Teaching hospitals
Elizabeth Bradley, MBA’86, pursues a truly universal health care.
By Melissa F. Pheterson
Illustration by Richard Thompson
For all her emphasis on leadership, Elizabeth Bradley, MBA’86, also knows when to follow. “One of my favorite things to do is follow rivers,” says Bradley, a professor of public health at Yale University and director of its Global Health Initiatives. “They separate into tributaries, and you never know where they’ll take you.”
It sounds like a pat turn of phrase meant to invoke openness to new ideas, but then she props her bandaged foot on a chair. “In fact, that’s how I gashed my ankle. I was following a river in New Hampshire and fell into a makeshift bear trap.”
Bradley’s exploratory impulse has taken her across the globe to teach hospital leaders how to improve the quality of care in their organizations and satisfaction among their patients. It’s also primed her to lead the Global Health Initiatives’ push to improve quality and access and to promote health-care equity in low-income countries.
In June Bradley hosted delegates from Ethiopia, Ghana, Liberia, Mexico, and Rwanda to brainstorm remedies for their countries’ beleaguered health-care systems. Using “grand strategy,” a problem-solving approach borrowed from the military, participants deliberated how to stretch modest resources to meet major challenges, says Bradley.
Raised in New Britain, Connecticut, a hardware-manufacturing center, Bradley never imagined studying health systems as a career. “Everyone I knew, including my father, worked in a factory.” As part of a ninth-grade church confirmation class, she volunteered as an orderly at New Britain General Hospital. She rinsed and packed tools in the operating room while watching hip replacements and hernia repairs. “Turns out,” she says, “I had a strong stomach.”
But medicine still felt foreign to Bradley’s mechanical mindset. A high-school athlete with high marks, she enrolled at Harvard, where she majored in economics and submitted a thesis on the volatile modern-art market. “I was always interested in markets that didn’t work right,” she says. During her junior year, she took a sociology course on the blurred boundaries between public and private ownership and obligations in industries like health care. The experience renewed her interest in hospitals and steered her toward a Chicago MBA with a health-care administration focus. Afterward Bradley accepted a two-year fellowship at Massachusetts General Hospital and stayed on as an administrator for another four years, refining such front-office policies as emergency-room admission.
Yet the academic in her craved empirical study. “After six years, I realized I was constantly making decisions, but I had no idea of their impact within the hospital,” she says. She enrolled in Yale’s PhD program in epidemiology and public health. When she graduated in 1996, she joined the School of Public Health faculty.
“As a hospital administrator, I was not even beginning to tackle the changes needed to make the people of Boston healthier,” Bradley says. Public health and medicine are often at odds, each fighting to apply scant resources to competing agendas—for example, obesity prevention through exercise and nutrition versus bariatric surgery for patients who are already obese.
In 2002 Bradley became associate director of the school’s health-management program, assessing ways to improve medical care’s quality, delivery, and efficiency. Two years later she was named director. Her research had expanded from a focus on hospice care to also include a directive on global health, in which the overarching goal, she says, is to improve management systems in ways that also improve patient experiences and quality of care. “This is critical in all countries and all aspects of care,” she says. “We can prevent much suffering by managing the resources we have better and in more compassionate ways. I learned that with hospice and see it repeated in many health-care settings now.”
Bradley focuses on hospital reform, acting as patient advocate for the poor. “It’s my deep belief that hospital management is a critical aspect of clinical practice and patient outcomes,” she says. “But there is slippage between policy and on-the-ground care, where information doesn’t always flow into the best decision-making.” For instance, hospitals may pledge basic health care to everyone, but if most patients live too far away for effective treatment, that promise comes up short.
On sabbatical in 2005, Bradley worked for the William J. Clinton Foundation in Ethiopia, training hospital CEOs to ensure better treatment for their patients, from newborns and their mothers to those with HIV/AIDS. Tracking a year’s worth of outcomes for about 50 Ethiopian hospitals, and training a cadre of hospital CEOs both in the classroom and on the job, Bradley and her 26-person team ushered in a culture shift within hospital governing boards, as career managers relieved physicians who’d been forced to fill out reams of paperwork after hours.
“We’ve had to be creative on getting more for less,” she says, citing strategies like cross-training staff and simplifying medical records. “You’ve got to get every drop out of every penny.” Leading three weeks of classes every four months, reinforced by site visits, her team helped the CEOs drastically reduce waiting times for beds and for ER treatment.
Noting her success, the Clinton Foundation asked her to help improve management in Liberian hospitals and clinics. “Many people think global health is mostly concerned with infectious diseases like HIV and TB,” she says. “But a major aspect of global health is improving hospitals, clinics, and the delivery system.” Touring JFK Hospital in Monrovia was “upsetting,” says Bradley. “There were no sheets on many beds, one physician covering five units, doctors with inadequate training. And then you’d go to the fourth floor and admire the beautiful ocean view. It gave us hope.”
Bradley’s team worked with the hospital staff to rebuild a patient-care unit, improve record-keeping and sanitation, and clarify job descriptions. Last year Liberia’s president, Ellen Johnson Sirleaf, visited Yale to thank Bradley and others for supporting her country’s fledgling health-care system.
Broadening her focus, Bradley developed similar hospital programs in South Africa and the United Kingdom. She also worked with an executive management-training program at Yale. In the United States she’s led research for the Door-to-Balloon Alliance, a campaign that promotes best practices for the hospital treatment of heart-attack patients.
Yale’s Global Health Initiatives draw faculty from the schools of public health, medicine, and nursing, as well as business, law, and arts and sciences. It’s not only clinicians and researchers who have a stake in solving the world’s health problems. “We live in one globe,” she says. “If there are problems in places like Liberia, we will have those problems in the U.S.” The swine-flu outbreak, she says, offers only the latest cautionary tale of how unequal access to health care can feed a global crisis. And children in poor health will likely find themselves ill-equipped as adults to engage in the global economy. “This hurts the stability of those countries,” she says, “and hence limits trade, development, and security for the U.S. too.”
At Yale or abroad, Bradley refuses to coast. She never gives the same lecture twice, she says, especially because her curriculum integrates current events such as Washington’s proposed overhaul of the health-care system.
Nor does she try to sugarcoat health-policy challenges like the clashes between hospital executives and doctors. “Both are quite autonomous, and few physicians like to report to a CEO,” she says. Yet both help to keep the hospital running smoothly, much like the factory lines of New Britain. Only through frank discussion can one side acknowledge its dependence upon the other. “You want to provoke people to dialogue,” she says, “so they can understand potential conflicts and find compromise.”