Health Policy

Paul O’Neill, Health Care Hero


Paul O’Neill, who died from lung cancer earlier this month at age 84, was one of my personal heroes, but not because of anything he accomplished as Alcoa’s chief executive officer or as Secretary of the Treasury.

O’Neill was my hero because he saved patients’ lives. 

Two decades ago, when few dared speak openly about medical error, this titan of industry put his considerable clout behind a radical idea: not a single patient should be injured or killed by their medical care. And in pursuit of that goal, hospitals had to continually make care measurably safer.

No one of O’Neill’s stature, before or since, has shown anything close to his dogged determination to make this ideal real.

O’Neill first embraced zero harm after Karen Wolk Feinstein, the president of a small, local foundation, had the chutzpah to ask him to serve as co-chairman of a coalition to radically improve Pittsburgh’s health care. He make this commitment even though it was a goal championed by a non-physician book author (me) and by a PhD in labor economics (Feinstein), while being denounced as naively unrealistic by respected local medical leaders.

Feinstein had read my 1997 book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and she’d asked me to suggest ambitious patient safety goals for what would become the Pittsburgh Regional Healthcare Initiative (PRHI). I proposed zero hospital-caused infections and zero medication errors.

But O’Neill is not my hero just because he began working for safer care well before the Institute of Medicine (IOM) report, To Err is Human,  warned that as many as 98,000 Americans were being killed each year by preventable hospital errors.  It’s that O’Neill put all of himself into the effort, and he never gave up.

When PRHI first began, O’Neill led its meetings personally, thereby sending a message that nobody else in the coalition – hospitals,  insurers, businesses – should dare dispatch some lower-level functionary.

In private and in public, O’Neill was a blunt truth-teller. He continued to push for zero harm year after year, even as corporate colleagues quietly gave up, even as the largest local insurer backed down and even as the most powerful health system in Pittsburgh kicked him off its board for pushing too hard, too loudly and too long.

O’Neill did this because he was driven by logic, evidence and data. Since “nobody in their right mind” would agree it was acceptable for them, personally, to be harmed, O’Neill explained in a 2018 interview with Feinstein, “what’s the right number for things going wrong in a hospital? Zero.”

While “zero harm” talk has now become common, patient safety veterans I’ve polled believe that no more than 20 percent of U.S. hospitals are yet strategically committed to achieving it. 

To support what PRHI called “achieving the theoretical limits of perfection,” O’Neill helped  the group adapt the systemic quality improvement methods he’d used at Alcoa. The Perfecting Patient Care system, designed to improve safety and quality while reducing unnecessary costs, has since became a national and even international model.  

PRHI has also evolved and expanded as an operating arm of the Jewish Healthcare Foundation, which Feinstein continues to lead.

In her interview with O’Neill, Feinstein asked him about his best memory. He recalled that when PRHI was still striving to demonstrate its value, the group helped local hospitals reduce the incidence of central line infections by a startling 68 percent in just 18 months.

“That was an absolutely thrilling moment,” said O’Neill, “to see that together we could make this…gigantic improvement. When you think about the human beings who were saved from at a minimum an extended stay and higher cost ­– or death – it was fantastic.” 

Unfortunately, none of O’Neill’s impact on patient care is mentioned in the lengthy obituaries in The New York Times and other major media. However, the Pittsburgh Post-Gazette obit is filled with tributes to O’Neill as an extraordinary individual, an important local and national business and political figure and someone who helped transform health care. It’s worth reading.

The Talmud says, “He who saves one life is as if he saved the entire world.”  Paul O’Neill saved many, many worlds. May his memory be an inspiration.

Michael L. Millenson is president of Health Quality Advisors LLC and adjunct associate professor of medicine at Northwestern University Feinberg School of Medicine.

Categories: Health Policy

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