Issue link: https://beckershealthcare.uberflip.com/i/717576
87 PRACTICE MANAGEMENT THOUGHT LEADERSHIP Former CDC Director Dr. Bill Foege on Why He Stands Behind Theranos, How to Build an Effective Coalition & What Presidential Candidates Must Address By Emily Rappleye T he world's brightest minds work every day to untangle the complex issues that plague healthcare. And while many problems remain, occasionally someone succeeds. One of those breakthroughs was led by Wil- liam H. Foege, MD, MPH, an epidemiologist and former director of the CDC. Dr. Foege is credited with developing a strategy to eradi- cate smallpox when vaccine supplies ran out in the late 1970s. His resourcefulness and ad- vocacy became an integral part of the World Health Organization's global immunization campaign, helping wipe out an infectious dis- ease for the first time ever. Now, more than 35 years later, Dr. Foege has set his sights on another project with the ca- pacity to change global health: miniaturized blood tests. Dr. Foege serves on the board of directors and scientific and medical advisory board for Palo Alto, Calif.-based eranos, a startup developing affordable blood tests with smaller sample sizes. ough the company has faced significant challenges over the past several months — including class-action law- suits, investigations and lab license revocation — Dr. Foege says he stands behind eranos' technology and promise. We checked in with Dr. Foege to discuss why he is so excited about the global health poten- tial behind eranos' technology, what impli- cations Zika could have on the U.S. and his advice for those leading change in healthcare today. Editor's note: Responses have been edited lightly for length and style. Question: In your May commence- ment speech at Emory University, you advised graduates to always ques- tion tradition. Are there any traditions in healthcare you think our readers should question? Dr. William Foege: When I graduated from medical school 55 years ago, I was receiving a lot of warnings from the American Medical Association about the possibility of socialized medicine. ey had all of us looking over our le shoulder to see if socialized medicine was gaining ground, and no one ever said, 'Look over your right shoulder to see if capitalism is gaining ground.' And of course, it did. Our tradition has been that the marketplace is the place to deliver medicine. We're now in the position of spending more money per per- son on healthcare than any country, but our outcomes don't reflect that. We are not in top five, 10, 15 or even 20 countries when it comes to health outcomes. It's time to challenge the tradition: Is the marketplace the best place to deliver medicine? I don't think it is because once profits become the bottom line, it skews everything. Another tradition that's worth looking at is the concentration on process measurements. We put a lot of attention on process measurements rather than on health outcome measurements. In 1993, the World Bank came up with a new way of looking at this called disability-adjusted life years. It changed global health because you could combine illness, suffering and death into a single number. We should be clever enough in healthcare to figure out how to do a better job of measuring health outcomes, and at least part of reimbursement should be based on health outcomes. Q: When you first came up with the "surveillance/containment" tech- nique to eradicate smallpox, people felt it was a top-down approach. But, as William Watson Jr., then-deputy director of the CDC, said in Columns Magazine in 1994, "Bill has a great talent for coming up with creative ideas and presenting them in a way that doesn't threaten people." How did you convince people to get on board with this technique — and based on your experience — what advice would you give hospital and health system leaders who want to lead innovation and change at their organizations? WF: I have to admit coming up with that ap- proach was largely by accident. We did not have enough vaccines to do what we had been trained to do, which was to mass vaccinate. We were looking for shortcuts. [e surveil- lance/containment strategy] worked so well, we [took it] from an individual outbreak [and applied it] to all of eastern Nigeria, from there to other places in Africa, and finally we tried it in India. at was the most difficult place because in 1974, in one state alone, there were 1,500 new cases of smallpox every day. at's a new case every minute. It was just massive and overwhelming. e bottom line is we had the vision, and then we worked on managerial improvement. One thing that became clear to me is we don't do anything without a coalition. No one does anything on their own. So the question be- comes: How can you better the coalition? Leadership today is defined by the person who can make the coalition truly productive. e most effective coalitions are those built around an outcome — a definition of a last mile — rather than an interest. If you get peo- ple together because they are the same religion or the same political party, that's not nearly as good as getting them together against an out- come that is defined from the beginning. We also know leadership has to practice ego sup- pression for the coalition really to work. Suc- cess becomes group success, not a turf some person gets. An example of all of this in healthcare would be if a health system decides we are not only "The best decisions are based on the best science, but the best results are based on the best management."