David Pryor, MD
Senior Vice President for Clinical Excellence
Ascension Health

I’m David Pryor. I’m the Senior Vice President for Clinical Excellence at Ascension Health, and the Chief Medical Officer. Before joining Ascension Health, I was the Chief Information Officer for the Allina Health System. Prior to that, I was the president of New England Medical Center Hospitals. Before that, I had spent 15 years on the faculty at Duke University in both administrative and clinical and research roles.

Early on in my career, I focused on understanding how we take care of patients with cardiology problems, and how to better estimate outcomes and improve the quality of care they’re getting. When I moved to the administrative side, it was really to try and understand how to improve the quality of care by impacting the system and the environments in which care is provided, and all of my positions are characterized by that. 

In the mid- to late 1980s, we had done a lot of work to try and understand how to better estimate outcomes for patients with coronary disease. That work included not only the work that we had done with databases in terms of capturing all of the baseline information around patients, and then following them for important outcomes, but actually developing new statistical models in order to try and better couple long-term outcomes to the experience the patients had and the care they had. We had spent all this time and had developed these remarkable models, and yet I didn’t see them being used. I realized that it wasn’t just about knowing what to do; that we had to somehow figure out how to improve the systems and the quality of care that people were receiving, and really look at the systems that we were going to change the care that people received. 

Ascension Health is a relatively young organization, although our roots go back hundreds of years. Ascension Health came together in 1999, when four provinces of the Daughters of Charity merged with the Sisters of St. Joseph of Nazareth in Michigan. And now the Sisters of Carondelet have joined us. The System at present is the largest non-profit health care organization in the country, consisting of 65 acute care hospitals in 20 states and the District of Columbia. 

Ascension Health has our Call to Action, which was formulated among 120 strategy leaders. The Call to Action calls for “Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind.” The Healthcare That Is Safe strategy has as its goal that by July 2008, we’ll provide excellent clinical care with no preventable injuries or deaths, zero.

I think that the role all caregivers play is crucial to providing high-quality care. I think if we’ve learned anything at Ascension Health, and some of the impact that we’ve had, it really is about understanding that caregivers have to own it. I’m fond of saying that nothing really happens where I work because we’re not taking care of patients there. The work is all about trying to support caregivers who are providing that care. And in doing that, what engages those caregivers is when they believe that there is an opportunity to truly improve the quality of care that people are receiving, that there is data that can support that, and they can understand how to apply that in their own practice. I think that becomes compelling.

We’re very cautious because we believe there’s so much work that we have to do. I would say, however, that what people have told me is that as some of the results have become available, what convinces them is that in a large system, it is possible to create this kind of change. It becomes very difficult to argue, for example, that we can’t eliminate birth injuries, or we can’t eliminate pressure ulcers when, in fact, you see the data from our system illustrating that, in fact, most of them can be prevented.

I think a number of organizations have adopted our goals. It’s important that we’ve also learned from a lot of others. At Ascension Health we talk about ourselves as an “obligated clinical group.” Most large organizations, the organizations that make up the individual hospitals that might make up a large integrated system, will talk about themselves as being finically obligated, where they each guarantee the debt of the others. 

In our case, we also talk about ourselves as being clinically obligated.  And by that we mean we’re all accountable to each other for the quality of care we provide, and we further characterize that in shorthand by saying “everyone teaches, everyone learns.” So we see ourselves with a responsibility among ourselves, as well as in a broader sense, to both learn and teach from everyone.

I think the challenge really is that there are many reasons why change may be difficult, or things may be hard to do. The reasons will come easily to anyone’s lips when they’re talking about the particular problems we’re facing. On the other hand, if we look at it from the opportunity standpoint, or we look at what the goal should be, it’s easy because in the final analysis, all of us who work in health care, are not only health care workers, but we’re also recipients of care that is provided. 

Someone once asked me why it was so important to me to achieve zero preventable injuries and deaths, and what I told them was that the goal to me was actually very, very personal. And it was actually a story where an individual who was going to be the head of one of our committees really wanted to do it. And I asked them why. He told me that he thought it would be the best chance he had to transform health care in this country. I said, “You know, it’s more personal than that for me.” He said, “What do you mean?” I said, “For me, it’s the best chance I’ve got that my daughter, 15 years from now when she shows up with her child in an emergency room, she’ll receive the proper care.” 

The analogy that I use is about bypass surgery, and I talk about mortality rates in the 1970s that were anywhere from two to four percent and mortality rates that today are much, much less. If you look at the numbers, you would say that half the deaths in bypass surgery that were present in the 70s, today are being prevented. And yet, if you asked people in the 70s whether or not those deaths could be prevented, the answer would be no. So I think the whole history of medicine really should be about continuing medical progress and understanding how we improve the quality of care we provide. 

My father, who was a practicing physician, once told me that he thought half of everything he knew changed every five years; he just didn’t know which half. And as I reflected on that comment he made to me, I thought, you know, maybe as we get a little bit smarter and understand more about what works and what doesn’t work and how we improve, we might improve upon that figure.

04/24/2007