To operate more effectively in value-based programs and achieve the Quadruple Aim, hospitals can focus on improving outcomes across five critical areas.
Happiness...if you don’t believe me, read Victor Frankl.
This week in the hospital I gave a talk entitled, ‘Llamas, Lonely Old Men and Tepees.’
It drew quite a crowd.
As I said at the time, if you want to arouse interest, think of a catchy title. Clearly this will not work always, particularly if the talks are dull, but so far, I’ve been lucky.
&, on to happiness!
We all know that in Bhutan they measure Gross Domestic Happiness.
The H.E.A.R.T. of healthCARING With H.E.A.R.T. ... Hope Engagement Activation Relationship Trust ... we will evolve the healthcare system to a healthCARING system and achieve the quadruple aim.
Gaps in Healthcare Delivery Remain: CMS Report Confirms Care Coordination as a Priority
At ACT.md we are working with provider and payer organizations across the country in the various stages of the evolution from fee-for-service to fee-for-value models. Because of this, we have seen and heard the challenges related to coordinating care firsthand. Just this month, CMS released a report confirming such difficulties. The National Quality Strategy (NQS), led by the US Department of Health and Human Services, defined criteria and measurements to make healthcare better, safer, and more aligned with what patients and families want. They outline the following priorities:
Making care safer
Ensuring that each person and family are engaged
Promoting effective communication and coordination of care
Promoting the most effective prevention and treatment practices
Working with communities to promote wide use of best practices to enable healthy living
Making quality care affordable
The 2015 National Impact Assessment of CMS Quality Measures Report demonstrated progress, however it also stated that “significant gaps remain across all measure domains,” and specifically highlighted the gap in achieving effective communication and coordination of care. Healthcare organizations still struggle to meet the following goals: (1) reduce admissions and readmissions, (2) embed best practices to manage transitions to all practice settings and (3) enable effective healthcare system navigation.
This comes as no surprise to us, hence why we are purpose-built to support complex team interactions and workflows that involve patients, families, and a broad array of clinicians - each contributing aspects of a complex care plan.
Stakeholders face a number of challenges. Care includes providers from multiple disciplines involved at the same time, and these providers may work in different locations - even separate organizations and cities - and care teams are unique to each patient. The patient and family’s involvement is critical as they are very likely to perform key actions as part of the care plan, yet they have no meaningful tools to make this possible. Lack of appropriate incentives and attempts to navigate onerous documentation requirements with their associated IT investments have not fostered optimal workflow, collaboration and coordination among medical teams, let alone patient/family involvement (note: new CMS codes are a step, though). Care Managers who often sit at the center of care are siloed and don’t have the tools needed to scale their work to achieve the NQS measures.
The reforms underway in healthcare are driving stakeholders to rethink care delivery models in order to achieve the quadruple aim of healthcare. There are many encouraging strides being made in improving the quality of care across the country, but in reality this is not a transition, it's a transformation. As a country, we have some distance to cover with hurdles known and unknown ahead of us. Our team and partners have continuing, growing confidence that ACT.md is a solution to help organizations achieve the goals the NQS and CMS Strategy has outlined. The challenges don’t intimidate us. They’re why we exist. We are a platform to simplify a complex problem.
Bringing A Management Model To Healthcare: Team-Based Care
Guest post by Ted Quinn, CEO and Co-Founder, originally posted on Forbes
Early in my career I worked in management consulting with healthcare technology clients. We structured our engagements as a team of professionals with diversified skills, focusing on a strategic question facing a client’s business or operation. As a team, we worked to harness available data to analyze and formulate a set of recommendations to address this question. An Engagement Manager led projects, having overall responsibility for the development and execution of the plan including resourcing, budget, timeline, and deliverables.
In order to execute the plan, each project team member (including the client) had to clearly understand his or her role and their deliverables. At the end of the day, we were hired because the team executed a plan that led to the desired results and exceeded the expectations of our client. The single uniting factor I’ve seen repeatedly across a range of industries and professions is this: high functioning teams are central to success. What if healthcare had the same structure and accountability with Team-based Care? How do we support the physician or care manager who is often charged as the “engagement manager” for the patient?
Healthcare has an opportunity to apply the team-based models of other professions to the job of patient care. As business theorist Clayton Christensen defines, “The jobs-to-be-done framework is a tool for evaluating the circumstances that arise in customers’ lives. Customers rarely make buying decisions around what the ‘average’ customer in their category may do . . . [rather] because they find themselves with a problem they would like to solve.” Both patients and professionals involved in the care of patients have told me “I just want someone to tell me what I need to do.” Patients want to understand how to get better and physicians want to do what they came into this profession for – to deliver quality care and help people. Delivering on this job requires that providers and patients employ principles of Team-based Care.
Patients Are Like Projects
What if we thought of patient care as we do projects in other professional settings? These team-based projects would have diverse team members, tasks, plans, and objectives. As in management consulting, the patient project information would be available to all members of the team (in this case, the patient, caregiver, doctors and other healthcare professionals). At any point in time, all members of the team would quickly understand the state-of-play and know how to communicate to drive action. This is Team-based Care. This new care delivery model would help healthcare realize the quadruple aim of care: enhancing patient experience, improving population health, reducing costs, and improving the work life of clinicians and their staff. As I heard from an Oncology center in New England, “when we implemented a Team-based Care delivery model, accompanied by a patient-centered project management tool we reduced the time spent on coordination and communication activities by 30%.” Team-based Care can quickly yield measurable results.
Four Requirements for a Successful Team-Based Healthcare Delivery Model
Requirement 1: Metrics and Visibility to Measure & Improve
New models of care are driven by health quality metrics. To collect this data, organizations have invested in electronic medical records, health information exchanges and population health tools for the purposes of documentation, billing, aggregating data, identifying high-cost populations, and tracking quality metrics. These investments have led to provider dissatisfaction, staff burnout, and patient frustration as all parties are burdened with tasks often detached from care. In a 2014 survey, 68% of family physicians and 73% of general internists said they would not choose the same specialty if they could start their careers anew. As one physician noted, “I can’t believe how much of my time is now spent documenting instead of executing care!” The team-based project model of care would help improve care processes for everyone involved – creating greater efficiencies and higher quality.
In consulting, we always knew the status of the project. Questions such as, “Are we executing against the plan? Are all members of the team meeting their commitments? Are we on schedule, on budget, and meeting the goals of the client?” could quickly be answered. This data enabled the manager to measure, adjust, and improve team performance to meet commitments. Likewise, Team-based Care would provide new data (e.g., execution to plan, team composition, team loading, patient engagement, etc.) for the healthcare provider and their patients. Such analytics would empower organizations to implement continuous improvement initiatives to refine how care is happening. Knowing the state of play and being able to make adjustments in real-time is critical to delivering reliable healthcare.
Requirement 2: Know the Team
One of the first tasks in launching a consulting project is for the manager to find the best professionals available to study the strategic question of the client. Typically team members were from different offices, had never worked together, and had to quickly understand their unique responsibilities. In a Team-based Care model, all participants similarly understand the composition of the patient’s team. I have a great deal of sympathy for healthcare providers working in today’s environment. There seems to be an ever-increasing range of process pressures, relationships to manage, and technology challenges. A typical primary care physician must coordinate with 229 other physicians across 117 practices. And we see the results: 40% of all malpractice claimsinvolve underlying communications problems.
A large pediatric practice here in New England illustrates the challenge of team complexity. This practice hired a care coordinator to work with the most complex kids within their practice. The coordinator needs to work with various pediatricians, social workers, nurses, community resources, and a range of specialists to provide the best care possible to the child and family. Once a month this team of healthcare professionals meets in person to discuss the plan and define responsibilities. At the end of the meeting the team disperses with few means to communicate, no way to understand what’s happening in real time, and little visibility into the process of care. Handoff drops are commonplace because no one understands if tasks are completed and require dependencies addressed. It’s only when the team reassembles that they fully understand what did or did not happen, and are able to reset the plan. Kristy Trask, an RN who manages involved cases like these recently stated, “As a care coordinator for kids with complex needs, I need tools to work across all the players supporting the family and child.” Healthcare needs better tools for patient management.
Outside of healthcare, it would be extremely rare for professionals to be without support by the appropriate information technology to manage projects as complex as a sick child. Yet, even in the 21st Century, most healthcare professionals do not have the project management and communication tools to handle a single patient – much less a portfolio of 3,000. Patients often choose their own doctors and specialists. Therefore, different care team members may not know each other, may not have worked together previously, or communicate with each other regularly if at all. In a true Team-based Care model, clinicians, staff, patients, and caregivers could have the ability to know who is on the team, everyone’s role and responsibilities, and interact with each other to move care forward.
Requirement 3: Know the Plan
In management consulting, the central responsibility of the Engagement Manager is to facilitate communication and ensure efficient project execution. In Team-based Care, communicating the plan – including coordinating key activities and identifying responsible owners – is a requirement. With patients moving between different healthcare organizations, communication and coordination presents as a significant obstacle. This is complicated by the fact that health information technology is complex, sensitive, and siloed with little opportunity for easy access and implementation.
Requirement 4: Patient-Centered and Patient-Involved
The core job-to-be-done of healthcare is to help individual patients get better and enjoy the best quality of life as they manage their health. The core job-to-be-done of Team-based Care is to keep the patient and their needs at the forefront. Teams must be mapped around a patient. There must be real-time accountability to the status of the patient’s health. Patients and caregivers should be given visibility to (1) know who is on their team (2) know what the plan is – in a way they can understand and (3) know the current state of play.
The Power of Team-based Care
Earlier this year my PCP retired after 18+ years of providing me with outstanding care. It was interesting to hear him describe how the regulatory, contracting, and technology changes underway in healthcare were contributing to his decision to hang up his white coat and stethoscope. So much of what’s being asked of physicians and nurses has little to do with why they pursued a career in healthcare. We need to reduce the complex demands placed on healthcare professionals and simplify how clinicians work to deliver on the job of healthcare. The adoption of Team-based Care represents a path to engage all patient stakeholders in a simple and more cost effective model of care.
