Edward Hughes Interview Edward Hughes: How loudly should I speak? Male Voice: Inaudible. Elyse Morelli: Why did you choose to work in the field of health services research? Edward Hughes: That's a terrific question and I've been thinking a lot about it because there was no field of health services research. I would like to think I played a role in, possibly, creating it, but another way to answer the question is the field kind of found me. I'm one of the few physicians who were among the founders of the Association and I am actually unique among all. I'm trained in surgery. I entered medicine because when I was a student at Boston Latin School in the ninth grade, on a career day a physician came and said if you ever want to go into medicine, you'll do it to help people. And that has been the driving force of my entire life. It remains to be it. I left surgery. I started my internship in Columbia after Harvard Medical School on July 1, 1966, which is the day that Medicare was implemented. It was incredible. It was like being born on the fourth of July. And that stimulus was seeing how unprepared the health system was for the influx of what was then called the elderly. Medicaid came October first, a few months later, dealing with the poor. They were totally unprepared, arrogant, insensitive, and anybody who cared about people and wanting to improve their lives would be motivated, as I was, to seek more powerful tools to help people than simply being a surgeon. Being a good surgeon was terrific, but being part of this new field was enormously important, and my feeling was I could have more impact on people and the lives of people and help them much more being in this yet undefined field of health service research than being an individual physician. Elyse Morelli: In your opinion, what are the most significant contributions of health services research? Edward Hughes: I think there have been multiple, and I think one of the problems in the field, certainly in the beginning when we started the Association, was a sense of defeatism. I think the people were so close to what they were doing, they didn't realize how significant the accomplishments were. All of managed care grows out of health services research - the work of Harold Luft [phonetic] and others - people didn't really appreciate that. The whole emphasis now on quality, our ability to measure costs as well as we do, which I think is, at times, overdone as opposed to a more critical measurement of the impact of health on people. The quality of life, we're moving in that direction. We've made major advances in assessing functional status, the ability to make decisions, and I think in the future - or how people make decisions [indiscernible] - we'll move more in that direction. The whole introduction of evidence-based medicine despite the fact that people feel we are under providing it - we've made enormous strides. And further, the whole geographic variation of John Weinberg is enormous, pointing out that there are excesses that are inappropriate and, possibly, some under-service. The contributions have been enormous, and I don't think even in the field, as much as we've grown, are fully appreciated. Elyse Morelli: So, therefore, what are some of the biggest opportunities for the field of health services research? Edward Hughes: I think the biggest opportunity is just keep doing what you're doing. It's the old second law of medicine - if it works, keep it up. We have a lot to do, still, in the area of quality. We need to work more and more on individual decision-making by the patient. How can we advance adherence. I think statements made at this morning's meeting about implementing the research, moving from, shall we say, the theoretical or the academic side to really changing peoples' lives, which I've been doing now progressively over the last decade and a half in terms of speaking around the country implementing the research. I think that's a huge opportunity, but still stay close to the policy process. Be honest. And, I think, also important - don't become involved or overly identify with one particular political ideology. It's an objective field. Search for the truth. The future's on our side. Elyse Morelli: What advice would you give someone thinking of beginning a career in health services research? Edward Hughes: Go to it. It's a fantastic field. It's ever-rewarding. You'll never regret it. You'll have to work very hard, but that's true anywhere. But it's wonderfully rewarding. Elyse Morelli: Why did you become involved in helping to form a new organization - The Association for Health Services Research? Edward Hughes: This field that, essentially, didn't have a name when I first found it or discovered it, it was really a way of life. It was a way of trying to improve the lives of people, as I said earlier. And it became apparent to me that there were many, many talented people in the field or in that same area. They were addressing the same issues and had the same concerns I had, but at different angles. We also lacked political clout. We were not, I think, respected in the academic community. In medical schools we were sort of an upstart trouble-maker, nuisance, just go away, why are you asking all these questions. There was sufficient demand, I think, by the field, the work we were doing, to create a voice. And, I think, the goal of the Association was to create a voice for this field, for all the people to enhance their stature in the natural policy process and allow the field to grow and expand to the max percent possible. Elyse Morelli: What were some of the other goals of the founders who created the Association? Edward Hughes: I have no idea [laughter]. Ask them. Why do you ask the question? What do you mean? Elyse Morelli: Did you have a collective goal other than the ones that you mentioned? Edward Hughes: No. I think we all came to - I'm very proud of the fact that I was one of the first to have had the insight, the inspiration, the vision that we needed an organization. I remember I announced it at a meeting. We were meeting as, actually going back now, the HCFA then, it was announced, and the National Health Service Research had created centers. So there was a sense that there was centerism, centeredness created power, so those of us who were center directors were meeting at somewhat of a regular basis. And it became apparent that we needed to go beyond what we were doing. I think everybody had similar goals. Everybody has individual personal goals and professional aspirations, but on balance, the community of interest was quite unified. And what's amazing is how unified it has been maintaining, how active, which everybody who was a founder still is in the field. Nobody has left it for very good reasons. Elyse Morelli: How has your involvement with AHSR influenced your career? Edward Hughes: Again, that's an interesting question and worthy to ponder. I don't really know how it has influenced my career explicitly other than the fact that it gave me a mission beyond the many others that I already had. It provided an interactive forum to meet otherwise very talented and devoted people, to help them, to be enriched by them and to have a sense of identity. I mean we weren't fighting against darkness and ignorance as individuals anymore. We had a team. It's great to be part of a team. So I think it gave strength to my career, a further sense of meaning, and a sense of accomplishment. Elyse Morelli: What was the original purpose of the AHSR annual research meeting? Edward Hughes: The annual research meeting was really a means to an end, and the end was to assemble the young - because then we were virtually all young - people doing some very distinguished, shall we say, more accomplished investigating at the time, to bring them all together and to give a voice and to allow the work to be shared and create, for a lack of a better term, power. Let the power be realized. Create a sense of community and allow this community to have a voice and to move forward in a collective manner. Elyse Morelli: What were some of the health services research issues at the early meetings? Edward Hughes: Well, the same as now, I mean, the quality, cost, effectiveness, clinical judgment. Increasingly, now, more emphasis on individual healthcare decision-making with the organizational healthcare, managed care, et cetera. They're the same issues. They always will be the same issues. That's what's so great about it. We create, we advance, but the issues don't go away. Elyse Morelli: The first AHSR annual meeting had three hundred attendees, a surprisingly high number for a first meeting. What do you think attracted those attendees? Edward Hughes: The number didn't surprise me at all. I thought, if anything - I knew the people were there. That's why we started the Association. And I think they were attracted to come by virtue of their demand or desire for companionship, for furthering knowledge, for - I hate the word - networking, but to get to know each other. They were there. In other words, we did not create the field. We answered a demand in the community to provide a voice for what these people were doing. Elyse Morelli: What are some of your favorite memories of the annual research meeting? Edward Hughes: [Laughter] Getting to know people, some very - papers, but mostly it's the interpersonal interaction, and over time, just getting to see how people's career evolved, how the field has grown, the extent to which it's influenced the political process, its power, its sense of self. Those are the real take-aways. Elyse Morelli: Where do you see the annual research meeting twenty-five years from now? Edward Hughes: Just like it is now - double the number of people - same issues, having advanced knowledge significantly, having, I think, even more impact on the political process, a more positive - and I say enhanced, not positive - more positive since it has been positive - a more enhanced role in influencing the future health of this nation, the people of this nation and the people of the world. Elyse Morelli: What are some of the challenges you think the field faces in the next twenty-five years? Edward Hughes: There the same as, you know, things don't change. The same as we've faced these twenty-five years - I think getting public voice; having the research communicated effectively to both policymakers and, critically, to the American people; making sure the funding is there; to have the field be aware of its social responsibility; to communicate and affect people's lives, not become cloistered, as it were; to grow young people, which I think it will; and also not to become captive to one particular ideology or another, but to stay centered in the political process; advancing efficiency, quality and better decision-making. Elyse Morelli: What do you think Academy Health can do to help advance the field? Edward Hughes: By advancing all those things I've just mentioned. I think just keep up the good work. Create the forum, stimulate people, provide the inspiration, and the rewards. I think rewards are a very important part of leadership. Rewards in the sense of recognition, job well done, keep it up, we're together, we're winning, as it were. We've done a lot. And, I think, also, it should play an important role. It can help by pointing out what we have accomplished. There's so much always said about what needs to be done and how difficult it is, but stress the positive. We've done an enormous amount of good, and I think that should be pointed out. Elyse Morelli: Is there anything additional you would like to add about the field or for the next generation of researchers? Edward Hughes: No, I think it's been a tough battle - like all social change is tough, it never comes easy. There's someone who studied leadership at Harvard and said everybody who has been a successful leader has always had someone around who said, I love you and you're not crazy. And I think those of us in those early days when we were pushing that rock up the hill and having a lot of people trying to push it down and just kept persevering, persevering, persevering. That's the answer to the game - you just keep it up. It works. Let's have more of it. Elyse Morelli: Well, great. We are really pleased to have you as one of our founders and thrilled that you're here with us and appreciate you taking the time to speak with us today. Edward Hughes: My pleasure. Male Voice: We just need for you to say your name and probably spell it. Edward Hughes: How far - just my name - do you want the title? Male Voice: Title and name. Edward Hughes: Yeah, yeah. I'll give you the title, if I can remember it again [laughter} and then I'll spell it for you at the end. I'm Doctor Ed Hughes. I'm a professor of Health Industry Management and Management and Strategy in the Kellogg School of Management and a professor of Preventative Medicine in the Feinberg School of Medicine of Northwestern University. My name is spelled E-D-W-A-R-D. My middle initials are FX. And last name is H-U-G-H-E-S. MD, MPH. Male Voice: Okay, thank you. Edward Hughes: My pleasure.