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April 30, 2001

Shine enlightens Emory on health care

By Eric Rangus


Exploring the problems of the nation’s health care system and identifying the paths health care workers must take to fix it were the themes of the final Future Makers Lecture of the academic year, delivered April 25 by Kenneth Shine, president of the Institute of Medicine (IOM), in WHSCAB Auditorium.

“Crossing the Chasm in Health Care: Achieving Quality Care for All Americans,” the title of Shine’s speech, is also the name of a recently released IOM study commissioned to investigate the gap between the nation’s health care needed and health care received.

“It was too big and too broad to be ignored,” Shine said. So large, he continued, that the perceived gap was renamed a “chasm.”

“This study now provides the leadership agenda to move forward toward the kind of system and the kind of care we’d all like to see,” said Michael Johns, executive vice president for Health Affairs, in his introduction. Now in its fourth year, Future Makers is sponsored by the Woodruff Health Sciences Center.

A cardiologist and physiologist, Shine is a clinical professor of medicine at the Georgetown medical school and former dean and provost for medical sciences at the UCLA School of Medicine. He was elected IOM president in 1988.

“Doctors often don’t know how to measure quality,” Shine said. “Physicians tend to equate quality with the training and knowledge of other physicians. Actually, the ‘quality’ of care is that given to patients. It is not necessarily dependent on the skill of physicians.”

Shine then gave several examples about how faulty health care systems resulted in less-than-quality care.

He told the story of one hospital that was experiencing a high mortality rate of emergency room patients who needed surgery.

The reason for this, he said, is that the hospital’s surgeons wanted the patients brought into surgery as quickly as possible; hospitals with lower mortality rates stabilize the patients first, then wheel them to surgery.

Shine characterized this as a systemic problem. “The doctors were highly skilled,” he said, but there was nothing they could do to improve the problem without changing the system.

Shine’s elixir for the country’s health care system included a six-point agenda to recreate a system that is safe, effective, timely, patient-centered, efficient and equitable. “We need to translate what we know into better care for patients,” Shine said in conclusion. “It’s a big challenge, but I think we can do it.”

The IOM was created in 1970 and is a part of the National Academy of Sciences. Although created by the federal government, IOM is an independent body that acts as an advisor to the government on scientific and technical matters. Johns is one of IOM’s elected board members.

Following his hour-long address, he took several questions from the audience.

Shine’s full lecture is available online at by following the links to the Future Makers Lecture Series.


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