Reflections: Project ECHO, Quality and Leadership

By Alina Hsu

As I described in an earlier post, Project Echo is an innovative approach to delivering specialist care for complex chronic conditions to remote and/or underserved populations.  It has been shown to be as effective for treating hepatitis C as care in an academic medical center.

Primary care clinicians who have participated in this project with Dr. Arora are uniformly enthusiastic and personally grateful to Dr. Arora for enabling them to better care for their patients and for enriching their practice.  In a comment to a post on The Healthcare Blog, a community clinician remarked

“One of the features of the ECHO team is that is promotes a real sense of collegiality without the pretensions of many tertiary medical centers. ECHO really aims to please as well as inform.”

And Dr. Arora’s profile as an Ashoka fellow notes that

“Everyone who knows Sanjeev says that he is not a typical doctor, let alone specialist. He is humble and driven, not by ego but by a deep desire to help the underserved and to do something constructive in the broken United States healthcare system. He is also gifted with an extremely collaborative spirit, continually engaging others about his model, relating to people on all levels, from legislators down to drug-addicted patients.

“As a leader, Sanjeev is admired by his team, who see him as a mentor, a motivator and an inspiration, always encouraging innovation and initiative at all levels of the staff. Most importantly, however, Sanjeev brings a very human element to all of ECHO. During the weekly clinics, he is a teacher as well as a clinician and though specialists often come to him out of respect for his medical credentials and ECHO’s track record, they are quickly drawn to his deep belief in the importance and the power of what ECHO is doing.”

Other commentators note that he fosters innovation and incremental improvement across the entire care delivery process.  Learning is not only top-down; community clinicians quickly develop expertise and can initiate improvements which then spread through the ECHO network.

So we have a leader who is humble, respectful, collegial, collaborative, and seeks to serve.  Might it be that these are qualities that are important in driving the successful dissemination of best practices?  (It would be interesting to know whether Dr. Arora successfully models and sustains high levels of hand hygiene across the network of community providers.  Changing habitual behavior can be more challenging than training people in new practices and treatment skills.)

Abundant research has shown that physicians who themselves are team players and respect the comments and perspective of all members of the team are critical to improving quality and patient safety, as well as staff engagement, patient satisfaction, and even health outcomes.  Further, robust team communication across diverse roles can compensate for cognitive biases, blind spots, and oversights, thus aiding in “error-proofing” processes.

Perhaps Project ECHO, as led by Dr. Arora, will lead to better quality and safety than is typical in hospitals.  As ECHO initiatives are implemented more widely, with other leaders, it will be interesting to identify the factors that are important for success.