Harvard Business Review on Fixing Healthcare from Inside & Out

Saving Money, Saving Lives

by Jon Meliones

MY EPIPHANY CAME AT SEVEN O’CLOCK on a hectic November evening in 1996. I was the attending physician in the intensive care unit at Duke Children’s Hospital (DCH) in Durham, North Carolina. A six-month-old named Alex lay in a crib in the ICU with a stiff plastic tube in her throat. Awake and moving after heart surgery, the tiny girl was ready to come off the ventilator. As Alex squirmed and tried to breathe, the ventilator forced more air into her lungs. Her exhausted parents grew distraught. “Why can’t she come off the ventilator?” her mother asked. “Because we’ve had to cut back on night staff,” replied the busy nurse. “There’s no respiratory therapist available.” Alex was uncomfortable. She received ...