Big Ideas, Lasting Influence
- The Department of Orthopaedics.
- The multidisciplinary Spine Center.
- The landmark national SPORT study.
- The Center for Shared Decision Making.
- Patient-reported outcomes.
- The High Value Healthcare Collaborative.
- The Dartmouth-Hitchcock Health network of affiliations.
- The Jack Byrne Center for Palliative & Hospice Care.
These are just a few of the initiatives that didn’t exist before Dr. Jim Weinstein came to Dartmouth-Hitchcock (D-H) as an orthopaedic surgeon in 1996. In the years that followed, building on a vision of informed patients who are cared for by patient-centered caregivers, he and colleagues created programs, structures, practices and research projects that put patients and families first.
It’s a legacy that will be carried on long after Weinstein stepped down as CEO and President of Dartmouth-Hitchcock on June 30, 2017, not only programmatically, but in the culture he created among colleagues and collaborators.
For 20 years at D-H, Dr. Weinstein’s career has been marked by common themes: intellectual curiosity, determination and rigor, a drive to constantly improve, and a love of collaboration and mentoring others.
“There are no small ideas in Jim’s mind. They’re all big ideas,” says his longtime colleague William Abdu, MD, MS. Abdu, who has worked closely with Weinstein in research and clinical care for more than two decades, and who succeeded him as medical director of the Spine Center, says those “big ideas” had a profound impact on practitioners and on patients.
Through shared decision making and the development and implementation of patient-reported outcomes, “Jim gave us a new lens into the patient. He brought the patient into the process,” says Abdu. “Suddenly, we had so much better information about what was going on with that patient than we could ever get from an MRI [magnetic resonance imaging].”
The patient-reported outcomes were a key element of the SPORT (Spine Patient Outcomes Research Trial) study. Over 15 years, with more than $23 million in National Institutes of Health (NIH) funding, SPORT sought to answer the question of whether surgery for common conditions like a herniated disk and spinal stenosis was effective. Like Abdu, Jon Lurie, MD, MS, has been a member of the SPORT team since its inception and took over as primary investigator from Weinstein. Calling SPORT “a truly seminal study in spine surgery,” Lurie says, “Eighteen years later, we continue to use the vast amount of data collected to improve the information available to patients and physicians,” allowing truly informed decisions about how to manage spine conditions.
Adam Pearson, MD, MS, came to D-H first in 2003 as part of his medical student rotation, partly because of roots in the Upper Valley and partly because of Weinstein’s reputation and his position as department chair. Returning as an orthopaedic resident, he soon found Weinstein to be a generous and effective mentor. “Like numerous other people, I owe so much to his mentorship and the encouragement he gave me along the way,” Pearson says. “He had a huge impact on my career, as well as how I think about research and clinical practice.”
Fostering continued learning
Pearson was one of 25 Orthopaedic residents to benefit from a scholarship to the masters programs at The Dartmouth Institute for Health Policy and Clinical Practice (TDI). As chair, Weinstein obtained NIH funding from the U.S. Department of Health and Human Services to put two residents a year through TDI, something Pearson and Abdu say had a profound impact on the way the department approaches clinical care. “It significantly elevated our understanding of research, study design, methodology…it changed and enhanced the conversations we have in surgical and trauma conferences and grand rounds.”
Partly through a TDI Trustee Scholarship program Weinstein created, 175 former or current D-H employees have advanced through the graduate programs at TDI. A separate scholarship program funded by D-H has put 24 staff through the Masters in Health Care Delivery Science (MHCDS) program offered by the Tuck School of Business at Dartmouth College and TDI. To date, a total of 35 physicians and staff from across the D-H system have received MHCDS degrees.
Anna Tosteson, ScD, the James J. Carroll Professor in Oncology, succeeded Weinstein as director of the Multidisciplinary Clinical Research Center, which he created in 2003, and says his support was instrumental in the creation of the Comparative Effectiveness Research Program, which she also directs. “Jim’s extraordinary ability to bring diverse groups together and unite them toward a common purpose,” Tosteson says, has been a major factor in the success of SPORT and other projects he has led.
The legacy he will leave
Reflecting on Jim Weinstein’s legacy and the programs and projects he created and led, Abdu says he realizes now it was all part of a continuum. “Looking back, I can see how it all fits together: the creation of the National Spine Network, patient reported outcomes, shared decision making, SPORT, the High Value Healthcare Collaborative. Maybe he knew this in 1996—how all these things were pieces of a puzzle that fit into place perfectly, but none of us knew it.”
As D-H CEO and President, Weinstein’s focus on creating a sustainable health system can also be added to that continuum. This initiative is built around the principles that inform all his earlier work: informed patients; appropriate treatments driven by value, not volume; transparency in sharing information and outcomes; measurement of safety and quality; and a focus on the overall health of the patient, not the delivery of health care.
For Weinstein, all his work at D-H has one common thread: the patient. “Whether it’s researching if a particular surgery is effective, improving how we gather and present information about outcomes, ensuring that our safety and quality is among the highest in the nation, or continually finding new and better ways to deliver health and health care, it’s all about doing what is best for the patient and their family,” he says. “Everyone here knows my favorite word is ‘imagine.’ I’ll never stop imagining how we can make things better, for our colleagues, for the health system, for the nation, but most importantly, for the patients we are privileged to serve.”