Frontiers of Health Services Management - Summer 2013 - (Page 9)

physician group practice, and by focusing on the coe, they moved from a physicianpreferred decision-making paradigm to physician team–driven decision making. the coe structure was originally designed to get similar-specialty physicians talking and actively engaged. once those relationships were formed, Piedmont Heart had to decide • what the groups should be talking about, • how their efforts should be aligned with both Piedmont Heart and PHc organizational goals, • how to support the groups, and • how to measure performance. Defining and Developing Clinical Pathways Piedmont Heart defines clinical pathways as comprehensive care management tools used across the inpatient and outpatient continuum of care. More than order sets, clinical pathways are meant to improve quality, reduce variation, and ensure appropriate care is provided efficiently. essentially, a clinical pathway is a process flow diagram created from evidence-based guidelines and organizational standards or best practices for how to treat specific disease states. PHc previously viewed clinical pathway development as order set development, and it measured compliance to clinical pathways by compliance to order set utilization. With the hiring of a director of clinical transformation in July 2011, Piedmont Heart began to take a broader view of what pathways were, how they were developed, and the value they could provide. Piedmont Heart’s work to develop pathways started with identifying variations in care processes within the coes and then moved on to coe subcategories. each coe treats multiple diseases, which have numerous possible approaches to treatment, and potentially as many opinions on how that treatment should proceed as physicians in the coe. to help organize and prioritize pathway opportunities, Piedmont Heart developed a “trunk and branch” structure, which works as follows: the trunk relates to a general disease state oriented to a coe, such as heart failure. from that trunk, branches of the disease subcategories multiply until finally Michele M. Molden, FACHE; Charles L. Brown III; and Bryan E. Griffith • 9 f e a t u r e Piedmont Heart’s administration now provides each coe with specific goals related to quality, education, definition of models and processes of care, and strategic growth. these goals include creating and implementing clinical pathways and furthering cultural integration and clinical education. Piedmont Heart coes have created new value for patients and the organization. for example, physicians within the electrophysiology coe had once practiced eight different ways to dress a wound after an implant procedure. variation was present not only between legacy physician groups but also within those groups. through the coe approach of review of evidence-based literature, group discussion, and discernment, there is now one best practice approach. other organizations interested in adopting a similar structure should be realistic about the time needed to establish this type of structure and the necessary commitment of the physicians to achieve success. it is also important to select the right coe chief and identify the right focus areas early on so that coes do not spend time developing lower-value solutions.

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2013

Frontiers of Health Services Management - Summer 2013
Contents
Editorial
At the Heart of Integration: Aligning Physicians and Administrators to Create New Value
Volume to Value
Physician-Led Models of Accountability and Value: Observations on Payment Policy and Culture
Collaboration Across Clinical Silos
Breaking Down Clinical Silos in Healthcare

Frontiers of Health Services Management - Summer 2013