Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

A Paradigm Shift at the Local Level

10/2/2012 8:39:14 PM | 0 comments

Physicians have a unique opportunity to take a leadership role in response to the current healthcare budget crunch and the challenges ahead. The tight economic climate over the last four years has forced the private sector to focus on managerial efficiency. Managers have used new information technologies and team-based systems to raise the effectiveness of many organizations. The challenges in the healthcare system appear to be creating a paradigm shift in physician leadership mirroring the rapid change and innovation in the private sector.

A critical driver is the federal government promoting quality measures in the Affordable Care Act (ACA) such as pay for performance.  A second driver is all the data being made available through EMR systems and the real time ways to communicate and coordinate with a team. There are more options than ever for physicians to lead and change culture.

Terms like ‘leadership’ and ‘culture change’ are not the most scientific and many question how much can really be done in the hospital setting.  During an interview recently, I heard it said that most people “start rolling their eyes” when they hear the term culture change in the hospital. I must admit, at times in my life, I have been one of those people eye rolling. However, facts are facts and numbers are numbers, and it’s been astounding for me to see how directly physician leadership has impacted performance metrics and patient satisfaction scores.  Judging from some of the performance data I have recently seen, not only do I believe that leadership can make a difference, but seeing these leaders use modern business management techniques to develop innovations exemplifies how leadership roles in the hospital are creating dynamic change. With the advent of so much data available through EMR to leaders, being able to use analytics as a differentiator is an opportunity, and it will take leadership on the information management front to realize this potential.

At Mercy Medical Center in Oregon, a team care program was developed by Wade Fox, MD and Sam Jones, RN, BSN, that made a big difference for staff morale and patient care metrics. Turnaround time to discharge fell 20%, while at the same time both nurse job satisfaction scores and patient satisfaction scores spiked upwards.  Fox and Jones told me that their team enjoyed their work more and appreciated being part of a group that really felt like a team.  Fox and Jones were able to use technology to facilitate this program in a way that could not have been done five years ago.  A real time wireless communication system enabled the team to coordinate on the run, which was a huge contributor to implementing team care.  

At Adventist Medical Center – Selma in California, Imamu Tomlinson, MD faced a reduction in Emergency Room beds, yet he was able to reduce turnaround time to discharge while also increasing staff job satisfaction ratings and patient satisfaction scores.   Tomlinson used a blend of new programs and team motivation to increase efficiency.  He also brought in important management techniques like focusing on internal communications. He sent out emails of congratulations to his team and informed them of the daily metrics and challenges.  Both Selma and Mercy Medical Centers are examples of a manager who effectively used communication and innovative management techniques that mirror private sector concepts.

Smitha Chadaga, MD started a program integrating hospitalists onto the floor of the ED at Denver Health.  Changing the way these two departments approached the care and hand off of a patient took strategic planning and people skills from the leadership.  This initiative resulted in improved throughput as well as timeliness in patient care because the hospitalists were able to see the patients sooner.  The cost savings was also estimated to be more than a half million dollars.

The power of the leader will continue to evolve in the modern era of health reform in response to new requirements for reimbursement and innovation. And importantly, this will continue to take place on the local level.  Just as medical leaders are becoming further empowered to innovate within their department, a big picture movement towards integration and collaboration is developing across the whole Acute Care Continuum.  Some of the same principles that are defining business leadership trends in 2012 are more applicable to medicine than ever.  Forbes recently detailed five big trends in business innovation in 2012, and their number one trend was that ‘strategy and entrepreneurship will have ever-greater interdependence.’  This almost seems like the principles behind hospital-wide integration and the goal of bundled payments. Not only do physician leaders have the task of running agile hospital departments that function as efficiently as private sector enterprises, they have the added responsibility of integrating their department with others, a challenge similar to a corporate merger.  Considering health reform is now only being implemented, the paradigm shift for the physician leader appears to be only just starting.

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