Image: photo by K. Xu; "The Dance" by Regina Holliday
Last week, I joined thousands of people who gathered in Orlando, FL for the Institute for Healthcare Improvement’s 2015 National Forum, in which healthcare professionals from around the world, including inspirational leaders as Don Berwick and Magic Johnson, brainstormed on how to achieve the quadruple aim (including workforce joy). Three main themes that I found were reiterated throughout the conference were:
1. Value-based care and co-designing around the patient:
As healthcare moves from a volume-based care model to a value-based care model, healthcare leaders are struggling to define what “value” would mean to the patient versus the provider.
Anna Roth, CEO of Contra Costa Health System, a safety net hospital system, shared that underserved patients tended to be less concerned about their own health, than about meeting ‘basic needs’ such as having secure housing or food for their children. “Meeting the patient where they are at” has become the mantra for providers — to build a partnership revolving around the patient’s personal priorities and preferences. Southcentral Foundation Nuka System of Care is an example of a best practice that has successfully been able to implement a care model that addresses and cares for the “whole” patient.
Key Takeaway: Healthcare organizations should consider human-centered design in co-designing care together with the patients, through
a) addressing social determinants
b) using digital health to provide care everywhere, and
c) personalizing care for all patients
2. Capitalizing on technology for data capture and deriving meaning from that data
With the acceleration of technology in health care, the ability to capture data about patients has provided much value to providers in not only being able to better track patients’ progress through digital health tools, but also being able to make better evidence-based clinical decisions.
The challenges in the current system are:
a) interoperability of data and patient records
b) avoiding information overload and deriving meaning from the data to support clinical decisions
One of the best practices shared was CRISP Health Information Exchange (HIE) in Maryland, in which all patient records are kept within one system throughout the state and information could enter the HIE from other EHRs and be extracted. Johns Hopkins Medical Center was able to use the admit/discharge information in the HIE to better address the gap in care they were seeing in transitions of care from inpatient to outpatient, improving patient care coordination and follow-ups, and ultimately improving quality and outcomes.
Key Takeaway: Collecting data is helpful, but the true value is in making data available to all providers and making that data meaningful.
3) ‘Quality Improvement’ versus ‘innovation’
Health care organizations have started to be more proactive in launching quality improvement initiatives, and even encouraging residents and medical students to lead projects. As compared to last year’s conference, I noticed a much stronger emphasis on ‘innovation’ beyond quality improvement. But what’s the difference?
Chris Trimble, adjunct professor of Business Administration at Dartmouth and author of “How Physicians can Fix Healthcare”, describes it in the simplest way. Quality improvement involves a much smaller scale process in which one area or measure can be improved through analyzing current processes and removing waste. By contrast, the shift moves towards innovation when a completely new process or product is introduced to the current system. Trimble mentions that the only way that innovation can effectively be executed is through having a small full time team dedicated to a single initiative. This small team must be also able to execute this project themselves, which makes them more reliably available.
One example Trimble mentions is at Primary Children’s Hospital in Salt Lake City, in which a small full-time team formed with an MD, NP, nurse and MA. The team was able to completely redesign their clinical workflow and their schedules so that each of them had 1/3 of their time set aside per week for care coordination and follow-ups with patients/families. Overall results showed an achievement of the triple aim.
Key Takeaway: Trimble concludes that by rebuilding a care team from scratch, the team is able to practice ‘clean-slate team design’ without breaking anything in the care flow.
In our current health care ecosystem, we have struggled with the inefficiencies and the slow transition to value-based care models. However, this conference was an eye-opening and valuable experience that allowed health care professionals from around the world to share their struggles and experiences and also learn from best practices that have found success.