International Journal for Quality in Health Care 14:169-172 (2002)
© 2002 International Society for Quality in Health Care
In Memoriam |
John M. Eisenberg, MD, MBA
Director, Agency for Healthcare Research and Quality, Rockville, MD, USA. Senior Advisor on Quality to the Secretary. Co-Chair, Data Council. Principal Deputy Assistant Secretary for Health, Department of Health and Human Services. Operating Chair, Federal Quality Interagency. Coordination Task Force.Quality Improvement Loses a Visionary Leader
The battle to improve health care quality lost one of its most beloved leaders this spring. John Eisenberg, MD, the gifted and effective leader of the US Agency for Healthcare Research and Quality (AHRQ), lost his battle with brain cancer on March 10, 2002 at the age of 55. In what was sadly the last few years of his life, Dr Eisenberg had become an international leader for health care quality improvement. Called ‘John of AHRQ’, he was known for insisting that evidence from research should be brought to bear in answering key health policy, management, and practice questions. He was often heard to ask, ‘what’s the evidence for that?’ when assertions were made about the effectiveness of a particular course of action.
Dr Eisenberg was a magna cum laude graduate of Princeton University (1968) and Washington University School of Medicine (1972). After completing residency in internal medicine at the University of Pennsylvania, he earned a master’s in business administration from the Wharton School while serving as a Robert Wood Johnson Foundation Clinical Scholar. Dr Eisenberg was chief of the division of general internal medicine at the University of Pennsylvania from 1986 to 1992, during which time he wrote a landmark book, Doctor’s Decisions, exploring what was known about successful methods for changing physician practice to improve the quality of care. He was the Chairman of Medicine and Physician-in-Chief at Georgetown University from 1992 to 1997, when he was selected to be Director of the Agency for Health Care Policy and Research (AHCPR), which subsequently became AHRQ.
Dr Eisenberg authored more than 150 original articles, including articles on assessing and using evidence for decision-making, the effect of payment on health care quality, and improving health care quality through improving the working conditions for health care providers. He was also the winner of numerous awards, including the Robert Glaser Award from the Society of General Internal Medicine, the Nathan Davis Award from the American Medical Association, the Career Achievement Award from the Society for Medical Decision-making, and most recently was selected as the Baxter Prize winner by the Academy for Health Services Research and Health Policy.
Dr Eisenberg’s career was spent in the pursuit of improved quality of care. Specifically, he worked to bring the best available information from scientific research to all health care decisions. John was known for his keen intellect and impressive ability to read and remember facts. He voraciously read new journals, books, and papers. He listened and absorbed information from lectures and conferences, but it was clear that he thought that learning something new was simply not enough. Applying that knowledge to improve the health and the health care of people was his real goal, and he pursued it vigorously.
While Dr Eisenberg’s talents were many, he knew they would not be sufficient to provoke the kind of change in health care that enabled each and every patient to get the best possible health care. He extended his contributions to the field greatly through his mentoring of others. He was remembered by those who knew him as warm, optimistic, and always willing to help think through a health care issue, regardless of whether the question was raised by a patient, a new medical student, an experienced clinician, a health care administrator, or a key policy maker. Those who had been his students and colleagues remembered his ability to help them understand their potential and choose career courses that would enable them to take advantage of their skills to make a contribution to the commonweal.
US health policy-makers also learned from Eisenberg. His passion for and commitment to science as a solid basis for policy meant that he was respected by members of all political parties in the United States. He was viewed as a politically neutral provider of reliable information for informing decision-making. He played a major role in President Clinton’s efforts to identify and address problems in health care by serving as a resource to the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Based on the Advisory Commission’s vision of greater coordination in Federal efforts, Secretary Shalala chose Eisenberg to serve as the operating chair of the Quality Interagency Coordination Task Force (QuIC). Through the QuIC, Eisenberg brought large Federal agencies with health care delivery and purchasing responsibility, such as the Departments of Defense, Veterans Affairs, Labor, and the Office of Personnel Management, together with the Department of Health and Human Services offices to reduce duplicative or competing initiatives and improve the effectiveness of their efforts to increase the quality of care for Americans. When the Bush administration took over in 2001, Secretary Thompson came to feel the same respect for Eisenberg’s ability to advance health care quality and asked him to stay on in the role of Director of AHRQ and operating chair of the QuIC.
In addition to his work in improving quality in the US, Eisenberg was convinced that the scientific evidence about effective patient care methods should be shared broadly across countries and implemented as appropriate in the various health care systems. He is credited with being able to bring about the collaboration between the American Medical Association, the American Association of Health Plans and AHRQ that spawned the National Guidelines Clearinghouse, which puts evidence-based treatment guidelines for medical conditions at the fingertips of clinicians worldwide through the Internet. He worked extensively on an initiative with Russia to develop the capacity to analyze and use research to improve clinical care. He is also recognized as being a critical force behind the US–UK collaborative to improve health care quality, which was signed last summer by both countries’ Ministers of Health.
His legacy in improving health care quality will continue to develop as those projects he initiated bear more fruit, those individuals whom he mentored produce changes in care, and as the research he envisioned provides answers to health care providers, patients, and policy-makers across the world. Tangible evidence of the impact of his efforts can be heard in the growing chorus of voices from all aspects of health care and health policy asking: ‘What’s the evidence?’
Nancy E. Foster
Agency for Healthcare Research and Quality
Rockville, MD, USA
John’s departing has been a tragedy to us all as members of his family and his community, national and international, most of all to us as human beings. His accomplishments, personal and professional, have been and will be known in the future. His life’s work will bring new forces that contribute to the world, forces characteristic of John’s limitless energies, passions, and commitment to his belief, that to attempt to understand and create new pathways to build and rebuild using the world around him was a living-breathing daily part of life’s value, and certainly of his life.
John and his colleagues and friends looked daily into the history of medicine, science, and man in search of that common denominator in humanity—the creation and sharing of a better understanding. In the early 1980s John and I worked on the multiple interfaces between his GP background and my oncologist background as physicians and as researchers. Yves Matillon, current Director General of ANAES, and John worked during that same period on the World Recif Rockefeller Program on how to construct a bridge between the knowledge of the advanced western world and the countries and cultures not as privileged. In 1990, John was among the first of the US leaders to be named by the French Minister of Health as a member of the Scientific Commission of the French National Agency for the Development of Medical Evaluation. Over the years, every year, John shared with us and with his colleagues in programs that assured the exchange of knowledge about all aspects of health care from education to the creation of new approaches, to research in evaluation and quality sciences, in his collaborations with the French National Deans Conferences, the Academic Societies, the French Ministries and French Senate, as well as with European and other international organizations that engage in the endless, timeless efforts of development towards progress in health, ultimately in world health.
John Eisenberg was a ‘Renaissance man’ and if, as Galsworthy spoke of Conrad, ‘To a man’s deserts is measured out the quality of his rest’, John shall ‘sleep well’. Let us believe that John’s work will be known and shared not by comparison, but be known as an experience of inspiration and evaluation. Please know and feel our thoughts and most sincere condolences for his family and our sorrow as we stand beside his friends and colleagues in our thoughts.
James Goldberg
Agence Nationale d’Accréditation et d’Évaluation en Santé (ANAES)
Paris, France
Although I had been a casual professional acquaintance of John Eisenberg for many years, it was not until 1996 that I had an opportunity to work closely with him, and to have the opportunity to observe first hand the full scope of his marvelous intellect, diplomacy, and personal warmth. I was working for the American Medical Association (AMA) and John had recently assumed the directorship of the US Agency for Health Care Policy and Research (AHCPR), later to be renamed the Agency for Healthcare Research and Quality (AHRQ). AHCPR had invested several million dollars over a number of years in developing rigorously researched and documented clinical guidelines. But those guidelines often simply collected dust on bookshelves, rather than finding their way into the fabric of day-to-day health care in the US.
To change this situation, John wanted to create an electronic database of clinical guidelines, which would include not only those developed by AHCPR, but also guidelines that had been created by medical specialty societies and others. To improve the likelihood that the database would be used by clinicians, John decided that it needed to be developed as a public/private partnership, among AHCPR, the AMA, and the American Association of Health Plans (AAHP), the trade association for US health maintenance organizations, the common model of US health care systems. As one might expect, AMA and AAHP are organizations that rarely exchange civilities with one another, much less agree to work together on a project with the government. But John was undaunted. He saw physicians and health plans as the key players in getting guidelines used in practice, and he was determined to be the ‘broker’ that helped make that happen.
The first few meetings of the steering committee for the National Guidelines Clearinghouse were a bit like a negotiating session trying to achieve peace in the Middle East. To say that there was not much mutual trust in the room would be an understatement. But that is where one of John Eisenberg’s greatest talents came into play. Over a few weeks, he helped build bridges among the people and the organizations concerned. He helped us close the chasms between us, and focus on the benefits that patients would obtain from our collaboration. His personal warmth, his sense of humor, and his impeccable honesty and candor helped build trust among the parties and allowed the Clearinghouse to become a reality. Today, it is a worldwide resource for information on clinical guidelines [1] and one of many achievements that are testimonials to the vision and talents of John Eisenberg. I often wonder what he might have achieved if he had chosen to become a diplomat, rather than a physician...
Later, I had the privilege of helping John raise the level of Federal support for patient safety research, and served with him on the National Advisory Council to AHRQ. There, too, his amazing ability to bring people of diverse perspectives together was on full display. Originally appointed to direct the Agency by President Clinton, a Democrat, John was re-appointed in 2001 by President Bush, a Republican. That ability to attract support from both sides of the political spectrum is further testimony to John’s ability to put the science of health services research ahead of the politics of service in the Federal government.
John Eisenberg was indeed a unique individual. He leaves a great legacy, not only of his own research and patient care efforts, but of the lasting impact he has had on health services research, health care quality, and health policy. I will miss him.
William F. Jessee
Medical Group Management Association
Englewood, CO, USA
President, International Society for Quality in Health Care, 1989–1991
This issue of the International Journal for Quality in Health Care includes tributes to John Eisenberg by Nancy Foster, one of his colleagues at the United States Agency for Healthcare Research and Quality (AHRQ), a perspective on Eisenberg’s international intellectual influence from James Goldberg of the Agence Nationale d’Accréditation et d’Évaluation en Santé (ANAES), and atribute by William Jessee, ISQua President 1989–1991 and a member of the AHRQ National Advisory Council. Eisenberg’s accomplishments in the field of health care quality and in other related areas are well known to those of us within and outside of AHRQ who worked with him and can be viewed in detail via the AHRQ website [1]. Given my own academic background in general internal medicine and economics, Eisenberg’s intellectual contributions strongly resonated with me and continue to influence my work in health care research and improvement. I read his book Doctors’ Decisions and the Cost of Medical Care published in 1986 [2] as I was completing internal medicine residency training and have used it as a frequent reference in thinking about research and quality improvement efforts focused on influencing physician behavior to improve health care quality.
In addition to his seminal intellectual contributions to the field of health care quality, John was a mentor to a very large group of young scholars at the University of Pennsylvania and elsewhere who are among the leading lights in quality of care research and health care quality management in the United States. While I never had the good fortune to work for Eisenberg, I collaborated with him in the early 1990s through the participation of the Mayo Clinic and the University of Pennsylvania in the Clinical Appropriateness Initiative of the RAND/American Medical Association/Academic Medical Centers Consortium [3], and frequently looked to him for advice over the past 10 years. Among those who trained and published with Eisenberg were: Jose Escarce of RAND, Alan Hillman of the University of Pennsylvania, David Nash of Thomas Jefferson University, Neil Powe of Johns Hopkins University, Kevin Schulman of Duke University, David Schulkin, Chief Executive Officer of DoctorQuality and William Winkenwerder, Assistant Secretary of Defense, Health Affairs, Department of Defense. Eisenberg’s legacy can be observed, in part, in the scholarly and managerial impact of these and other people who were mentored by him in his distinguished career. For those of us who knew Eisenberg, we remember him most as someone who possessed an unusually keen intellect as well as the ability to bring out the greatest in the capabilities among those with whom he worked. Perhaps one of the most impressive legacies that he leaves is his unique ability to stimulate colleagues to do their best work. In this regard, before Eisenberg came to AHRQ as its leader, the annual ‘Quality of Worklife’ Survey of the US Department of Health and Human Services reported that the AHRQ was next to last among Health and Human Services agencies; for the past 2 years it has scored best. [4].
David J. Ballard
Baylor Health Care System
Dallas, TX, USA
President, International Society for Quality in Health Care, 2001–2003
References
- National Guideline Clearinghouse, USA: http://www.guidelines.gov. Accessed April 11, 2002.
- John Eisenberg Mourned. Adapted from Washington HealthBeat, March 11, 2002. John Reichard, Editor. Posted with permission, March 2002, Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/jme/mourned.htm. accessed April 11, 2002.
- Eisenberg JM, Doctors’ Decisions and the Cost of Medical Care, Ann Arbor, Michigan: Health Administration Press, 1986.
- Ballard DJ. The RAND/AMA/AMCC clinical appropriateness initiative: insights for multi-site appropriateness studies derived from the abdominal aortic aneurysm surgery project. Int J Qual Health Care 1994; 6: 187–198.
[Abstract] - AHRQ Accomplishments: John M. Eisenberg, M.D., M.B.A. March 2002, Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/jme/accomp.htm. accessed April 11, 2002.
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