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Taking on a TEDMED Great Challenge

By Jameson Case | Friday, November 2, 2012

By Kedar Mate, Faculty, IHI

Several months ago, I had an opportunity to be a part of something exciting: the 2012 TEDMED annual conference. In addition to taking in the dazzling array of presentations on the microbiome, the future of medical training, guitar playing from NIH director Francis Collins, and a surprise appearance from Cookie Monster, I had been invited to represent a “great challenge” in American medicine and healthcare. There were 50 challenges that had been selected by a team from the Robert Wood Johnson Foundation and TEDMED ranging from the obesity crisis, to the role of the patient, to the causes of sleep deprivation. Participants in the TEDMED universe voted for the ones they regarded as the most pressing with the top 20 vote-getting challenges selected to become topics for future conversations at TEDMED. 




For each challenge, a “challenge advocate” was selected to provide context, detail, facts and figures about the challenge. I was advocating for achieving faster adoption of best practices. As I prepared for the event, I remembered the oft-quoted statistic that it takes 17 years for a new medical innovation to make its way into common practice. In reflecting on this with IHI President and CEO, Maureen Bisognano, she suggested that I think about some way to make this personal.  I considered my own young son who was six months at the time of the event. Would it be acceptable to me to wait 17 years for the best in pediatric care to become available to him? Absolutely not!





IHI faculty member Kedar Mate presents his Great Challenge —
faster adoption of best practices — at the 2012 TEDMED conference.


I also thought about a quote I heard last year when I was visiting Kaiser Permanente’s Garfield Innovation Center in San Leandro, CA. One of the leaders of the Innovation Learning Network quoted sci-fi author William Gibson who’d famously said, “The future is already here, it’s just not evenly distributed.” That got me thinking that the benefits of our medical research enterprise were accruing haphazardly and were only available to a select few. A better approach was needed to secure rapid uptake of the best of evidence-based medicine. 


I proposed four answers to how we can encourage faster adoption of best practices: a campaign-style effort, similar to IHI’s 100,000 Lives Campaign; social media (highlighted Mike Evans’s “23 and a Half Hours” YouTube video); community grassroots organizing (Marshall Ganz’s work); and tools to improve reliability such as Atul Gawande’s checklists. If we invested more heavily in these types of delivery and spread innovations, we wouldn’t have to wait 17 years for our doctors, nurses and healthcare providers to give us the latest and greatest that global healthcare can offer.


I made one last point in my presentation: in 2009, the African Academies of Science noted that “Four million women, newborns and children in sub-Saharan Africa could be saved every year if well-established, currently available, affordable health care interventions could be implemented across the region.” By the same accounting that says 17 years is the average time delay in the US and developed economies for the adoption of best practices, investigators have suggested that patients in poor countries would have to wait till 2052 for the medical practices we discover today to reach them. 


A 40-year delay is an embarrassment for medicine when cell phone penetration has reached every corner of the globe in less than a decade. We need faster adoption of best practices in health and healthcare immediately. Please join a facilitated dialogue and pose your questions about this topic to a panel of experts by clicking here.

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