It seems counterintuitive to draw any similarities between the health system in the U.S. and the health system in Rwanda, but Melissa Gillooly says she sees some of the same troubling access and affordability problems in both countries.
Gillooly spent three years living and working in Rwanda for Partners In Health, a global health advocacy group founded by Paul Farmer, M.D. In Rwanda, Gillooly worked with the national Ministry of Health to build health facilities and establish comprehensive health services in two rural districts.
“I’m sure most Americans don’t believe we have the same problems as they do in Rwanda, but we do when patients lack access to some of the most basic preventive medicine, when they aren’t able to receive care close to their homes, or when they don’t receive affordable coordinated care,” Gillooly says.
“We’re using technology and social strategy to expose trainees to practices they wouldn’t necessarily receive as part of their formal academic training.” — Melissa Gillooly, executive director, Primary Care Progress |
Now the executive director of Primary Care Progress, a Cambridge, Mass.-based not-for-profit organization, Gillooly defines the job to be done as encouraging more health professional students to choose primary care as their medical specialty of choice. Gillooly believes this crucial work will expand patients’ access to preventive and primary care services.
Primary Care Progress uses a multi-pronged approach that includes exposing students to innovative primary care practices around the country. By showcasing the ways practices are transforming preventive and primary-care services in communities that need it most, Primary Care Progress helps students see a future for themselves in primary care.
After eight years with Partners In Health, Gillooly is experienced in managing teams in not-for-profit healthcare. She has a master’s degree in public policy from the Harvard Kennedy School. She also is mother to a six-month-old son.
“My six-month old keeps me up at night and not just because he’s crying,” she says. “When I think about the type of care that he’s going to have when he’s old enough to make decisions around his own healthcare, it worries me. Our system has broken down, and it doesn’t provide people with access to quality patient-centered care. We need to reverse that trend.”
The passage of the Affordable Care Act offers a unique opportunity to seize the reigns and steer the U.S. health system to a more patient-centered, prevention-focused and comprehensive care model, she adds. Primary Care Progress dovetails with some of the goals in the health reform law by advocating for team-based, prevention-focused and patient-centered care.
Putting the Patient at the Center
Health professional students interested in primary care understand that the current physician-centered, fee-for-service environment in which providers get paid based on the volume of sick patients in their practice is broken. They know we need to be thinking about team-based models focused on population health. Primary Care Progress is building the next generation of leaders who will drive these changes to the health system.
“We’re using technology and social strategy to expose trainees to practices they wouldn’t necessarily receive as part of their formal academic training,” Gillooly says. “Innovation is not just about discovering new interventions — it’s also about properly deploying the ones we already have.”
This is one of the reasons Primary Care Progress produces monthly webinars spotlighting innovations in patient-centered team-based practices. Trainees across the country see that practice and can envision a different delivery of care than one they might be exposed to in the classroom or local academic setting.
While in Rwanda, Gillooly worked on improving access to HIV/AIDS treatment. She quickly learned that, in order to deliver high-quality care, clinics need to be holistic in their approach.
“Rwanda improved health despite scarce resources by focusing on the root causes of disease. People don’t come in just to receive HIV treatment,” she says. “They come because their child is malnourished or because they are suffering from a rash. Offering coordinated services that take into consideration patients’ behaviors and environment is an important way to keep patients healthy and out of the clinic.”
The experience made her a firm believer in giving patients care in settings that are close to their homes and that make sense to them. Part of that effort is teaching providers to work in care teams with nurse practitioners, health coaches and social workers to think about not just what patients need in a 15-minute appointment but also their total health. Opportunities might include sitting in a group visit with other patients with the same chronic medical condition, for instance.
“Traditionally, physicians are trained in very siloed systems of academic medicine,” Gillooly says. Yet, the only way we can effectively address the complex problems facing our healthcare system is through a multidisciplinary team approach. “We at Primary Care Progress believe if health professional trainees learn together and provide clinical care in larger teams, then they are going to be more satisfied in their jobs and able to provide better care for patients.”
|Innovator Insight: To truly innovate, you need to put yourself in the place of the customer you’re trying to serve and identify the barriers that prevent them from being completely satisfied with whatever they are trying to accomplish. Innovations that attack those barriers will be embraced by your customers. Innovations that don’t address those barriers will be ignored.|