One of These Docs Is Doing Her Own Thing
Gabow’s odd-sounding voice is caused by something called spasmodic dysphonia. There are a few types of the disorder, but all of them are caused by involuntary movements, spasms, in the larynx. One of the possible treatments is Botox injections into the larynx, which Gabow undergoes every three to four months. Interestingly, the prevailing medical theory on spasmodic dysphonia is that it may be a neurogenic disorder, which means it has something to do with nerves. What’s more, the ultimate root cause may be psychogenic, which means the problem is all in one’s head.
Gabow will tell you she doesn’t remember exactly when or where her voice troubles started. It was sometime, she thinks, around the mid-’90s, which just happens to be right about the time she was talking Mayor Webb into turning over Denver General to her. She jokes away the topic of her voice by saying the condition provides for humorous ice-breakers when she gives presentations or speeches. She says it gives her the opportunity to compare herself to the breathless Marilyn Monroe.
You think: It’s just like Gabow to take a perceived weakness and make it a strength, not unlike what she’s done with Denver’s city hospital.
Dr. Joel S. Levine says Denver Health has become a nationally recognized hospital because of “Patti’s ability to speak despite her voice, to speak by her actions and what she’s been able to accomplish at the hospital.” Levine is on the board of Denver Health, and so you think, Well, of course he’s going to say what a miracle worker Gabow is. But what makes Levine’s take on Gabow especially noteworthy is that he is also a senior associate dean on the staff of University of Colorado School of Medicine, and on the staff of the University Hospital, which is one of Denver Health’s competitors.
“People look at what they’ve done in terms of quality and reorganization,” Levine says. “Denver Health is a city hospital, a safety-net hospital providing close to the best measurable care of university hospitals around the country, and that is remarkable. It’s not just Patti. But she is the one that enables the process. She has been able to aggregate people around her who believe the same thing. This is remarkable evidence that you can produce a very high quality of health care for less, but you have to have a very efficient system to do that. I think this is what’s engaging people around the country.”
Depending on the perspective, it’s also what’s driving or missing from the ongoing debate about President Obama’s health-care legislation. A Wall Street Journal article last summer didn’t just point out that the nation’s public hospital system is on life support, it also cited that reality as an example of why the health-care legislation may not be such a great idea: “Faced with mounting debt and looming costs from the new federal health-care law, many local governments are leaving the hospital business, shedding public facilities that can be the caregiver of last resort.”
The new health-care law requires hospitals to meet mandates in technology, accounting, and overall care and systems integration in order to qualify to care for Medicare and Medicaid patients, and to remain competitive for other government money. For already cash-strapped public hospitals reaching these mandates, this amounts to drastic and dramatic improvements, and, to read the Journal, is next to impossible. Presumably, then, more of these hospitals will vanish.
These facts resonate with critics of “Obamacare.” Among other objections, opponents of the legislation have maintained that government-run health care for everyone—which, they would say, this new law paves the way for—cannot work. The problem, they say, isn’t for-profit health insurance providers, hospitals, or pharmaceutical companies. Rather, the troubles are a mix of wasteful spending, poorly managed hospitals coupled with the fact that we’re a nation of supersizing smoker types, and a country, particularly in states like Colorado, dealing with an influx of uninsured non-U.S. citizens.
Republicans who refused to vote for the law last March, and who this past January voted (symbolically) to repeal it, say more government involvement, imposing mandates, will make it harder, not easier, to provide health care for the uninsured. Instead, we should empower the “free market” to fix things. Just look at the Journal article: If small governments have been having such a hard time managing public hospitals in the first place, why in the world would Americans turn to Washington, the biggest government of them all, expecting it to successfully reform the entire nation’s health-care system?
Gabow knows better than anyone that providing medical attention for the masses isn’t easy, that it’s going to take time. “What I tell everybody,” she says, “is we didn’t get health care screwed up in a year, and to think we’re going to fix it in a year is incredibly naive. But you have to start somewhere.” She believes the health-care legislation is a good start. She points out that one of the first RIEs at Denver Health didn’t work, and that it didn’t work because, simply put, it was too ambitious. The Value Stream was essentially the “Patient Experience,” everything that happens to a patient from the moment his or her experience with the hospital begins until it ends. What the group, what Gabow, what everyone at Denver Health realized was that by breaking the Patient Experience down into small RIEs…well, that made a difference. It was kind of like a microcosm of the nation’s health-care system.
It’s about time, and political will, and commitment, Gabow tells you. Why is there resistance to President Obama’s legislation? “Let me explain,” she says. “Health care is a $2 trillion industry. If it cost us what it costs the rest of the world, we would be a $1 trillion industry. Think about how many people’s pockets you’re going to get into if you really take $1 trillion out of the system. So guess why everybody doesn’t want [change]. People are making a lot of money off of the dysfunction. And this is the core of why the system needs to change.” m
Maximillian Potter is executive editor of 5280. E-mail him at email@example.com.