Two unexpected deaths within the AAPL community have affected our association: Lucian L. Leape and MaryBeth Kimball. Their deaths impacted me on a personal level as well, and I believe they affected some of you also.
Lucian Leape
Lucian Leape was a pediatric surgeon whose insights into medical mistakes in the 1990s are credited with bringing forth the concept of patient safety, which irritated much of the healthcare establishment at the time. His paper “Error in Medicine”(1) was the first major article on the topic in the medical literature.
NEJM rejected the paper. The timing of the publication in JAMA just before Christmas in 1994, however, was intentional, he shared with me in a personal communication, because he and the editor of JAMA knew it would receive little attention and therefore wouldn’t upset colleagues.
The idea of systemic error, though widely accepted in other industries, was an unfamiliar concept in medicine, and it rubbed up against the existing norm of medical culture, which focused on individual accountability, in addition to the malpractice traditions of that era, which focused primarily on individual physicians’ outcomes.
Our industry initially did not want to acknowledge or accept that patient safety was not guaranteed in healthcare! And yet, as a physician leader, Lucian persisted in promulgating his message. His efforts gradually transformed our industry. In recognition of his significance, AAPL named an annual award after him. The Leape Ahead Award recognizes institutions and their leaders who are dedicated to improving the quality of healthcare by improving patient safety.
Lucian’s JAMA article subsequently led to the Institute of Medicine (now Academy of Medicine) often-quoted sentinel reports To Err Is Human(2) and Crossing the Quality Chasm.(3) These reports helped galvanize healthcare regulators and accreditors to enact tighter standards for hospitals, limit work hours by medical residents, and require public reporting of serious errors. Because of regulations and public pressure, healthcare systems around the world began to tackle medical mistakes as a system-level problem, launching patient safety departments and hiring patient safety officers.
In an interview with Dr. Robert Wachter in 2006,(4) Lucian describes how he first became interested in medical errors. “I went to the library one day and did a literature search on what was known about preventing errors, and I didn’t find anything,” he said, adding that he went to the librarian for help. The librarian suggested that he look in the humanities literature.
“I know what humanities are, mind you. But it really never occurred to me. So, she tried the same search strategy in the humanities literature, and boom, out came 200 papers. ... A year later, I came up for air and realized that we in healthcare could use this. If I didn’t know how errors happen, most other people wouldn’t know it either. So, I decided to write a paper.”
Parenthetically, the reason Lucian’s death impacted me personally is that I became the inaugural chief patient safety officer for The Joint Commission shortly after those IOM reports were released. In that role, I was fortunate to get to know and interact with Lucian, plus several others, as we each worked to help launch improved patient safety and quality initiatives from our respective platforms of influence. Lucian was a strong mentor of mine, and I will be eternally grateful for the opportunity of having been able to learn from him.
MaryBeth Kimball
MaryBeth Kimball recently passed away following a rapid-onset, aggressive cancer.
For 23 years, MaryBeth was the director of new business development and administration for professional programs in the Isenberg School of Management, University of Massachusetts, Amherst. In this role, MaryBeth interacted closely with our AAPL team and was the primary liaison between the UMass master’s program and the AAPL education programs.
She was also the dedicated MBA advisor to the more than 1,000 physicians who passed through their program and obtained their CPE from AAPL. The alumni from this program certainly benefitted from MaryBeth’s presence, encouragement, and insightful contributions.
In her interactions with those of us at AAPL, she always shared smiles, hugs, and laughs. She had an infectious optimism and thirst for a vibrant life. She taught me an important lesson in the last few days of her life as we exchanged communications: to be kind, to be caring, and to be mindful of others, regardless of our situation — a leadership lesson for us all in its own right.
In an email to me just before her death, MaryBeth shared: “Wish things were working out differently too, but they told me at the very beginning 6 months — this was a rare and aggressive cancer, so I think I did fairly well, and still holding out on a miracle!!”
Making a Difference
Physician leadership can help create miracles and promote change in healthcare.
Lucian Leape helped launch and create large-scale change on a macro level that our industry is still navigating. MaryBeth Kimball helped create change on a more individual level, but through her influence and support of others, she made a ripple effect of change. The ripples and waves from both will be recognizable for years to come.
Healthcare is an incredibly complex and expensive industry whose evolution is affected by non-clinical influences. As physician leaders, we must assume that unwanted and unexpected events will continue. In that way, we can be prepared to decide how best to address those challenges on a practical as well as an emotional level.
Knowing how to navigate challenges on a personal level will ultimately benefit those around us, including those who are influenced by us in our leadership roles — regardless of the level of formal or informal leadership we represent within our environments of influence. AAPL trains all physicians to lead from within — rooted in the care for others, regardless of the unwanted or unexpected external influences currently shaping the industry.
Remember, creating and leading significant positive change is our overall intent as physician leaders. AAPL successfully awakens the visionary stewards of medicine across all disciplines and backgrounds. AAPL is the place where physicians can reclaim their deeper calling and gain the tools to lead from personal integrity. The industry is at a stage when we need all physicians to become leaders at deeper levels to shape the future of medicine.
Therefore, as physician leaders, we must embrace the complexities of our industry. We can choose to embrace the opportunities where our individual and collective energies can help create the beneficial changes so desperately needed. We must continue to be innovative and adaptive in our efforts.
Let us continually maximize the opportunities placed before our profession. Imagine a world where every hospital, clinic, and health system is shaped by people who understand healing from the inside out. That’s not just leadership. That’s transformation.
So, ask yourself, not just how you can grow with leadership, but also how you can better serve yourself and others to improve the healthcare industry within your level of influence by better absorbing and navigating the unwanted or unexpected as they occur.
Through this international AAPL community, we all can continue seeking deeper levels of professional and personal development, and recognize ways we can each generate constructive influence at all levels.
As physician leaders, let us become more engaged, stay engaged, and help others to become engaged. Exploring and creating the opportunities for broader levels of positive transformation in healthcare across the globe is within our reach — individually and collectively.
References
Leape LL. Error in Medicine. JAMA. 1994;373(23): 1851–1857. https://doi.org/10.1001/jama.1994.03520230061039 .
Institute of Medicine. To Err Is Human: Building a Safe Health System. The National Academies Press; 2000. https://doi.org/10.17226/9728 .
Institute of Medicine Committee on Quality of Health Care in America. Crossing the Chasm: A New Health System for the 21st Century. National Academies Press; 2001. PMID: 25057539.
Wachter R, In Conversation with…Lucian Leape, MD. PSNet, August 1, 2006. https://psnet.ahrq.gov/perspective/conversation-withlucian-leape-md .