TED Community » Bruce Ramshaw

More About Me

I'm passionate about

Changing our health care system

An idea worth spreading

We are changing the system structure for health care (specifically disrupting the traditional model for academic medicine). Using a systems approach, we are replacing the individual physician practice and hospital vertical department silo and hierarchy models with a patient-centered, team based system built around definable patient groups and diseases.

Talk to me about

Improving our health care system, improving our world, getting down to the core system structural problems that are the cause of suffering in our world and in health care.

People don't know that I'm good at

Juggling (at least I can do basic juggling- three balls for a little while)

My TED Story

I was a tenured Professor of Surgery (and Chief of General Surgery) at a major US state university, but in 2009 I quit my job because I learned enough to know that the traditional academic medical centers and major universities are not currently able to make the necessary structural system changes required to evolve our health care system to a sustainable model that provides value for all of society. I searched the United States to find a medical center that would be willing (both physicians and medical center leadership) to implement a new model for academic medicine that is patient-centered, based on a team approach and is driven by continuous learning and continuous clinical quality improvement principles. To lead this change, I have had to unlearn almost everything I was taught as a surgeon and TED talks and the TED community have been one of the resources I have utilized.

Comments

• TEDCred score: +2.00 TEDCred reflects your contribution to the TED community.

• A reply on Conversation: "Are patients getting sick or cured in hospitals?''

  Feb 25 2012: Hi Anne- Yes, I'm familiar with many of the attempts of the UK system to address the health care issues. They have all failed (at least for the most part- I know some have had limited success due to the extraordinary efforts of individuals who are passionate, committed people) due to a reductionist science (fragmentation) approach. It is necessary for the specialist to relinquish control of their knowledge (codifying it for all others to learn from on the team) and be driven by the purpose to improve care for identifiable patient groups. Everyone working together for the purpose of improving care is the core of the solution. Our current health care system structure (individual physician practice and hospital hierarchy and vertical department silos) does not support this care structure- that's why everything starts with a new system structure. The attempts at multidisciplinary care in the UK never included a structural change in how care was delivered- that is why the specialists had the ability to function autonomously. In our model, no one, not even the specialist, has any more authority or status than the patient, family and anyone else on the team.

• A reply on Conversation: "Are patients getting sick or cured in hospitals?''

  Feb 25 2012: We don't have a publication yet, but if you would like to email me (bramshaw98@yahoo.com) I could send you some of our business plan- most recently summarized for a CMS grant application. Thanks for your interest, Bruce
• +1

  A reply on Conversation: "Are patients getting sick or cured in hospitals?''

  Feb 24 2012: I agree with you Anne- I believe it is the system structure (hospital hierarchy and vertical department silo model) that is one of the core problems. Add to this that the individual physician practice model is just as outdated as the hospital system structure and you end up with what we currently have in health care today. We can design a new system structure for care, but it is not easy because the current large organizations that dominate health care today are benefiting from the status quo.
  
  We have recently started a new academic medical center in a new system structure for health care (it is a start-up, only five divisions so far). Physicians are part of teams that work with definable groups of patients (and patients and family members are part of the team). With the help of a new professional, the patient care manager, each team evolves care communities that work together to help each other develop caring, loving relationships. It is through these relationships that care can be compassionate as well as high quality and efficient. Although there is an increased cost initially to implement this model, we are seeing that the efficiency and quality that can be gained in care, and the lack of bureaucracy, can potentially lead to a system that is actually much lower cost, while providing better and more compassionate care. In our new model, it's everyone's job on the team to care and there is never a hand-off. We start a new residency training program in July, so soon we will be training physicians in this model.
  
  As far as the original question, the answer is both- patients get sicker and are cured in hospitals. But, we should and we can do much better. We need to change our thinking (from reductionist to complexity science thinking) and change our models (from hierarchy and vertical silos to small teams and care communities).

• A reply on Conversation: How do we make safe surgery part of the global health agenda?

  Feb 23 2012: Sorry for the delayed response- I was boarding a plane. I think it will work anywhere- construct a group of passionate people around a patient problem (our group that is farthest along is constructed around hernia disease). The group includes patients and family members and evolves into a care community. I wish I could say we have had great support, but it has not been easy- this model goes against all established organizations that have benefited from the status quo fee for service model and hierarchy and vertical department silo approach. We are now in a start-up academic medical center and have only raised some initial seed funding. But, we do have some partnerships (with a local hospital, surgeon practice group and community college) and a funded surgery residency program starting this July.
  It is interesting that we can do a more efficient job of fixing hernias at a Mission in the Dominican Republic than we can in a hospital in the US.
• +1

  A reply on Conversation: How do we make safe surgery part of the global health agenda?

  Feb 23 2012: This is critical- not just internationally, but everywhere. We don't currently have teams in the OR. Imagine eleven football players showing up at the stadium to play a game and they are just meeting each other. That's what we currently do. I was Chief of Surgery at a University, but I quit so we can start a new model based on a bottom-up team approach. Loving our patients and being humble is the key to patient safety (got this from Peter Pronovost, but it is exactly what we are doing and teaching at our new academic medical center).
• +6

  A comment on Conversation: What do you have to be grateful for today?

  Dec 27 2011: I am grateful for the change in mindset I am going through over the past few years (and I am grateful to see others who are already in it and also going through it). As a surgeon in my old mindset, I saw less and less hope, increasing fear and frustration in my profession and in the world. In a renewed mindset, I see hope and opportunity for change. I see love everywhere and I am driven less and less by fear.
• +2

  A reply on Conversation: How would we treat each other if we were not controlled by a need to be right?

  Dec 22 2011: I agree apathy is the most frustrating, but someone who insists on being right also has a flaw- what Carol Dweck calls a fixed mindset. I believe there is a third option- someone who engages in passionate dialogue with an open, or growth (Dweck), mindset. I think we would treat each other with much greater respect and empathy if we all worked on having a growth mindset (not saying I'm right- just my opinion).
• +1

  A comment on Talk: Daniel Goldstein: The battle between your present and future self

  Dec 21 2011: I'm glad to see many people recognizing that simple system solutions/ideas will work less and less well in our increasingly complex world. Complex systems science suggests a different approach. There is plenty of research: economic, sociology, psychology, neuroscience, etc. that would suggest financial security is not what leads to happiness and paradoxically, by focusing only (or primarily) on saving for retirement, someone could end up with a worse future self (see Dan Pink's TED talk). Our world is changing fast and I believe that financial security should not be the primary goal for our future self (or our present self for that matter)- but, it could be a byproduct if we all focus on a better goal to join together to change our mindsets (from simple system thinking to understanding complexity) and improve our world.

• A comment on Conversation: If you could teach the world 1 valuable thing you learned, what would it be and why?

  Aug 6 2011: Our reductionist mindset has contributed to our current problems. Changing our mindset is a path toward consciously designing the solutions for our problems.
• +1

  A reply on Conversation: "WHY is the patient the most under-used resource in healthcare?? How did that happen?" (Follow-up to LIVE TED Conversation July 27)

  Jul 27 2011: I think this is a major cause of the current health care system problems. The industry was developed with reductionist thinking (industrial revolution type organization structures).