Journal of Healthcare Management - January/February 2014 - (Page 4)

Journal of H ealt H care M anage Ment 59:1 J anuary /f ebruary 2014 culture. The people who have helped me understand this concept are James W. Begun, PhD, and John Griffith. Jim introduced me to complexity science 20 years ago, and John has influenced my thinking on the topic as well. Complexity science alters the way we typically view change. It shows us that we cannot effect a culture change until we shift from a transactional management perspective to a transformational leadership focus. We have to change the culture to completely refocus on what the goals should be, which brings me to my second point: defining the goals of care. We tend to favor efforts to reduce costs and increase volumes, but those activities will not change a culture. We need to attend to outcomes that matter to the patient. Furthermore, we must improve outcomes that matter to patients relative to the cost of those improvements. The work of Michael Porter and Thomas Lee (2013) on integrated practice units provides a good model for organizing care and structuring our healthcare organizations around the patient's medical condition. Integrated care would contribute to the value proposition, but most organizations are not doing it. Some of the very best healthcare organizations in the United States have made terrific changes, but the diffusion of those best practices is slow. We wonder why many organizations haven't adopted some of the best practices that are working elsewhere. For instance, the integrated practice unit would take all of the healthcare providers and bring them to the patient-rather than being organized by departments in different buildings-but that idea has been slow to spread. This model is related to interprofessional teamwork, which I have studied with Jim Begun and Gordon Mosser (2011). The University of Virginia's Center for Academic Strategic Partnerships for Interprofessional Research and Education (ASPIRE) uses the interprofessional care model as an integral component of its day-to-day operations. Being interprofessional is not just about working in multidisciplinary teams; it is working at the microsystem level around a patient's medical condition and, as such, is a change strategy that can lead to increased value for the patient. To do so necessitates that our health professionals function to the fullest extent of their licensure and scope of education. Another key change strategy is to measure outcomes that matter to patients. We focus on outcomes that matter to organizations, but what outcomes matter to patients? Say a patient has an advance directive that states the outcome he desires is quality of life, yet he ends up in an ICU and dies a horrible death with lots of tubes, infections, and adverse events to deal with. This is not an outcome preferred by the patient, so why do we keep doing it, despite the fact that evidence supports early intervention of palliative care and symptom management? A final aspect of change for delivering high-value healthcare is to examine how health delivery systems are structured. As far as I can tell, integrated delivery systems are not all that integrated. We still have the silos, the individual organizations, and the greater emphasis on acute care than on the patient over her entire lifespan and illness or disease trajectory. 4

Table of Contents for the Digital Edition of Journal of Healthcare Management - January/February 2014

Journal of Healthcare Management - January/February 2014
Contents
Interview With Kenneth R. White, PhD, FACHE, Associate Dean for Strategic Partnerships and Innovation and the University of Virginia Medical Center Professor of Nursing, University of Virginia School of Nursing
Team-Based Care at Mayo Clinic: A Model for ACOs
The Management Springboard: Eight Ways to Launch Your Career as a Healthcare Leader
The Role of a Public–Private Partnership: Translating Science to Improve Cancer Care in the Community Donna M. O’Brien and Arnold D. Kaluzny
The Value of Patients’ Handwritten Comments on HCAHPS Surveys John W. Huppertz and Robert Smith
Can Inbound and Domestic Medical Tourism Improve Your Bottom Line? Identifying the Potential of a U.S. Tourism Market
Success Factors for Strategic Change Initiatives: A Qualitative Study of Healthcare Administrators’ Perspectives

Journal of Healthcare Management - January/February 2014