• Look for the hidden gateways. A few years ago, I was asked if I wanted to be an institutional leader by the person who currently had that role. I was kind of thrown for a loop, since of course I would not want to appear like I wanted to take his job. I said everything was fine and I felt pretty good about my current positions. It was only a few weeks later that I realized that he was ascertaining my interest in his job since he was leaving. They gave the job to someone else and the word on the street was I was not interested. I totally missed the gate! While it wasn’t necessarily the job I missed out on, it was the opportunity to consider the job because I was afraid. So, don’t miss the gate. It’s the wormhole to a different life that may be the right one for you, but you need to “see it” to seize it.
• Work hard for the money and for the fun. There are many things Gwyneth Paltrow does that I do not agree with, but I will give her credit for one important lesson: she divides her movie roles into those she does for love (for example, The Royal Tenenbaums) and those she does for money (for example, Shallow Hal). It made me realize that even a Hollywood starlet has to do the stuff she may not want to do for the money. So, as a young person, you have to work hard for the money, but ideally it will help you take on a project you love, whatever it is. You’ve won the game when you’re mostly paid to work for the fun ... but that may take some time.
• Always optimize what is best for you personally AND professionally. While I was on maternity leave, the job of my dreams presented itself – or so I thought it did. It was at the intersection of policy, quality, and education, with a national stage, and I would not need to move. But, I knew I could not accept the travel commitment with a young child. While I wondered if I would have regrets, it turns out the right decision professionally also has to work personally. Likewise, there are professional obligations that I take on because it works personally.
• Figure out who your tea house pals are. A few years ago, I was in San Francisco with two close friends having an epic moment about what to do with our lives as adults. We were all on the cusp of changing our directions. Not surprisingly, we could see what the other needed to do, but we could not see it for ourselves. We still text each other sometimes about the need to go back to the Tea House. Sometimes your “tea house pals” are not necessarily those around you every day. They know you, but not everyone in your work place. This “arm’s length” or distance gives them the rational, unbiased perspective to advise you, that you or your colleagues will never have.
• Look for ways to enjoy the journey. Medicine is a very long road. I routinely think about this working with all the trainees and junior faculty I encounter. You can’t be in this solely for the end of the journey. The key is to find the joy in the journey. For me, that has always come from seeking out like-minded fellow travelers to share my highs and lows. While I tweet for many reasons, a big reason is that I take pleasure in watching others on the journey and also sharing my own journey.

Here’s to your journey and living your legacy!

Dr. Arora is associate chief medical officer, clinical learning environment, at University of Chicago Medicine, and assistant dean for scholarship and discovery at the University of Chicago Pritzker School of Medicine. You can follow her journey on Twitter.

Recently, I was asked to present my top public speaking tips for a group of women leaders. This is a topic near and dear to my heart, and one that I teach a number of groups, from medical students to faculty.

I also benefited from just returning from the Harvard Macy Educators Course, where Victoria Brazil, MD, an experienced emergency medicine physician from Australia, provided her top tips. Here is a mash-up of the top tips to think about for any of the speakers out there among us – with a few shout-outs for the ladies out there. Please add your own!

The Dos

• Do project power: Stand tall with a relaxed stance and shoulders back – posture is everything. This is especially important for women, who may tend to shrink their bodies, or anyone who is short. A powerful messenger is just as important as the power of the message. The same also applies to sitting down, especially if you are on a panel. Do not look like you are falling into the table.
• Do look up: Think about addressing the people in the back, not in the front row. This looks better in photos as well since you are appealing to the large audience and not the front row. Dr. Brazil’s tip came from Cate Blanchett who said that before she gives talks, she literally and physically advises “picking up your crown and put it on your head.” Not only will you feel better, you will look it too.
• Do pause strategically: The human brain needs rest to process what you are about to say. You can ask people to “think of a time” and take a pause. Or “I want you to all think about what I just said for one moment.” And TAKE a moment. But think about Emma’s pause during the March For Your Lives. Pauses are powerful and serve as a way to cement what you are saying for even the most critical crowd. Think about when anyone on their phone pauses, even if you’re on a boring conference call others will wake up and wonder what is going on and are now engaged in the talk.
• Do strategically summarize: Before you end, or in between important sections, say the following: “There are three main things you can do.” Even if someone fell asleep, they will wake up to take note. It’s a way to get folks’ attention back. There is nothing like challenging others to do something.

The Don’ts

• Don’t start with an apology for “not being an expert”: Or whatever you are thinking about apologizing for. The voice in your head does not need to be broadcast to others. Just say thank you after you are introduced, and launch in. Someone has asked you to talk, so bring your own unique expertise and don’t start with undermining yourself!
• Don’t use your slides as a crutch: Make your audience look at you and not your slides. That means at times, you may be talking and your slides will not be moving. Other times, if you are starting with a story, maybe there is no slide behind you and the screen is blacked out. Some of the most powerful moments in a talk are when slides are not being used.
• Don’t stand behind the podium if you can help it. This means ask for a wireless microphone. Most podiums will overwhelm you. If you have to use a podium, go back to the posture in the “dos.” One year, I had a leg injury and definitely used the podium, so obviously there may be times you need to use a podium; even then, try as hard as possible to make sure you are seen.
• Don’t engage grandstanders during Q&A: Invariably, you will get someone who stands up and goes into a long comment that is not a question to hear themselves speak. Insert yourself, say “thank you” and take the next question. If there is not a next question, you can add, “Before I forget, I want to share another question I am often asked which may be of help to you.” Then, answer your own question. You get the final word this way!

Happy speaking! I look forward to seeing you in warmer weather during the spring conference season.

For more posts from the Hospital Leader blog, visit hospitalleader.org.

Recently, I was asked to present my top public speaking tips for a group of women leaders. This is a topic near and dear to my heart, and one that I teach a number of groups, from medical students to faculty.

I also benefited from just returning from the Harvard Macy Educators Course, where Victoria Brazil, MD, an experienced emergency medicine physician from Australia, provided her top tips. Here is a mash-up of the top tips to think about for any of the speakers out there among us – with a few shout-outs for the ladies out there. Please add your own!

The Dos

• Do project power: Stand tall with a relaxed stance and shoulders back – posture is everything. This is especially important for women, who may tend to shrink their bodies, or anyone who is short. A powerful messenger is just as important as the power of the message. The same also applies to sitting down, especially if you are on a panel. Do not look like you are falling into the table.
• Do look up: Think about addressing the people in the back, not in the front row. This looks better in photos as well since you are appealing to the large audience and not the front row. Dr. Brazil’s tip came from Cate Blanchett who said that before she gives talks, she literally and physically advises “picking up your crown and put it on your head.” Not only will you feel better, you will look it too.
• Do pause strategically: The human brain needs rest to process what you are about to say. You can ask people to “think of a time” and take a pause. Or “I want you to all think about what I just said for one moment.” And TAKE a moment. But think about Emma’s pause during the March For Your Lives. Pauses are powerful and serve as a way to cement what you are saying for even the most critical crowd. Think about when anyone on their phone pauses, even if you’re on a boring conference call others will wake up and wonder what is going on and are now engaged in the talk.
• Do strategically summarize: Before you end, or in between important sections, say the following: “There are three main things you can do.” Even if someone fell asleep, they will wake up to take note. It’s a way to get folks’ attention back. There is nothing like challenging others to do something.

The Don’ts

• Don’t start with an apology for “not being an expert”: Or whatever you are thinking about apologizing for. The voice in your head does not need to be broadcast to others. Just say thank you after you are introduced, and launch in. Someone has asked you to talk, so bring your own unique expertise and don’t start with undermining yourself!
• Don’t use your slides as a crutch: Make your audience look at you and not your slides. That means at times, you may be talking and your slides will not be moving. Other times, if you are starting with a story, maybe there is no slide behind you and the screen is blacked out. Some of the most powerful moments in a talk are when slides are not being used.
• Don’t stand behind the podium if you can help it. This means ask for a wireless microphone. Most podiums will overwhelm you. If you have to use a podium, go back to the posture in the “dos.” One year, I had a leg injury and definitely used the podium, so obviously there may be times you need to use a podium; even then, try as hard as possible to make sure you are seen.
• Don’t engage grandstanders during Q&A: Invariably, you will get someone who stands up and goes into a long comment that is not a question to hear themselves speak. Insert yourself, say “thank you” and take the next question. If there is not a next question, you can add, “Before I forget, I want to share another question I am often asked which may be of help to you.” Then, answer your own question. You get the final word this way!

Happy speaking! I look forward to seeing you in warmer weather during the spring conference season.

For more posts from the Hospital Leader blog, visit hospitalleader.org.

Recently, I was asked to present my top public speaking tips for a group of women leaders. This is a topic near and dear to my heart, and one that I teach a number of groups, from medical students to faculty.

I also benefited from just returning from the Harvard Macy Educators Course, where Victoria Brazil, MD, an experienced emergency medicine physician from Australia, provided her top tips. Here is a mash-up of the top tips to think about for any of the speakers out there among us – with a few shout-outs for the ladies out there. Please add your own!

The Dos

• Do project power: Stand tall with a relaxed stance and shoulders back – posture is everything. This is especially important for women, who may tend to shrink their bodies, or anyone who is short. A powerful messenger is just as important as the power of the message. The same also applies to sitting down, especially if you are on a panel. Do not look like you are falling into the table.
• Do look up: Think about addressing the people in the back, not in the front row. This looks better in photos as well since you are appealing to the large audience and not the front row. Dr. Brazil’s tip came from Cate Blanchett who said that before she gives talks, she literally and physically advises “picking up your crown and put it on your head.” Not only will you feel better, you will look it too.
• Do pause strategically: The human brain needs rest to process what you are about to say. You can ask people to “think of a time” and take a pause. Or “I want you to all think about what I just said for one moment.” And TAKE a moment. But think about Emma’s pause during the March For Your Lives. Pauses are powerful and serve as a way to cement what you are saying for even the most critical crowd. Think about when anyone on their phone pauses, even if you’re on a boring conference call others will wake up and wonder what is going on and are now engaged in the talk.
• Do strategically summarize: Before you end, or in between important sections, say the following: “There are three main things you can do.” Even if someone fell asleep, they will wake up to take note. It’s a way to get folks’ attention back. There is nothing like challenging others to do something.

The Don’ts

• Don’t start with an apology for “not being an expert”: Or whatever you are thinking about apologizing for. The voice in your head does not need to be broadcast to others. Just say thank you after you are introduced, and launch in. Someone has asked you to talk, so bring your own unique expertise and don’t start with undermining yourself!
• Don’t use your slides as a crutch: Make your audience look at you and not your slides. That means at times, you may be talking and your slides will not be moving. Other times, if you are starting with a story, maybe there is no slide behind you and the screen is blacked out. Some of the most powerful moments in a talk are when slides are not being used.
• Don’t stand behind the podium if you can help it. This means ask for a wireless microphone. Most podiums will overwhelm you. If you have to use a podium, go back to the posture in the “dos.” One year, I had a leg injury and definitely used the podium, so obviously there may be times you need to use a podium; even then, try as hard as possible to make sure you are seen.
• Don’t engage grandstanders during Q&A: Invariably, you will get someone who stands up and goes into a long comment that is not a question to hear themselves speak. Insert yourself, say “thank you” and take the next question. If there is not a next question, you can add, “Before I forget, I want to share another question I am often asked which may be of help to you.” Then, answer your own question. You get the final word this way!

Happy speaking! I look forward to seeing you in warmer weather during the spring conference season.

For more posts from the Hospital Leader blog, visit hospitalleader.org.

EDITOR’S NOTE: A version of this article originally appeared on Medpage Today on May 5, 2015.

By now, we have all heard the stories about unconscionable medical bills causing financial harm for patients. We have read about more Americans than ever before on high-deductible health insurance plans. Some of us have even helped our parents navigate the deceptively simple-looking bronze, silver, and gold tiers of the insurance exchanges, weighing the gamble of increasingly unaffordable monthly premiums against catastrophically high deductibles and out-of-pocket costs.

We have accepted the fact that healthcare costs are out of control and causing real constraints on every level, from individuals to communities to businesses to states to our nation.

OK, but now what are we supposed to do about it?

“Remarkably, given the importance of this issue, until now, we lacked a roadmap to attack it,” wrote Bob Wachter, MD, in the foreword to our new book, Understanding Value-Based Healthcare. “Now we have one.”

For starters, we can supply a pipeline for change by embedding the principles of value-based care in the apprenticeship of health professional education. Recently, the leaders of the soon-to-open Dell Medical School at University of Texas-Austin articulated their plan to build their entire curriculum around teaching students to root out waste and to care for the health of the community. This is the clearest example that medical educators are taking seriously the calls to action coming from the Accreditation Council for Graduate Medical Education (ACGME), the Association of American Medical Colleges (AAMC), the American College of Physicians (ACP), and other leaders to address healthcare value in training very seriously. However, the front lines are not waiting for new medical schools to open up or for massive curricular overhauls. The Second Annual Teaching Value and Choosing Wisely Challenge that we organized resulted in 80 submissions spanning the country (and Canada). The authors, including five students, 30 residents or fellows, and at least 41 faculty members, described their bright ideas and innovations for integrating healthcare value into education.

Education is fundamental but will not be enough. We must also practice what we preach. Practicing clinicians can deflate medical bills for their patients by advocating for appropriate care, considering patient affordability in customizing treatments, and leading local initiatives to improve value of care.

Clinicians can advocate for appropriate care by avoiding low-value services at the point of care. Specific targets for improving appropriate resource utilization may be identified from resources such as Choosing Wisely lists, guidelines, and appropriateness criteria. Physicians will need to understand the true risks and benefits of recommended therapies and learn ways to communicate this balance with patients.

Patient affordability is increasingly important, with more patients now facing astronomically high out-of-pocket bills, even for simple medical treatments or procedures. A December 2014 CBS/New York Times poll found that 80% of Americans now think their doctor should discuss the cost of recommended medical treatment with them ahead of time. Clinicians can screen their patients for financial harm and can help them navigate the trade-offs of lower cost options. Physicians should seek to provide high-value prescribing, which entails recommending the simplest medication regimen that minimizes physical and financial risk to the patient while achieving the best outcome. In other words, decreasing either cost, complexity, or risk of medications can improve value—and clinicians should aim to improve all three simultaneously.

In addition to reducing waste and considering patient affordability, clinicians are ideal leaders of local value initiatives, whether they accomplish this by running value improvement projects or by launching formal high-value care programs. Our framework to guide value improvement project design is “COST”: culture, oversight accountability, system support, and training. This approach leverages principles from implementation science to ensure that value improvement projects successfully provide multi-pronged tactics for overcoming the many barriers to high-value care delivery. At some locations across the country, individual efforts have matured into entire groups dedicated to designing and implementing value-improvement initiatives, including the UCSF High Value Care Committee, the Johns Hopkins High-Value Care Committee, Johns Hopkins Bayview Physicians for Responsible Ordering (PRO), and “High-Value Carolina” in North Carolina.

Health professionals are faced with a responsibility to help deflate medical bills. To achieve this goal, clinicians can advocate for appropriate care, consider patient affordability, and lead local value improvement initiatives. For those ready to tackle this challenge, we elaborate on and explain some of these necessary tools in our book, Understanding Value-Based Healthcare.

The Hospital Leader

Hospitalists of all kinds are sharing their perspective and experience at SHM’s official blog, “The Hospital Leader,” including their reflections on how hospitalists can tackle healthcare costs. For more posts, visit www.shmblog.org.

Hot on HMX

Hospital Medicine Exchange (HMX) empowers SHM members to share and collaborate on some of the most important topics in healthcare today. Recently, hospitalists have been discussing issues like:

• Patient satisfaction • Geographic rounding • LACE Score

To share your own perspective on these topics—or start a new conversation.

EDITOR’S NOTE: A version of this article originally appeared on Medpage Today on May 5, 2015.

By now, we have all heard the stories about unconscionable medical bills causing financial harm for patients. We have read about more Americans than ever before on high-deductible health insurance plans. Some of us have even helped our parents navigate the deceptively simple-looking bronze, silver, and gold tiers of the insurance exchanges, weighing the gamble of increasingly unaffordable monthly premiums against catastrophically high deductibles and out-of-pocket costs.

We have accepted the fact that healthcare costs are out of control and causing real constraints on every level, from individuals to communities to businesses to states to our nation.

OK, but now what are we supposed to do about it?

“Remarkably, given the importance of this issue, until now, we lacked a roadmap to attack it,” wrote Bob Wachter, MD, in the foreword to our new book, Understanding Value-Based Healthcare. “Now we have one.”

For starters, we can supply a pipeline for change by embedding the principles of value-based care in the apprenticeship of health professional education. Recently, the leaders of the soon-to-open Dell Medical School at University of Texas-Austin articulated their plan to build their entire curriculum around teaching students to root out waste and to care for the health of the community. This is the clearest example that medical educators are taking seriously the calls to action coming from the Accreditation Council for Graduate Medical Education (ACGME), the Association of American Medical Colleges (AAMC), the American College of Physicians (ACP), and other leaders to address healthcare value in training very seriously. However, the front lines are not waiting for new medical schools to open up or for massive curricular overhauls. The Second Annual Teaching Value and Choosing Wisely Challenge that we organized resulted in 80 submissions spanning the country (and Canada). The authors, including five students, 30 residents or fellows, and at least 41 faculty members, described their bright ideas and innovations for integrating healthcare value into education.

Education is fundamental but will not be enough. We must also practice what we preach. Practicing clinicians can deflate medical bills for their patients by advocating for appropriate care, considering patient affordability in customizing treatments, and leading local initiatives to improve value of care.

Clinicians can advocate for appropriate care by avoiding low-value services at the point of care. Specific targets for improving appropriate resource utilization may be identified from resources such as Choosing Wisely lists, guidelines, and appropriateness criteria. Physicians will need to understand the true risks and benefits of recommended therapies and learn ways to communicate this balance with patients.

Patient affordability is increasingly important, with more patients now facing astronomically high out-of-pocket bills, even for simple medical treatments or procedures. A December 2014 CBS/New York Times poll found that 80% of Americans now think their doctor should discuss the cost of recommended medical treatment with them ahead of time. Clinicians can screen their patients for financial harm and can help them navigate the trade-offs of lower cost options. Physicians should seek to provide high-value prescribing, which entails recommending the simplest medication regimen that minimizes physical and financial risk to the patient while achieving the best outcome. In other words, decreasing either cost, complexity, or risk of medications can improve value—and clinicians should aim to improve all three simultaneously.

In addition to reducing waste and considering patient affordability, clinicians are ideal leaders of local value initiatives, whether they accomplish this by running value improvement projects or by launching formal high-value care programs. Our framework to guide value improvement project design is “COST”: culture, oversight accountability, system support, and training. This approach leverages principles from implementation science to ensure that value improvement projects successfully provide multi-pronged tactics for overcoming the many barriers to high-value care delivery. At some locations across the country, individual efforts have matured into entire groups dedicated to designing and implementing value-improvement initiatives, including the UCSF High Value Care Committee, the Johns Hopkins High-Value Care Committee, Johns Hopkins Bayview Physicians for Responsible Ordering (PRO), and “High-Value Carolina” in North Carolina.

Health professionals are faced with a responsibility to help deflate medical bills. To achieve this goal, clinicians can advocate for appropriate care, consider patient affordability, and lead local value improvement initiatives. For those ready to tackle this challenge, we elaborate on and explain some of these necessary tools in our book, Understanding Value-Based Healthcare.

The Hospital Leader

Hospitalists of all kinds are sharing their perspective and experience at SHM’s official blog, “The Hospital Leader,” including their reflections on how hospitalists can tackle healthcare costs. For more posts, visit www.shmblog.org.

Hot on HMX

Hospital Medicine Exchange (HMX) empowers SHM members to share and collaborate on some of the most important topics in healthcare today. Recently, hospitalists have been discussing issues like:

• Patient satisfaction • Geographic rounding • LACE Score

To share your own perspective on these topics—or start a new conversation.

EDITOR’S NOTE: A version of this article originally appeared on Medpage Today on May 5, 2015.

By now, we have all heard the stories about unconscionable medical bills causing financial harm for patients. We have read about more Americans than ever before on high-deductible health insurance plans. Some of us have even helped our parents navigate the deceptively simple-looking bronze, silver, and gold tiers of the insurance exchanges, weighing the gamble of increasingly unaffordable monthly premiums against catastrophically high deductibles and out-of-pocket costs.

We have accepted the fact that healthcare costs are out of control and causing real constraints on every level, from individuals to communities to businesses to states to our nation.

OK, but now what are we supposed to do about it?

“Remarkably, given the importance of this issue, until now, we lacked a roadmap to attack it,” wrote Bob Wachter, MD, in the foreword to our new book, Understanding Value-Based Healthcare. “Now we have one.”

For starters, we can supply a pipeline for change by embedding the principles of value-based care in the apprenticeship of health professional education. Recently, the leaders of the soon-to-open Dell Medical School at University of Texas-Austin articulated their plan to build their entire curriculum around teaching students to root out waste and to care for the health of the community. This is the clearest example that medical educators are taking seriously the calls to action coming from the Accreditation Council for Graduate Medical Education (ACGME), the Association of American Medical Colleges (AAMC), the American College of Physicians (ACP), and other leaders to address healthcare value in training very seriously. However, the front lines are not waiting for new medical schools to open up or for massive curricular overhauls. The Second Annual Teaching Value and Choosing Wisely Challenge that we organized resulted in 80 submissions spanning the country (and Canada). The authors, including five students, 30 residents or fellows, and at least 41 faculty members, described their bright ideas and innovations for integrating healthcare value into education.

Education is fundamental but will not be enough. We must also practice what we preach. Practicing clinicians can deflate medical bills for their patients by advocating for appropriate care, considering patient affordability in customizing treatments, and leading local initiatives to improve value of care.

Clinicians can advocate for appropriate care by avoiding low-value services at the point of care. Specific targets for improving appropriate resource utilization may be identified from resources such as Choosing Wisely lists, guidelines, and appropriateness criteria. Physicians will need to understand the true risks and benefits of recommended therapies and learn ways to communicate this balance with patients.

Patient affordability is increasingly important, with more patients now facing astronomically high out-of-pocket bills, even for simple medical treatments or procedures. A December 2014 CBS/New York Times poll found that 80% of Americans now think their doctor should discuss the cost of recommended medical treatment with them ahead of time. Clinicians can screen their patients for financial harm and can help them navigate the trade-offs of lower cost options. Physicians should seek to provide high-value prescribing, which entails recommending the simplest medication regimen that minimizes physical and financial risk to the patient while achieving the best outcome. In other words, decreasing either cost, complexity, or risk of medications can improve value—and clinicians should aim to improve all three simultaneously.

In addition to reducing waste and considering patient affordability, clinicians are ideal leaders of local value initiatives, whether they accomplish this by running value improvement projects or by launching formal high-value care programs. Our framework to guide value improvement project design is “COST”: culture, oversight accountability, system support, and training. This approach leverages principles from implementation science to ensure that value improvement projects successfully provide multi-pronged tactics for overcoming the many barriers to high-value care delivery. At some locations across the country, individual efforts have matured into entire groups dedicated to designing and implementing value-improvement initiatives, including the UCSF High Value Care Committee, the Johns Hopkins High-Value Care Committee, Johns Hopkins Bayview Physicians for Responsible Ordering (PRO), and “High-Value Carolina” in North Carolina.

Health professionals are faced with a responsibility to help deflate medical bills. To achieve this goal, clinicians can advocate for appropriate care, consider patient affordability, and lead local value improvement initiatives. For those ready to tackle this challenge, we elaborate on and explain some of these necessary tools in our book, Understanding Value-Based Healthcare.

The Hospital Leader

Hospitalists of all kinds are sharing their perspective and experience at SHM’s official blog, “The Hospital Leader,” including their reflections on how hospitalists can tackle healthcare costs. For more posts, visit www.shmblog.org.

Hot on HMX

Hospital Medicine Exchange (HMX) empowers SHM members to share and collaborate on some of the most important topics in healthcare today. Recently, hospitalists have been discussing issues like:

• Patient satisfaction • Geographic rounding • LACE Score

To share your own perspective on these topics—or start a new conversation.

Background: Several studies suggest that hospitalists can improve costs or outcomes in academic medical centers, but almost all of these studies have nonrandom assignment of patients to hospitalists, and no multi-center studies exist. We studied patients assigned to hospitalist or non-hospitalist physicians based only on day of admission to determine the effects of hospitalists on outcomes and costs in 6 academic medical centers.

Methods: From July 2001 to June 2003, 31,891 general medicine inpatients were assigned to hospitalist or non-hospitalist physicians according to a predetermined daily call schedule. Patient interviews at admission and 1 month after discharge and administrative data were used to study effects on outcomes and costs.

Results: Twelve thousand and one patients were cared for by hospitalists and 19,890 by non-hospitalists. There were no statistically significant differences in age, race, gender, Charlson Index, or distribution of primary diagnosis between the 2 groups. There were no statistically significant differences in in-hospital mortality, 30-day readmission and emergency room use, 30-day self-reported health status, or patient satisfaction. Mortality data up to 1 year after admission are pending. Average length of stay was 0.05 days shorter for hospitalist patients but this difference was not statistically significant. Costs were also similar between the groups. Individual center analyses had large confidence intervals on outcomes and costs and failed to show statistically significant effects on any measure of outcomes or costs except for 1 of the larger centers, which had lower length of stay and costs for hospitalists.

Conclusions: Hospitalists had small effects on selected outcome measures available to date, but did not produce the large resource savings that had been suggested by some earlier studies. The effectiveness of hospitalists appeared to vary by site, but was difficult to assess due to limited statistical power for site-specific analyses. Understanding the factors, such as physician experience, that may influence the effectiveness of hospitalists is important for maximizing the efficacy of hospitalist programs, because effects on outcomes may be small, vary by site, and be difficult to distinguish from chance in a specific clinical setting.

Background: Several studies suggest that hospitalists can improve costs or outcomes in academic medical centers, but almost all of these studies have nonrandom assignment of patients to hospitalists, and no multi-center studies exist. We studied patients assigned to hospitalist or non-hospitalist physicians based only on day of admission to determine the effects of hospitalists on outcomes and costs in 6 academic medical centers.

Methods: From July 2001 to June 2003, 31,891 general medicine inpatients were assigned to hospitalist or non-hospitalist physicians according to a predetermined daily call schedule. Patient interviews at admission and 1 month after discharge and administrative data were used to study effects on outcomes and costs.

Results: Twelve thousand and one patients were cared for by hospitalists and 19,890 by non-hospitalists. There were no statistically significant differences in age, race, gender, Charlson Index, or distribution of primary diagnosis between the 2 groups. There were no statistically significant differences in in-hospital mortality, 30-day readmission and emergency room use, 30-day self-reported health status, or patient satisfaction. Mortality data up to 1 year after admission are pending. Average length of stay was 0.05 days shorter for hospitalist patients but this difference was not statistically significant. Costs were also similar between the groups. Individual center analyses had large confidence intervals on outcomes and costs and failed to show statistically significant effects on any measure of outcomes or costs except for 1 of the larger centers, which had lower length of stay and costs for hospitalists.

Conclusions: Hospitalists had small effects on selected outcome measures available to date, but did not produce the large resource savings that had been suggested by some earlier studies. The effectiveness of hospitalists appeared to vary by site, but was difficult to assess due to limited statistical power for site-specific analyses. Understanding the factors, such as physician experience, that may influence the effectiveness of hospitalists is important for maximizing the efficacy of hospitalist programs, because effects on outcomes may be small, vary by site, and be difficult to distinguish from chance in a specific clinical setting.

Background: Several studies suggest that hospitalists can improve costs or outcomes in academic medical centers, but almost all of these studies have nonrandom assignment of patients to hospitalists, and no multi-center studies exist. We studied patients assigned to hospitalist or non-hospitalist physicians based only on day of admission to determine the effects of hospitalists on outcomes and costs in 6 academic medical centers.

Methods: From July 2001 to June 2003, 31,891 general medicine inpatients were assigned to hospitalist or non-hospitalist physicians according to a predetermined daily call schedule. Patient interviews at admission and 1 month after discharge and administrative data were used to study effects on outcomes and costs.

Results: Twelve thousand and one patients were cared for by hospitalists and 19,890 by non-hospitalists. There were no statistically significant differences in age, race, gender, Charlson Index, or distribution of primary diagnosis between the 2 groups. There were no statistically significant differences in in-hospital mortality, 30-day readmission and emergency room use, 30-day self-reported health status, or patient satisfaction. Mortality data up to 1 year after admission are pending. Average length of stay was 0.05 days shorter for hospitalist patients but this difference was not statistically significant. Costs were also similar between the groups. Individual center analyses had large confidence intervals on outcomes and costs and failed to show statistically significant effects on any measure of outcomes or costs except for 1 of the larger centers, which had lower length of stay and costs for hospitalists.

Conclusions: Hospitalists had small effects on selected outcome measures available to date, but did not produce the large resource savings that had been suggested by some earlier studies. The effectiveness of hospitalists appeared to vary by site, but was difficult to assess due to limited statistical power for site-specific analyses. Understanding the factors, such as physician experience, that may influence the effectiveness of hospitalists is important for maximizing the efficacy of hospitalist programs, because effects on outcomes may be small, vary by site, and be difficult to distinguish from chance in a specific clinical setting.