Why It Matters
After four decades of work, Dr. Edward H. Wagner has had a huge impact on efforts to improve primary care. Some IHI leaders share how he influenced their work and their thinking.
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Dear Ed: Reflections from Your Friends at IHI

By IHI Multimedia Team | Thursday, June 29, 2017
Ed Wagner

Dr. Edward H. Wagner, a trailblazer in the health care industry, the founding Director of MacColl Center and the Group Health Research Institute (now KPWHRI), is retiring after four decades of remarkable service. Several IHI leaders reflected on Ed’s impact on health, health care, and their own lives:

Maureen Bisognano
IHI President Emerita and Senior Fellow

It’s been over 20 years since you first changed my life, and I want to say thank you for so much. I so wish I was there in person, to give you a hug of gratitude and appreciation, and to tell you what you have meant to me and so many others. I remember sitting with Don and Tom Nolan, so long ago, and drawing the challenges of caring for patients with chronic illness on a flip chart. Back in those days, we still thought of caring for people. You’ve changed all that, and when we started to draw your Chronic Care Model alongside, to see what you would teach us, the balance of power started to shift!  

Your idea that patients and teams co-produce health and care was profound back then, and all in health care have moved so far with your counsel and ideas. All over the world, I’m seeing amazing new models emerge that draw on all the assets of patients and families to produce better outcomes. From Africa to Latin America and Europe, and surely here in the US, examples of this model are becoming the best ways to care. Your focus on teamwork also changed my thinking in profound ways. I am still studying best ways to develop and nurture multiprofessional, multigenerational, and multicultural teams, including with patients and families, to get best outcomes and to build joy in work. “Prepared, proactive practice teams” has inspired my work all these years, and today, I’m seeing new models emerge that prove that health care is always delivered by teams, and that team development produces IQ (using all the intellectual assets of multiple team members) and EQ (because when the team has joy in their work, they can reach out with empathy and compassion for their patients and families) and CQ, because great teams have the energy and curiosity to continue learning and improving.

Without your ideas, IHI could never have led BPHC chronic illness collaboratives for the federally-qualified health centers, and I know you have reached thousands of people at IHI Forums and Summits, and inspired them to innovate and improve.

And I remember how much you influenced my thinking when you put the health systems and the community on equal footing as resources for health! The entire system has moved under this influence. We never would have contemplated support for the 100 Million Healthier Lives Campaign without this way to see and think. It’s so exciting today, to see the impact of the communities on health today, way more than anyone in health care could have had before your vision and provocation.

And your respect for the assets of patients and families has had such an impact on me. “Informed activated patients” and “productive interactions” are in my head and my heart every day. Every new design I’ve worked on has seen your ideas and influence in this way.

So, as you get set to “retire,” I do wish I was there in person to hug you and thank you. You have given me so much, and I’ve tried to share with others. You’ve influenced so many in diverse parts of the health system, and I hope you know the impact and effect you have already made. And your warm, humble, generous style has always invited me and the world to work with and learn from you. You are a joy!

It is my hope that one of these days, I’ll be there on the west coast or you on the east, and we can enjoy a dinner together to reflect and laugh, and plan for your next phase!

Cory Sevin, RN, MSN
IHI Senior Director

I got to know Ed Wagner when Clinica Family Health Services joined the first HRSA/IHI pilot to test the BTS Collaborative model with the Chronic Care Model. At the time, I was Director of Health Promotion and Disease Prevention at Clinica. The Chronic Care Model helped to make sense out of chaos of trying to serve our vulnerable population; helped us to break down the silos of internal departments; and helped us align all our work towards better care of individuals and families. It worked then, and it works now! 

The Chronic Care Model might have stayed hidden as an intellectual exercise if Ed Wagner had not worked to bring it out into the real world. Under Dr. Wagner’s leadership—always brought with a gentleness yet persistence—we all learned how to redesign our care in ways that brought much better outcomes to our patients and much joy in our work. Dr. Wagner never gave up and dedicated himself to helping practices make care significantly better. I am personally very grateful for his leadership and dedication. Health care is so much better for individuals and families because of him. Thank you, Ed.

Andrea Kabcenell, RN, MPH
IHI Vice President

Ed Wagner, you are a true renaissance man. You embody the ability to do it all—and superbly. You care for patients, lead a movement, drive landmark research, teach in a way that is so meaningful. And you turned out to be an outstanding improver!

I am not sure where health care would be without you, especially for those who may need chronic illness care. What I learned in my too brief work with you opened up my view of care systems and old age. Enjoy your well-earned retirement and know we are forever grateful.

Marie Schall
IHI Senior Director

I saw personally through my work with primary care practices and health systems the profound impact of the Chronic Care Model on both patients and providers. The concept of how a fully prepared practice team and an empowered patient could together transform care was (and still is) the core of what health care should be about. I found every opportunity that I had to work with Ed both exciting and challenging. He always pushed my thinking and introduced me to new ways to better help practices, providers, and patients to improve health and health care. 

Pat Rutherford, RN, MS
IHI Vice President

More than 20 years ago, Ed and his colleagues at the MacColl Institute introduced a transformative model of care for chronic disease management. This model of care is perhaps even more important today with the dramatic rise in chronic conditions in the US and throughout the world. The transformative elements of the Chronic Care Model — “prepared practice team,” “informed, activated patient,” and “productive interactions” — are fundamental to creating genuine partnerships between clinicians and patients to produce the best possible health outcomes. Today, many are advocating for co-production of care — and in my mind, the productive interactions are the vehicle for producing the very best outcomes for patients with chronic conditions. This model of care which stresses the importance of the health care system infrastructure in concert with community resources is applicable throughout the world in every imaginable context — in complex tertiary health care systems and in health care in developing countries alike.

Ed stands among the health care giants of this era — as an esteemed researcher and passionate primary care physician. His contributions to the health and well-being of individuals worldwide leaves a legacy that will transcend his active advocacy, research, and teaching as he moves into a well-deserved retirement. I wish him the very best in this next chapter of his life!

Don Berwick, MD, MPP, FRCP
IHI President Emeritus and Senior Fellow

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The Chronic Care Model

WIHI: The Road to Team-Based Primary Care and Behavioral Health

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