HPH NOW, February 3, 2006, Brennan to Leave HSPH to Be Chief Medical Officer at Aetna

Troyen Brennan

HSPH Professor Troyen Brennan speaks very rapidly-but then his speed of thought may reflect his high-octane career, launched in 1984 when he received degrees in medicine, law, and public health from Yale University on the same graduation day. Since then, he has become a national authority on the quality of U.S. medical care, a practicing physician, a legal expert in public health, and a leader of HSPH's human subjects committee.

Brennan will soon leave HSPH to bring his expertise to health insurer Aetna, where he will begin a new career as chief medical officer on February 21. Aetna has a nationwide network of more than 700,000 health care professionals.

MEDICAL ERRORS MOVEMENT

Brennan is a pioneer of the medical errors movement. In 1991, he was the lead author on a groundbreaking paper in The New England Journal of Medicine on mistakes made in patient care in 51 New York hospitals. The paper-part of the Harvard Medical Practice Study-described how researchers pored through 30,000 medical records, finding that 3.7 percent of patients received a disabling injury from medical treatment. Of those cases, two-thirds involved a complication caused by medical error. The paper's co-authors included Howard Hiatt, former HSPH Dean, and current HSPH faculty members Lucian Leape, Joseph Newhouse, and Nan Laird.

The study was a loud wake-up call to the medical community and helped lead to a national report nearly 10 years later from the Institute of Medicine called To Err Is Human. The report and the NEJM paper both emphasized the need to reform patient care systems to avoid mistakes in the first place.

HOSPITAL LIFE

Brennan carried this passion for improving the quality of patient care to Brigham and Women's Hospital (BWH), where he began working as a physician in 1987. Five years later, he became director of quality measurement and improvement. In 1997, he became president and CEO of BWH's Physician Hospital Organization, a position he held through 2005, and also assumed the additional responsibility of president and CEO of Brigham and Women's Physicians Organization. Through these roles, Brennan was responsible for managed care contract negotiations, designing both primary care and specialty medical management and incentive programs, and overseeing the merger of seven specialty physician foundations and eight hospital departments into a single physician organization. In joining Aetna, Brennan will leave his posts at BWH.

"Troy is one of the leading health policy scholars in the country," said HSPH Associate Professor David Studdert, who has collaborated with Brennan and with Associate Professor Michelle Mello on papers about law and public health. "As a health lawyer, he has really moved the field forward, not only in terms of showing a generation of legal scholars how tremendously productive empirical study of the medical malpractice system can be, but in demonstrating that improvement of patient care is an enterprise that we can and should be very involved in."

Brennan practices what he preaches. He chaired the Medical Professionalism Project, which developed a physician charter of principles to improve the quality of care. The project was launched by the American Board of Internal Medicine (ABIM) Foundation, the American College of Physicians and American Society of Internal Medicine Foundation, and the European Federation of Internal Medicine. One of the principles calls for a commitment to professional competence, and Brennan has worked toward revising how doctors are recertified through ABIM so that lifelong learning is emphasized. He has since volunteered to undergo the revised process to demonstrate its usefulness and to set an example.

PROTECTING HUMAN SUBJECTS

At HSPH, Brennan has chaired the Human Subjects Committee (HSC) almost continuously since 1992. The HSC serves as the School's Institutional Review Board (IRB), helping to ensure that all HSPH studies that involve human subjects are compliant with regulations and are ethically sound.

"Troy has brought an extraordinary perspective to human subjects research, linking the medical, legal, and ethical aspects of tough decision making in a way that was consistent with the highest values of care of every individual, in this country or in developing countries," said Dean Barry Bloom. "And he has had the courage to question the prevailing wisdom on more than one occasion in a most courageous way, and his judgment and values invariably prevailed. We have all been enriched by his wisdom and experience."

Added Sarah Putney, director of the Human Subjects Administration: "Troy has led the IRB with tremendous vision and energy during a time when IRBs across the nation have undergone much change and federal scrutiny. With his educational and professional background, he has lent both a legal and medical expertise to our work. But, more important, he is sincerely interested in what's good for humanity as a whole. He takes the view from 30,000 feet to get the big picture."

A NEW CHAPTER

At Aetna, Brennan will evaluate how the company can help its clients receive the best, most cost-effective care. He hopes to develop data collection and analysis systems to improve patient care and to influence industry standards.

"At HSPH, I have been fortunate to work with scholars such as Michelle Mello, David Studdert, and others to research what was once a largely untapped field of law and public health," said Brennan. "In addition, my work with Sarah Putney and the IRB has been very gratifying. It has allowed me to meet members of all of the different departments, as well as gain insight into the plethora of fascinating research at the School."