The theory of evolution by natural selection, the telephone, the fortissimo E flat major chord at the beginning of Beethoven’s Piano Concerto #5. All of these are now seemingly mundane things that at first were the product of true genius. To that list I would add the concept that health care does, but should not, cause harm. When I was in school 30 years ago, that concept didn’t really exist, the idea that hospitals and physicians could do anything other than good – perhaps as a result of gross incompetence, but not as a byproduct of normal operations.. One of the people who understood and helped raise awareness that providers must acknowledge and control their inherent potential for harm has now been recognized for the genius of that insight. Gary Cohen, founder of Healthcare Without Harm, was announced this week as a recipient of a 2015 MacArthur Foundation “genius” award.
Cohen began with a grass-roots campaign to eliminate mercury from use in healthcare over 20 years ago. Given its ubiquity in thermometers, sphygmomanometers (blood pressure cuffs), and other devices, that might have seemed quixotic. Yet mercury has now essentially disappeared from hospitals. More broadly, Cohen and his colleagues saw this as just one example of the ways in which health care organizations were major contributors to environmental degradation, with the potential to undermine, directly (e.g., mercury, toxic cleaning chemicals) or indirectly (e.g., power plant emissions) the health and well-being of their patients, workers, and communities. Healthcare Without Harm brought together all of those stakeholders to not only advocate but also to create solutions.
As noted in the MacArthur Foundation citation, Cohen “led a paradigm shift in the perceived responsibility of health care providers, from a narrow, patient-centered duty of service regarding individual health to a broader obligation to also ‘do no harm’ to surrounding communities, their residents, and the global environment.” Like the patient safety movement inspired by Don Berwick among others, Healthcare Without Harm and the Healthier Hospitals Initiative (also co-founded by Gary Cohen) are helping hospitals and providers to see their positive responsibility to minimize the negative effects of their activities, and to make the necessary systemic changes to do so. Hippocrates urged us not to harm the individuals under our care; Cohen urges us not to harm everyone else. It’s nice to have that recognized as a stroke of genius.