Changing the culture of a hospital to accept these changes proves difficult, said committee member Dr. Richard Afable. It could take time. “These are changes that must occur to improve outcomes,” said Afable, president and CEO at 422-bed Hoag Memorial Hospital Presbyterian in Newport Beach, Calif. “We can’t wait till 2014.”
The committee divided its suggestions into four sections: must-do strategies, “second-curve” metrics, core organizational competencies and self assessments.
Ten must-do strategies were listed, including four key ones: ensuring proper alignment between hospitals, doctors and other stakeholders; using evidence-based practices to improve quality and safety; improving efficiency through productivity and financial management; and developing integrated information systems.
Each strategy is illustrated with a case study. Hoag’s creation of its orthopedic institute in 2010 was one example, showing the successful impact of properly aligning doctors and decreasing patient volume in operating rooms. For hip and knee replacements, the number of hospital-acquired infections dropped—as did costs.
“For us, joint replacement is not about two days sitting in the hospital, but 30 days before the surgery and two days after surgery; that entire thing is our product,” Afable said. Gauging the impact of implementing strategies has changed, he noted. The old ways include counting how many patients suffered blood clots during a procedure. Now there’s more focus on after-care and the patient’s quality of life, Afable said.
The report then introduces “second-curve metrics,” referring to healthcare consultant Ian Morrison, who dubbed the current volume-based hospital environment as the “first curve” and the future’s “value-based market dynamic” as the “second curve.” These measures include the quantity of doctors properly aligned and engaged with a hospital, the use of evidence-based outcomes to improve performance, increased cost efficiency and development of information systems—including reducing the time between analysis and treatment.
A third section focuses on preserving a hospital’s core competencies, such patient-centered care, financial stewardship, accountable governance and leadership teams, and engaging employees at their full potential.
The report also discusses accountable care organizations and notes that “it is essential for organizations to work closely with their clinical staff throughout the negotiation process, to receive buy-in, and to expose the means by which clinical quality improvements might be able to reduce costs overall.”
Ten-hospital Advocate Health Care, Oak Brook, Ill., is lauded for a “first mover strategy” in the Chicago market with a three-year ACO agreement with Blue Cross and Blue Shield of Illinois struck in 2010 (Aug. 29, p. 6). Martin Manning, president of Advocate Physician Partners, said providers considering ACOs should start small. “They can start in ways that involve collaboration among providers that have traditionally thought of themselves as separate parts of the care continuum.”