Some see smaller, regional companies as better-positioned to achieve clinical and operational integration. “I think a regional system has an advantage in creating systemness,” Sentara’s Kern said. “National organizations have an issue with consumer trust in handling personal information. Consumers are going to look to connect with providers they trust.”
Big provider companies need to nurture a culture of continuous quality improvement and develop a system of spreading learning throughout the organization, said Dr. David Pryor, senior vice president and chief clinical officer for Ascension. A key element is recognizing that front-line staff in each market and facility have to take the lead in making changes. That requires a deft touch in balancing corporate directives and local control.
“It’s the leadership at the individual organization level that makes change happen,” Pryor said.
The importance of local leadership was clear when Mayo Clinic launched an effort several years ago to standardize the post-operative recovery process in gynecological surgery. That involved evidence-based changes in traditional practices, such as eliminating bowel preparation, trimming opioid use, reducing IV fluids after surgery, and letting patients eat and drink almost immediately after the procedure.
The changes first were tested at Mayo’s flagship hospital in Rochester, Minn. Six months in, the average length of stay for ovarian cancer surgery patients had dropped from seven to four days, and cost savings for all gynecological surgery patients totaled nearly $800,000.
After that, the revised post-recovery processes for gynecological surgery patients were rolled out to all Mayo facilities.
There was resistance from some department chiefs, said Dr. Sean Dowdy, Mayo’s chair of gynecologic oncology. “In one instance we had to wait for a leadership change before rolling it out,” he said. “You can’t force-feed it. You have to have people buy in or it won’t happen.”
To increase local buy-in, Mayo implemented the new protocols through specialty councils for each department, with representation from all its regions. It’s continued to hone the original pathway, with successive rounds of innovation, better outcomes, and less variation among surgeons. “The best way to do it was through face-to-face meetings because there were some centers that needed more help,” Dowdy said.
Mayo’s experience illustrates why hospital company executives may hesitate to tackle system standardization efforts—it takes a lot of time and staff resources. Moving to one way of doing things roughly translates to about 50% more work every day for leaders and front-line staff, said Ben Umansky, a managing director at the Advisory Board. “System leadership consistently underestimates the time and effort it takes to get integration and systemness right.”
Because of the resource demands, an organization may opt to remain a holding company and never embrace the challenge of integration, he added.
Despite the difficulties, some are taking on that task anyway. They’re doing it out of a combination of commitment to patient safety and quality of care, market competition, desire to improve staff morale, and external pressure for providers to become more efficient and reduce costs.
Northwell Health’s leaders know their 23 hospitals are below the national average on patient experience survey scores reported on the CMS’ Hospital Compare website for quiet rooms at night. The hospitals also vary substantially among themselves both on that measure and their overall patient experience rating, scoring from two stars to four. So Northwell’s quality leaders have worked with clinical and operations staff at each hospital on a package of changes to enable patients to sleep restfully through the night.
Front-line staff have bought into the quietness project because they realize it generally makes no sense to wake patients up at night, said Sven Gierlinger, Northwell’s chief experience officer. The quietness campaign has prompted staff to identify other processes that need improvement.
“When front-line staff think it’s about saving money, they aren’t engaged,” said Dr. David Battinelli, Northwell senior vice president and chief medical officer. “But when something is really a good idea that improves both provider wellbeing and patient experience, it’s easy to adopt.”