medical leaders interviews

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Martin Gabica MD

August 16, 2011

Interview with Marty Gabica MD, Chief Medical Officer, Healthwise



  • It is my belief during my 27 years in practice that a physician’s job has three parts: diagnosis, treatment, and education. When I was training residents and other providers, I would emphasize to them that they need to see themselves as teachers. I emphasized that ensuring that the patient understands his or her diagnosis and treatment plan is a skill set just as important as delivering the diagnosis or determining a treatment plan.

  • I believe in the power of the patient to transform health care. By engaging patients in taking an active role in their own health and expanding their skills, we can reduce costs and improve the quality of health care. So I view the patient as more than a passive recipient of my care, but as a motivated partner who is willing to do their part in their own health care—and has the potential to make a real difference.

  • Health care in the United States is in crisis, but a solution lies in the transformation in the role of the average patient. The patient is the only health care resource that has enough potential to make a real difference.

  • If you look at the various requirements for these new ideas you find lots of rules about how providers should act. You find very little about how to motivate patients to become involved in their own care. Studies have revealed that a patient’s feeling of empowerment is one of the most important factors in motivating behavior change.

  • We must be willing to discuss the patient’s personal beliefs and preferences when discussing their health issues so that we, as clinicians, can provide the kind of support that helps patients ask for care they should receive and refuse care they do not need.

  • The solution to the health care crisis is the transformation in the role of the average patient.  What is needed is a better understanding of what empowers people.  We need more research on what motivates patients.  What is also needed is time and training of physicians and a different way to reimburse them.

  • Time and training for providers to enable them to listen to their patients and guide them is a huge barrier. This means reimbursement for doing so. It also means being paid when a patient chooses to not do a procedure as well as when they decide to do it. Providers need to be willing to accept patient choices that may not be what they want the patient to do. They need to get the training in residency that enables them to counsel, listen, and educate. They need the tools to help them do so without disruption to their work flow. Health education must be included in the standard of care. And the provider must be willing and able to shift some of the control and responsibility back to the patient....Helping patients help themselves will improve the quality of care and reduce the burdens on the provider.

Full Interview »

Dr. Bat Shunatona

March 1, 2011

Interview with Baptiste Shunatona MD, OMNI Medical Group: Family Practice Doc & Assistant Medical Director for Knowledge Management



  • The Knowing/Doing Gap: What “ought to be” frequently isn’t, and it’s not always easy to go from “ought to” to “is.”

  • Making it happen involves all the human stuff. Most of the time the answer is to be very creative about implementation. And frequently an important part of the answer is to provide effective feedback. And the feedback has to be actionable with appropriately short feedback loops.

  • I would advise folks to start by learning some simple principles and methods by reading something like “Quality for Dummies.” Learn about quality by design and quality by inspection. Understand why the system is the problem; not the people. Then do projects starting with plans and pilots.

  • Reward what you want more of.

Full Interview »


November 1, 2010

Interview with Howard Cohen MD, Neonatologist, Chair of Quality and Safety for Northwest Newborn Specialists P.C. primarily at Salem Hospital; Patient Safety Officer, Chair of Pharmacy and Therapeutics Committee at Salem Hospital, Salem Oregon



“ I am guided by a strong belief that individual caregivers and health care organizations have three jobs:
1. Provide highest quality patient care to each individual patient in our care;
2. Improve our systems of care; and,
3. Improve our own competency and capabilities…”

“ The system must allow people to come forward to help improve it…”

"Health care providers, individually and collectively (organizationally)—

  • Have expectations of perfection.
  • Don’t easily understand error science.
  • Take a disciplinary approach to errors and risk.
  • Have a history of accepting disrespectful behaviors so as not to jeopardize finances.
  • Have been risk adverse and secretive.
  • Don’t understand or trust quality improvement methods.

Full Interview »



Interview with Joe Schnabel, PharmD, BCPS, Clinical Pharmacy Manager
Salem Hospital, Salem Oregon



“ The advent of “evidence-based medicine” has helped create a common mission for patient care..."

“ There seem to be more and more non-clinicians pushing “efficiency” before systems are in place to allow it to happen safely. Clinicians need to be forceful in their patient advocacy to assure that healthcare needs are met in the most beneficial way possible...”

“Atul Gawande’s “The Checklist Manifesto” finally articulated what I have felt was missing in the healthcare system as I knew it. We have been willing to allow variability in the system so as not to “upset” physicians practicing the “art” of medicine...”

Full Interview »



Interview with Ward B. Hurlburt, MD, MPH, Chief Medical Officer & Director, Alaska Division of Public Health



“The road we are currently on is a detour around being a truly successful nation because of the massive waste in our healthcare system (non-system) …”

“Chronic diseases are our biggest challenges, and they are quite often determined by life choices—diet and life-style choices …”

“As I said many years ago, we need to imprint the principles and methods of EBM into the DNA of clinicians and other healthcare decision-makers…”

Full Interview »


Interview with Mark Greenawald MD, Chair, Department of Family Medicine, Virginia Tech Carilion School of Medicine
Medical Director, Carilion Clinic Office of Professional Development
Education Director, Carilion Clinic Family Medicine Residency Program
Associate Professor of Family Medicine, Virginia Tech Carilion School of Medicine



“ …an…important process…is the “art and science” of seeking, receiving and processing feedback…Many people in positions of leadership…simply don’t ask others about their own impact….Not doing so creates the potential of our not being effective, even when our intentions are good…”

“ … Leaders need to model their own ability to receive feedback. By asking, “How are we doing?”; by inviting feedback in a manner that says “I want to learn and do better,” shows them you are willing to hear and consider. One positive result of this is when receiving feedback is modeled in a constructive way, others are more open to feedback from the leader…To take action takes great courage.”

“ We see what we look for...”

Full Interview »


Interview with Tim Young MD, President, OMNI Medical Group, President, St. Johns Physicians & President, Physician Support Services, Inc. Tulsa, Oklahoma



“…I believe that patients aren’t getting enough information…to allow them to make an informed choice that’s right for them…”

“ …You need to carefully lay the groundwork for EBM, have a good understanding of how to achieve process improvements and people to start doing the work…Laying of the groundwork in EBM…has made this much easier… culturally we accepted the premise that good evidence is required to ensure effective treatment. For us, EBM is truly a big piece of 'the' answer…

Someone in the organization needs to know how to do it and just start doing it — I think it’s just that simple.…”

“ I’d like to create a culture where, when physicians want something, they have to figure out how to justify it generally via cost and patient benefit and to measure it.…”

“ …we have used a lot of group process activities to implement EBM in our group…. Beyond evidence-based QI activities, the small groups are great forums for new ideas and discussions…one of the groups is specifically charged with doing new stuff.…”

Full Interview »


Interview with Karen Ching MD, EBM Director & Nephrologist, Kaiser Permanente Hawaii

Kaiser Permanente Hawaii (KPHI): Prevention of Venous Thromboemobolism (VTE) in Total Hip and Total Knee Replacement — Including Guideline & Decision Support


“The VTE prophylaxis project was started because there was so much variation in way VTE prophylaxis was administered, even within a department of a single hospital. This variation and controversy was in part fueled by a body of medical evidence that does not provide conclusive answers...This project was a perfect opportunity to gather surgeons, hospitalists and allied health personnel in a room to go through the work of reviewing the evidence collaboratively and in detail. The common goal was to make an evidence-based guideline that everyone could endorse. It also was a terrific educational opportunity to teach evidence-based medicine principles and to illustrate that even published guidelines on this subject have pitfalls."

"Institutional readiness as well as recruiting engaged participants are very important. It took persistence as well as the support of leadership..."

"This was an important project, and it was successful because each of the members of the workgroup was engaged in the process and participated fully. It was also helpful to have group leaders representing orthopedic surgery and hospital medicine to represent differing viewpoints....It also can be intimidating to approach a vast body of medical literature, especially one that is controversial. Having facilitators like Mike and Sheri really made the difference; they did an incredible amount of work behind the scenes. They guided the group through the process and made the work of EBM easy and fun."

"This project was an important investment to our institution. At the most fundamental level, the project encourages evidence-based practice and thinking. For the hospital, it means a focus on quality and patient-related outcomes."

Full Interview »

Read about the project: Kaiser Permanente Hawaii (KPHI): Prevention of Venous Thromboemobolism (VTE) in Total Hip and Total Knee Replacement and access the Clinical Guideline & Decision Support


Interview with Pieter Cohen MD, Associate Program Director at Cambridge Health Alliance and Harvard Medical School Tutorial Course Director



Trying to motivate future generations of clinicians to pursue expertise in primary care is a passion of mine...I would like to address the importance of encouraging primary care clinicians to pursue expertise and debunking the common myth that only subspecialists can become experts."

"...clinicians must find special areas that particularly interest them and develop those interests to create a balanced career. One area in which many clinicians might find unexpected satisfaction is learning to become health advocates and applying lessons learned caring for individual patients to the larger community."

"In the coming years we are likely to move to a system of healthcare in the US in which primary care will take center stage. It will be important to capture this moment to make sure that we reinvigorate the practice of primary care at the same time...I could envision a national organization emerging that incorporates the best of family practice, pediatrics and primary care internal medicine into one strong organization focused on academic primary care."

"In respect to reinvigorating medical education, I think no group is more innovate in this respect than the Consortium of Longitudinal Integrated Clerkships....One extremely creative model which has been used in parts of the country for years and has begun to be used in major medical centers is the concept of longitudinal integrated clerkships...we really want to show the students the power of being connected with patients. This can really drive change and should really drive system changes. We want students to see the patient plus the illness, not just the illness abstractly. Our goal is to be keeping patients in the center."

To read more about reivigorating primary care, about longitudinal integrated clerkships and more stories from Pieter, read the full interview.

Full Interview »

Joe Eichenholz

08/15/2009: Interview with Joseph Eichenholz, Executive Director, The Pharmacy and Therapeutics Society



"Our nation's economic, social and political priorities are being rebalanced. There are unique exogenous factors affecting healthcare. I think we are facing a 'perfect storm' in healthcare right now, and I don’t think the healthcare system is ever going to forget the period that began with 2009. Addressing many such issues in health care is like solving a simultaneous equation model. Solutions must simultaneously satisfy all of the equations."

"We need a framework that is useful and robust—one that will stand up to scrutiny by any stakeholder, be accepted by the public, policymakers and health care providers as being in their best interest and is versatile enough to allow modification as needed. It is an evidence-based framework for successfully developing and implementing clinical and economic policies and generating and utilizing clinical information to the greatest advantage."

"Healthcare leadership needs to support the organizational infrastructure and processes necessary to collect, evaluate and communicate evidence to physicians and other health care practitioners in a way they can apply it in patient care and translate the implications of healthcare decisions to patients in a way that maximizes their ability to make choices consistent with their values where there are choices to be made."

"The Pharmacy and Therapeutics (P&T) process should be a key focal point for future decision-making regarding many aspects of health care coverage and payment. The committee needs to be the fulcrum for the balance between rigorous analysis of issues and the human factors inherent in employers’ health care coverage or a public-sector benefit program to achieve a delicate balance of the evidence and the true needs of the patient....greater consideration of outcomes is an issue for P&T committees. They need to be able to move across traditional benefit 'silos' so that both medical benefits and pharmacy benefits are addressed..."

"P&T committees must be able to synthesize the evidence, establish clear priorities and put forward choices for patients to make with their physicians and other health care providers. The P&T process should stand between us and making those choices in ignorance."

Full Interview »

Editor’s Note: For more information on the Pharmacy and Therapeutics Society, please contact Joe at, 201-923-4534, or visit their web site at

Paul Wallace MD

06/15/09: Interview with Paul Wallace MD, Medical Director, Health and Productivity Management Programs; Senior Advisor, The Care Management Institute and Avivia Health, The Permanente Federation, Kaiser Permanente



“ ‘Things’ are changing faster than we are currently set up to manage — it is necessary to know with validity and precision what works for which patient, and the number of considerations are exploding. In other words, the rate of knowledge-generation is changing rapidly. And with that comes a need for a change in roles…. This is a fundamental change and leaders need to be aware that new role models are needed to help manage this change… A challenge to senior leaders in academia is to listen carefully to new ideas brought forth by younger faculty and others …”

“ A key issue for leaders is to retool to a mode of working to manage the “rate of change” to help make it tolerable and to have an awareness of the need for managing change over time as compared to a thinking of it as managing a single change and then we are done…”

“ We are now moving into an era of real accountability and having meaningful monetary impact through their effective use. This has only come about because of a greater understanding of, and focus on, EBM. This area is another in which I think it’s important to see a vision, keep the faith and continue to work in this area presuming that eventually all will have this view of the importance of valid science and its appropriate application. Again, I think it is important to think of science as one contributing factor to healthcare decision-making along with a host of other considerations…”

“ We are now moving to an era much more typical of ‘farming,’ where data, generated as a by-product of care delivery, will be abundant — perhaps overwhelmingly so — and potentially widely accessible. Harvesting knowledge in this new context will require no less of a transformation in infrastructure, roles and ‘rules’ than it took for hunters to adapt to the plow…. If we are successful in doing this type of by-product-knowledge, it can complement and substantially extend the data generated from well-done RCTs…”

“ Our approach to learning and knowledge-generation has been an elite and separate process parallel to mainstream delivery of care and also quite distant and opaque to the key object of that care — the patient…. It’s important to step back and really listen to the patient….to involve consumers to look at things through a different lens. It’s...about reconciling points of view…”

Full Interview »

Dave Clark RPh, MBA

06/15/2009: Interview with David L Clark, RPh, MBA, Senior Vice President Health Care Services, Regence



“ …I have seen that motivated health care practitioners can really make a difference in the delivery of care and improving outcomes for individuals and populations.…”

“ … Evidence should only be counted if it has passed a critical appraisal.…”

“ … Quality evidence can tell us what the outcome can be, and what it takes to achieve that outcome.… studies need to be well-designed and carried out to provide the evidence…The evidence should then be critically appraised, and the results of valid and clinically useful studies made available, quickly, to those make treatment decisions, or to the individuals that may have those treatments… Then focus on actually improving care and outcomes. It does not matter how many individually are started on appropriate therapies unless those treatments are completed and a successful outcome
occurs …”

Full Interview »

Michael Stuart MD

04/01/2009: Interview with Michael E. Stuart, MD
President & Medical Director, Delfini Group



“ Leaders universally need to take critical appraisal seriously and act on it locally… Teachers need to understand these principles and apply them in ways ranging from just-in-time with patients at point-of-care to participating in evidence evaluation and teaching activities…”

“I want change in which 1) quality research is performed and reported well enough to evaluate its validity and usefulness, 2) health care professionals can tell the difference between the good and the bad to know what is valid and clinically useful and what is not, and 3) patients are provided with clinically useful information that helps them make decisions based on their own values and preferences…”

Full Interview »

If you'd like to be considered for an interview, please email your answers to our questions here or contact us at delfini (at)


04/01/2009: Interview with Sheri Ann Strite
Principal & Managing Partner, Delfini Group



“ …We are in crisis. And almost know one knows this. Most research is unreliable irrespective of source. Most health care professionals do not know this nor do they have skills to evaluate the medical literature. This includes faculty, researchers, editors and peer-reviewers. Bias tends to inflate results up to a relative 50 percent. I believe clinical pharmacists can be an effective solution to this critical information problem that harms patients and causes waste …”

Full Interview »

If you'd like to be considered for an interview, please email your answers to our questions here or contact us at delfini (at)


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