In 2008 the world lost a great pioneer of the patient-centered care movement when Harvey Picker died at the age of 92 years. As the founder and enduring inspiration of the Picker Institute, Harvey challenged the healthcare system to improve patient care by prioritizing, honoring, and reflecting the patient perspective. One could not accurately describe this, though, as Harvey’s ‘life’s work.’ To do so would unfairly abridge a most distinguished and multi-dimensional career as a scientist, businessman, academic, public servant, and philanthropist
A Varied Career
Long before his championing of patient-centered care, Harvey Picker was making immense contributions to the scientific and technological advancement of medical science. Harvey was born in New York City in 1915, and attended Colgate University, Harvard Business School and Oxford University. The advent of World War II found him volunteering for service in the United States Navy, followed by five years at MIT’s Radiation Laboratory working on microwave radar research and development. As President and CEO of Picker X-Ray, a company founded by his father, Harvey oversaw such pioneering developments as cobalt therapy for cancer and ultrasound and nuclear imaging diagnostics. At age fifty, Harvey changed course and entered the world of academia, pursuing a PhD and then becoming a Professor of Political Science at Colgate University. In 1972, he was appointed Dean of the Graduate School of International and Public Affairs at Columbia University, a position he held for eleven years. Government service included serving as a member of the National Science Board, a U.S. delegate to the International Atomic Energy Commission and on the Board of Trustees of the United Nations Institute for Training and Research. Later, he moved to Maine and owned one of the largest boatyards on the East Coast while also serving on numerous community boards.
The Science of Compassionate Healthcare
It was these cumulative experiences, as well as his family’s personal encounters with the healthcare system, that imbued Harvey with an invaluably well-rounded perspective about how healthcare could be improved by being more sensitive to patients’ concerns and comfort. For both professional and personal reasons, Harvey spent time in hospitals regularly. About what he encountered, he once remarked:
“I am under no illusion that my wife and I were given above-average attention in hospital [sic]. But while we were there we saw how other patients’ needs were badly neglected. They were left unattended on stretchers in corridors for hours…Until the middle of the 20th century, if you became ill there were few things we knew how to cure, so patients got very personalized nursing care for almost everything, trying to pull the person through the illness. Then, with penicillin and the introduction of other medical technologies, there was a complete flip. Because you could cure people, personal care became less important and the attitude of healthcare professionals changes from looking at the person to looking at the disease. The pendulum had swung too far the other way.”
Belying his professional background, Harvey concluded that while science and technology were thriving in medicine, humanity and empathy were the antidotes needed to fix a broken system. Nonetheless, a man of science, Harvey’s tactic was to rely on research and measurement as a basis for addressing the dearth of compassion in healthcare. In 1986, the James Picker Foundation Board of Directors made the decision to re-direct its resources from funding projects in the field of academic radiology to research into the patient perspective of their medical care.
At a time when patient-centered care was largely unvetted and consequently considered either a “radical” notion or a superfluous “nicety” in healthcare, Harvey Picker was able to approach patient-centered care not only through the eyes of the patient, but through the scrutinizing and rigorous eyes of a researcher. The Picker Institute became the first body to systematically collect data to evaluate patients’ perceptions of their healthcare experiences. To do so effectively, Harvey realized, required a completely new approach to patient satisfaction surveying—not one driven by patients’ ratings on questions reflecting institutional priorities, but rather one that focused on patients’ objective comments on aspects of care that mattered most to them. He engaged many partners in this early work, among them a research team at Harvard University Medical School, The Commonwealth Fund, and Beth Israel Hospital (Boston, MA, USA).
Over the course of seven years, more than 8,000 patients, family members, physicians and hospital staff were interviewed about their personal interactions with the healthcare system. They were asked where the problems existed and what improvements were necessary. The findings indicated that patients largely lacked a relationship of trust with their providers, they did not receive sufficient information about their care, and poor communication between patients and caregivers was rampant. More recent studies reinforce that these characteristics of the health care system continue to this day These common themes became the foundation for the Picker Survey, the first-ever patient-centered performance measurement tool.
A Lasting Legacy
While these challenges remain prevalent in many hospitals today, Harvey Picker deserves tremendous credit for putting into motion systems worldwide to understand how medical care is perceived through the patients’ eyes. Certainly, at the time of this groundbreaking effort, a national, standardized patient perception of care survey with results made publicly available to consumers would have seemed unthinkable. And now healthcare consumers in the U.S. are able to go online to compare hospitals based on measures of the patient experience.
Despite Planetree and the Picker Institute sharing a remarkably similar vision for a healthcare system that integrates the patient perspective into every aspect of care, our two organizations worked on parallel paths for decades. It was only in the last few years that these paths converged. The opportunity to partner with the Picker Institute and to carry on Harvey’s vision has been a gift to Planetree. Harvey’s contributions to the patient-centered care movement are vast, and yet his humility and gentle spirit meant that he did not consider himself a pioneer. In fact, only with assurances that it would benefit the greater cause of patient-centered care would Harvey, when approached about having a profile appear in this publication, agree to such a testament:
“Pleased? No! Honored? No! They are both too weak. ‘Overwhelmed’ is much closer to the mark. If you think it will be helpful to our mutual cause, I’d be very happy to do anything that you believe would be wise and useful.”
Harvey’s interest was not in the past, but on what we could do in the future to assure that patients in hospitals, nursing homes, and physician offices are treated with respect, dignity and compassion. Harvey set the priorities of the Picker Institute to address what he considered the great challenges of our healthcare system. Even as we mourned the passing of a venerable pioneer, a remarkable renaissance man, and a kind and gracious gentleman, Harvey Picker’s vision has laid the groundwork for exciting work underway to improve continuing care and incorporate patient-centeredness into health professional education.
Indeed, Harvey left a powerful cadre of individuals and organizations that have been touched by his tenacious dedication to advancing patient-centered care and his vision for how healthcare should be delivered. In our collective efforts to partner with patients and families, to instill caring attitudes in medicine, and to heed the patient voice, Harvey’s legacy will be long lasting and far-reaching.
Please watch this tribute video to Harvey Picker
To gather more information about the Harvey Picker Center of Innovation & Applied Research Program, Future Grant Opportunities and Planetree
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This Guide is designed as a practical resource for health care organizations that are striving to become more patient-centered. It contains best practices and practical implementation tools contributed by hospitals from across the United States. The Self-Assessment Tool can help identify and prioritize opportunities for introducing patient-centered approaches into your organization.
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