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Making care integration work

Report cites barriers to patient-centered care

By Maureen McKinney
Posted: November 24, 2012 - 12:01 am ET

It's one of healthcare's toughest nuts, but care integration, if addressed properly, can deliver on improved safety, lower costs and better outcomes. That was the message of a recently released position paper from the Lucian Leape Institute, a think tank housed within the Boston-based National Patient Safety Foundation.
According to the 27-page report, Order from Chaos: Accelerating Care Integration, a host of barriers currently stands in the way of care that's patient-centered and coordinated among settings, including a lack of leadership, “the straitjacket of physician autonomy and economic independence” and “a payment system that reinforces fragmentation and independent decisionmaking.”

But a number of high performers have successfully overcome many patterns of poor integration, such as weak transitions of care and inadequate exchange of information, said Dr. David Lawrence, retired chairman and CEO of Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, a member of the Lucian Leape Institute and a co-author of the report. He named several organizations, including Virginia Mason Medical Center, Seattle, and Cincinnati Children's Hospital Medical Center, whose leaders stress continuous process improvement and learning.

“What those hospitals tell us is that the model that most hospitals use does not work,” Lawrence said. “The difference in performance is stark, and it really means that most of us in healthcare are faced with a moral dilemma: I can continue to provide care that is not reliably safe or I can begin to transform to these systems that provide much safer care and do so less expensively. There really is almost no choice.”

Crafted with input from an invited nine-member expert panel that included David Posch, CEO of Vanderbilt University Hospital and Clinics, Nashville, and Yuehwern Yih, a professor of industrial engineering at Purdue University, West Lafayette, Ind., the report outlined strategies for integrating healthcare, smoothing transitions and improving processes.

Those tools include education and training and the use of robust measures that track integration efforts, according to the report. Patient engagement also plays a central role, said Sara Singer, assistant professor in the department of policy and management at the Harvard School of Public Health, Boston, who served on the expert panel.

Dr. Gary Kaplan, chairman and CEO of Virginia Mason Medical Center, also served on the panel and was charged with sharing lessons learned from his organization's much-publicized application of the Toyota Production System. “Having the opportunity to share our successes as part of the panel was very rewarding,” Kaplan said in an e-mail.

This latest report is the second to come from the Lucian Leape Institute. The first, released in March 2010, focused on the need to improve medical schools' approach to teaching the principles of safe care. Future reports will explore transparency, consumer involvement and other topics.

Lawrence said he's not expecting the care integration paper to trigger a sea change. Instead, he said he hopes that the paper—coupled with the Institute of Medicine's recent report on a “learning” health system—will create a drumbeat that over time will convince providers to change their practices.

“I think these documents are a source of motivation for everyone,” Kaplan said. “The need to change is clear. We know our healthcare system is full of waste, and as we tackle and remove that waste, we increase the quality of care and provide it at a lower cost.”
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