Fra Filippo Lippi - Madonna with the Child and two Angels
What does this 15th century Renaissance painting
have to do with a 21st century academic medical center? Painted by Fra. Lippi (a monk of some
questionable repute) in about 1465, I selected this image as an analogy for our
two broad challenges in building a successful academic medical enterprise in the
rapidly changing healthcare environment.
The first challenge is the need to innovate. At first blush, Lippi’s Madonna With Child and Two Angels may not scream innovation. However, in its time it included a number of
groundbreaking techniques. For a moment,
focus on the landscape in the background of the painting. The use of realistic perspective was an
innovation of the period, and separated it from flat two-dimensionality of
medieval art. Note also the painted
frame surrounding the scene; the placement of the characters in front of the
frame brings them into the world of the viewer.
Coupled with the cherub in the lower right – who makes direct eye
contact with the viewer, and looks like he knows a secret he wishes to share –
the effect is to draw you into the painting.
This is a degree of interactivity that would have been startling at the
time; something akin to watching a 3D movie when all you have known is black-and-white
television.
The need for innovation in today’s academic medical center
is driven by the pace of economic, demographic and scientific change. This topic could consume (and probably
deserves) many pages of discussion.
However, at least some of the challenge is represented in the Institute
of Medicine’s call to create the Learning Health System (LHS) of the future
from the Academic Medical Center (AMC) of the past. A Learning Health System uses data to drive
continual improvement in the care of patients.
All three words – Learning Health
System – have meaning.
Academic could be
interpreted by some as detached and separate from the care delivery
system. Note, that one secondary definition
of the word “academic” is “theoretical, speculative; having no practical or
useful significance.” Learning implies
a continuous and ongoing feedback loop.
The process of discovery and acquisition of new knowledge, while still
invaluable in their own right, must be actively applied to improve care. Care that is suboptimal or inconsistent
across populations must be a major catalyst for the process of discovery.
Medical strongly suggests
we are focused on the diagnosis and treatment of disease –still a priority in
the new world order. However, the
concept of health broadens the
mission. Not only will our emerging LHS
develop startling new treatments, we will also take responsibility for
maximizing the health of populations.
Prevention of disease and improvement of environmental and behavioral
determinants of health will become much more critical components of an
institution’s academic portfolio.
Center strongly
invokes a specific place (perhaps an ivory tower). The concept of system conveys a heightened priority on connectivity. In the traditional model, the care delivery
system is where learners go to practice when they finish training. In the emerging model, learners and the
educational process will be integrated into the delivery system. In the Academic Medical Center, research
produces knowledge that is pushed out to providers of care. Frequently, it takes many years for this
knowledge to be integrated into practice for the benefit of patients. In the Learning Health System, the
acquisition of new knowledge remains critical.
However, in addition, the science of care delivery – the implementation
of new knowledge – takes on added importance.
The care delivery system becomes an important laboratory.
The second challenge represented by Lippi’s painting is the
changing nature of the “halo effect” in academics. The Madonna’s halo is faint and
ethereal. It does not jump off the
canvas at the viewer, and could even be missed by the casual observer. This reflects the diminishing value the
patina of academia has for health care systems.
Over the past half a century, in a system relatively flush with revenue,
a hospital could reasonably be expected to contribute resources to education
and research almost purely for the associated reputational benefit. In the emerging health care economy, hospital
margins are small against historical standards, and economic success is driven
by managing cost and improving outcomes.
The economic value of reputation is waning.
The challenge for the LHS of the future will be to repaint
Lippi’s halo with heavy, bold, thick brushstrokes. Successful Learning Health Systems must
foster partnerships with successful care delivery systems (like Catholic Health
Initiatives). Ideal partnerships will be
mutually symbiotic: the care delivery
system will provide new academic opportunities for educators and
researchers. In return, the engine of
academia must drive concrete strategic advantage back to the health system
partner. I will develop this concept
more fully in a future posting.
Lippi’s Madonna and
Child frames the questions we all need to be asking of ourselves. How does my work help the Baylor College of
Medicine drive the culture of innovation necessary to be the national model of
a Learning Health System? How do our
great strengths in education and research drive measurable strategic benefit to
our health system affiliates and partners?
Finding the right answers to these questions will drive our success for
decades to come.
This has been cross-posted from the Baylor College of Medicine blog Momentum
This has been cross-posted from the Baylor College of Medicine blog Momentum