Coaching Physicians to Become Leaders - Richard Winters. Two or three times a week, a physician contacts me, in search of executive coaching. Department chairs, managing partners, medical directors, chiefs of staff—they’re all frustrated. As a practicing physician with experience in several leadership roles, I know how they feel: They don’t recall saying to their childhood friends, “I want to be Vice President of Medical Affairs when I grow up.” Rather, they longed to care for people, to earn a good living, and to make a dent in the world’s suffering. They wanted to be doctors. However, at some point that wasn’t enough. They found they also possessed a desire to improve their organizations.
They stepped forward, spoke up, and became leaders. Now they need help getting things done. Here are four of the biggest challenges they face, along with some solutions that I’ve seen work for them. Challenge #1: They feel overwhelmed by organizational noise. Physician leaders have a cacophony of goals and demands ringing in their ears. Intelligent Redesign of Health Care - Robert S. Kaplan, Thomas W. Feeley, Mary L. Witkowski , and Heidi W. Albright. By Robert S. Kaplan, Thomas W. Feeley, Mary L. Witkowski and Heidi W. Albright | 12:00 PM October 14, 2013 The health care industry has survived economically by cross-subsidizing margin shortfalls in one activity with the revenues generated from others. But the very existence of these cross-subsidies is symptomatic of deep flaws in the health care reimbursement system.
As we move forward we need to be mindful of two principles that must be at the heart of any fundamental health care reform: “no margin, no mission” and “if you can’t measure it, you can’t manage it.” The University of Texas MD Anderson Cancer Center is seeking to reduce its cost structure by redesigning its health-care-delivery model to reflect the true costs of care (the early stages of the project were described in a 2011 Harvard Business Review article by Robert S. The project requires clinicians to learn process mapping and cost-accounting tools that are not taught in medical school or residency. Understanding the Drivers of the Patient Experience - James I. Merlino and Ananth Raman. Many hospitals, including the Cleveland Clinic, are implementing a variety of strategies to improve the patient experience —an issue that’s rapidly becoming a top priority in health care. The Accountable Care Act now links performance related to patient-experience metrics to reimbursement.
For the first time, the pay of hospitals and eventually individual providers will be partly based on how they are rated by patients. Few disagree on the importance and the need to be more patient centric, but what exactly is the “patient experience”? A 2012 industry survey asked top hospital leaders (CEOs, COOs, and others) what was necessary to improve the patient experience. The top six recommendations included: new facilities, private rooms, food on demand, bedside-interactive computers, unrestricted visiting hours, and more quiet time so patients could rest. To truly improve the patient experience, it is important to get the patient’s perspective. Create patient advisory councils. Tell stories. Getting Real About Health Care Value - David Blumenthal and Kristof Stremikis. By David Blumenthal and Kristof Stremikis | 12:15 PM September 17, 2013 Words can spearhead social transformation. Let’s hope that’s true for “value” in health care. Where other mantras – such as quality or managed care – have failed to galvanize the system’s diverse stakeholders, value may have a chance.
What seems special about the term is that, seemingly simple, it is actually complex and subtle. Under its umbrella, a wide range of interested parties can find the things they hold most dear, from improved patient outcomes to coordination of care to efficiency to patient-centeredness. The question, of course, is whether the term will help spur the fundamental changes that our health care sector so desperately needs. Michael Porter has defined value as “health outcomes achieved per dollar spent.” Porter and colleagues adapt microeconomics to health care through their definition of output: patient-centered health outcomes. The Hidden Cost of Moving Patients - Marlyn T. Conti. By Marlyn T. Conti | 12:15 PM September 17, 2013 A good example of a program that improves patient care, enhances the work environment, and reduces costs — all in an area of medical care that is often overlooked — is one that I lead: Intermountain Healthcare’s Integrated Safe Patient Handling Program. It focuses on reducing injuries to patients and employees due to transfers, lifting, and falls.
Perhaps surprisingly, more injuries occur while lifting patients of average weight than overweight patients, because too often it’s assumed that the lifting will not be a problem. Before we started the program in 2008, we did an analysis of our 22 hospitals and more than 100 clinics, which collectively had 33,000 employees. Data on patient events or injuries likewise revealed a four-year average of 219 patient falls related to lift or transfer activities. Employee injuries were more common than those to patients, in large part because the employees were doing the lifting or transferring. Why Health Care Is Stuck — And How to Fix It - Michael E. Porter and Thomas H. Lee. The pressures for fundamental change in health care have been building for decades, but meaningful change has been limited while the urgency of change only grows. The moment of discontinuity has arrived. Already unsustainable costs, an aging population, advances in medicine, and a growing proportion of patients in low reimbursement government programs have made the status quo unsustainable.
Change is inevitable. There is only one real solution, which is to dramatically increase the value of health care. Value is the outcomes achieved for patients relative to the money spent. Without major improvements in value, services will need to be restricted, the incomes of health care professionals will fall, and patients will be asked to pay even more. In our October Harvard Business Review article “The Strategy That Will Fix Health Care” we describe the strategic agenda that is necessary to create a high value health care delivery system. Flying blind is dangerous. Redefining the Patient Experience with Collaborative Care - Leonard L. Berry and Jamie Dunham. It’s a common patient complaint about the people involved in their care: “Sometimes the left hand doesn’t seem to know what the right hand is doing. I don’t feel everyone is working together.”
To address this issue, nurses at ThedaCare employed lean techniques to create a patient-centered, team-based model that’s producing solid results. Based in Appleton, Wisconsin, ThedaCare is a five-hospital health system with 26 clinics, other allied services, and more than 6,000 employees. It has been a pioneer in applying lean methodology in health care in order to tackle quality and cost issues. ThedaCare opened its first “collaborative care” hospital unit in a medical-surgical unit at Appleton Medical Center in 2007 after 18 months of interdisciplinary planning led by nurses. The results to date show that the inpatient-care model is succeeding in improving safety, efficiency, and effectiveness.
Team Care at the Bedside Struggles — and Lessons — from the Journey Start from scratch. An Obstacle to Patient-Centered Care: Poor Supply Systems - Anita L. Tucker. It is widely acknowledged that patients and their families should be deeply involved in the design of and decisions about the health care that the former receive — and that it is integral to achieving high quality and patient satisfaction. But delivering such “patient-centered care” has proven challenging. After hundreds of hours of observations in hospitals throughout the U.S. and Canada, I have come to the conclusion that health care professionals will continue to struggle to deliver it unless hospitals redesign their internal supply processes, structures, and measurement systems so that staff have the specific materials and equipment needed for patients’ individual care plans, when they are needed.
The good news is that approaches in other industries offer possible models for hospitals and other care providers. My research shows that problems with the supply of equipment and materials — which I call “operational failures” — disrupt care and waste up to 10% of nurses’ workdays. It's Time for Episode-Based Health Care Spending - Adi Kumar, Thomas Latkovic, and Daniel Tsai. There is widespread agreement that if the United States is to achieve sustainable levels of health care spending, it must make greater use of payment mechanisms that reward physicians, hospitals, and health systems for the results achieved. The vexing question is how best to make this transition.
Today, payers and providers are using a range of strategies to accomplish this goal, including patient-centered medical homes, value-based contracting, and accountable care organizations (ACOs). We applaud this trend. However, our research and experience have convinced us that the transition to outcomes-based payment will occur more easily if both payers and providers take an intermediate step and make greater use of retrospective episode-based payment (REBP). The desire to jump straight to outcomes-based payment models focused on the total cost of care for an entire population has led many payers and providers to overlook, or give up on, episode-based payment.
The Advantages How Does REPB Work?