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Solve healthcare problems with collaboration, accountability

Posted Apr 03 2013 2:33pm

by Judith D. Bentkover

Last month, Yahoo CEO Marissa Mayer stunned the business community when the company announced it would abolish its work-at-home policy.

Publicly, the internet company stated it made the controversial decision to encourage greater face-to-face interaction, chance encounters and serendipity, which it argued would lead to more collaboration and drive innovation. These opportunities, Yahoo asserted, cannot be achieved when employees are working remotely.

Regardless whether Yahoo's decision was necessary to support collaboration, it points to a challenge that all organizations face today: the need to generate continuous and accelerating performance improvement.

In the healthcare universe, hospitals are facing increasing pressure to improve the quality of care, reduce utilization and lower costs.

As Mayer recognized, rapid and continuous innovation can only emerge from high levels of collaboration. The healthcare system is moving towards higher levels of collaboration, especially through the emergence of accountable care organizations (ACOs). High levels of collaboration are essential if ACOs are going to deliver on their promise of effectively managing the health of a population.

Improving quality of care at lower costs for whole population will require continuous improvements in how care is delivered operationally and clinically. This transformation will require not only greater coordination within a single clinical setting--which can be challenging enough--but also collaboration across clinical settings and in conjunction with other key stakeholders, such as payers.

Yahoo may not be the company to emulate, but at a time when healthcare leaders are looking to lower costs and improve efficiencies, perhaps they should look to the business community for inspiration and insight into how to drive continuous improvement.

Instituting a collaborative approach to problem solving

In the 16th century, Sir Francis Bacon declared "knowledge is power." However, as my colleague Larry Chait has pointed out, knowledge only brings power when it is shared. Exhorting staff members to collaborate and share information will not suffice; healthcare organizations must set up the systems to support higher levels of integrated decision making.

For instance, Atrius Health, a Pioneer ACO comprised of five medical groups of more than 800 physicians operating across more than 30 care sites, has organized a committee of doctors and staff who examine all aspects of operations looking for specific ways to improve efficiencies.

Atrius also has initiated a process of analyzing and discussing patient records with the goal of sharing best practices across the whole physician staff regardless of which group they belong to or where they practice.

Boston Children's Hospital's Standardized Clinical Assessment and Management Plan (SCAMP) initiative is another example of how collaboration among experts can resolve pressing challenges. Seeking to eliminate costly unnecessary care and testing, a team of physicians determined clinical practice guidelines (CPGs) and randomized controlled trials (RCTs) were too narrowly focused to increase efficiencies and improve care.

The physicians decided to look at the decisions they themselves were making, and used that qualitative information to construct a dynamic decision-tree-type algorithm to help physicians determine the best course of action. Since its initial implementation, this methodology has been used in departments across the hospital to reduce utilization in numerous areas of care

Creating a system of accountability

Like knowledge, collaboration cannot exist in isolation. To be most effective, collaboration must be paired with a strong system of accountability. Leaders need to construct clear lines of responsibility and institute performance-based compensation systems aligned with the organizational goals for delivering high-quality, high-value and efficient healthcare.

Geisinger has brought its physicians together in cross-disciplinary teams to redesign its care process models and develop its ProvenCare bundles of evidence-based practices. This coordinated approach, which also includes a system of peer review and strong financial incentives, has been essential to Geisinger's success in achieving extremely high levels of compliance with these practices.

Beth Israel Deaconess Medical Center in Boston has taken accountability one step further. In pursuing the hospital's goal of eliminating all preventable harm, leadership didn't only require hospital-wide collaboration in examining all aspects of how medical staff delivers care.

To reinforce how serious the hospital was, leadership decided to regularly andpublicly report on the results. This decision added another dimension of accountability in promoting high levels of collaboration, which are essential to driving continuous and rapid innovation.

Judith D. Bentkover, PhD, is an adjunct professor of Health Services, Policy and Practice at Brown Alpert Medical School and the academic development director in the Executive Master of Healthcare Leadership program at Brown University. She also is president and CEO of Innovative Health Solutions, which provides research and strategic analysis to healthcare manufacturers, providers and payers.

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