On the same day last week, two notable moments occurred regarding healthcare in New Jersey. One received a great deal of public attention; the other did not. Their coincidence offers an opportunity to remind ourselves how easy it is for us to be distracted by what is new and lose sight of what is extraordinary.
One announcement pertained to the scramble for money and a change in the competitive economics of hospital contracting by the state’s largest carrier. Although notable (particularly to those hospitals and consumers who will be financially exposed), the underlying theme is predictable: a company is developing its market share.
The other event last week involved passing of a baton in the race for better healthcare: the New Jersey Healthcare Quality Institute (NJHCQI) said farewell to its principal founder and CEO, David Knowlton, and welcomed his successor. It was quietly observed (unless one counts the stitch-requiring example of his inclination to throw himself headfirst into obstacles).
Although consistent with his personal wishes, I find this relatively low-key transition inadequate to convey the magnitude of what he has accomplished and the public value which comes from widespread awareness of the difference one individual can make. Those who are aware of the work of Dave Knowlton and NJHCQI are remiss if they don’t take this transitional moment to express admiration and gratitude to both.
Dave Knowlton’s resume is lengthy and distinguished (psychologist, president of NJHCQI, state health commissioner, FEMA emergency response trainer, Rutgers faculty member, chair of the nationally prominent Leapfrog Group, and Forbes Magazine designee as one of the most nationally influential people in healthcare). In short, he is a psychologist by training and public policy-maker by practice. More importantly, he has become the conscience of New Jersey healthcare.
In a world increasingly inclined to define public value in terms of celebrity and private wealth, public policy-making may seem like a milquetoast endeavor. Perhaps that is one reason so few pay any attention to it at all. Even those who are supposed to do so (e.g., elected and appointed officials) seldom do, and most can’t or won’t do the necessary homework. Therefore, New Jersey public life is often characterized by political dealing-making of convenience instead of policy-making for the health of our body politic.
Yet, because of David Knowlton (and honorable souls who work alongside him), one of the few New Jersey public policy-making success stories is the NJHCQI. Its mission, as stated on its, is to “…undertake projects that will ensure that quality, safety, accountability, and cost containment are all closely linked to the delivery of healthcare in New Jersey.”
It is an angelically simple but devilishly challenging mission because of all the economic conflicts of interests which drive the healthcare delivery system today. In spite of this landscape, NJHCQI has crafted, advocated and coordinated public initiatives for better healthcare solutions in New Jersey with unparalleled success. It is a unique institution in that it has been selfless and effective in an arena not known for either of these qualities. Keeping a laser-like focus on patient welfare, while holding politicians, providers and insurance companies accountable to high-minded goals, is seldom attempted, let alone accomplished. With Dave Knowlton as the philosophical and operational leader, NJHCQI’s success is no accident.
The healthcare industry in New Jersey is dysfunctional on a variety of levels. However, without the work of NJHCQI we would be in even worse shape: New Jersey would have less financial transparency, weaker performance reporting, weaker practice and procedure standards, fewer consumer cost-containment protections, less public health education, and less cooperation among hospital systems. It is more than a lamp in the darkness or a bullhorn in a crowd; it has been able to assemble a work crew to build pathways and bridges for delivery of better care.
The consequences of last week’s reshuffling by healthcare players have yet to play out. We don’t know what will happen as a result of most of the state’s hospitals being reimbursed differently by the state’s largest insurer.
However, the NJHCQI transition has all the earmarks of success. Knowlton’s successor, Linda Schwimmer, comes with the full package of brains, experience, temperament, and a similar commitment to sound public policy. I would guess Dave is confident that one of his greatest contributions to NJHCQI is the one in whose hands he has left the helm.
The takeaway here isn’t only the critical importance of NJHCQI to New Jersey’s future. It is that the organization didn’t emerge mysteriously from the mists of time. Nor was it created to advance certain business interests. It is the direct fruit of the ingenuity, energy and public-spiritedness of a man and those he gathered to help him. His presence is a rebuke to those who think nothing can be done to make things better in public life and his character is to be emulated.
I am unaware of anyone who has been more interested and active over a longer period of time in promoting the commonwealth of New Jersey and as disinterested in personal gain. He is an example of all that is best in public service not only because of what he accomplished but that he did it for the principal of the matter: his was an uncompromised commitment to make his community, the state of New Jersey, a better place. His legacy, NJHCQI, is the gift that keeps on giving even in the midst of remarkably predatory times.
Sometimes, good stories make things most clear. One of the more provocative Biblical narratives is the Genesis account of Abraham’s dialogue with divine emissaries at the Oaks of Mamre. At the heart of the passage is the profound truth that the presence of only a few good people is sufficient to sustain the place in which we live. Looking at it from a different angle and put in current vernacular, without these good people, our society and the rest of us are toast.
The discussion takes place when Abraham becomes aware that his mysterious visitors -- whom he understands represent God -- are journeying to nearby twin cities in order to judge whether they are guilty of chronic injustice as charged and if so, to destroy them. In a short inquiry, both deferential and bold, Abraham persistently engages God about whether there is a threshold number of righteous inhabitants sufficient to shield a place from destruction. He asks for the sake of the righteous but profoundly by implication, for the sake of the city as well. In short, he asks God “How many good people does it take to save a community?” The final answer is at first reassuring yet in retrospect, humbling: it takes only a few.
Dave Knowlton is one of these. I’m confident we owe him more than we realize.