Posts Tagged ‘fee-for-service’

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ECRI Conference Notes: Creating and Replicating ‘Systemness’ within Health Care Delivery

December 5, 2012

By Joyce Pulcini, PhD, RN, FAAN, Policy and Politics contributing editor, AJN

The ECRI Institute’s 19th annual conference (November 28–29) looked at system-level innovation and quality in the health care system. It brought together experts from many fields, including medicine, nursing, hospital or health system administration, informatics, health care quality, policy makers, journalists, and academics. ECRI Institute is an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care. The goals of the conference were to address the following:

  1. What is “systemness”?
  2. Which elements within mature health care systems result in the best clinical outcomes?
  3. Are approaches taken by long-established systems transferable to smaller, newer, or less integrated systems?
  4. Are financial incentives enough to drive change?
  5. How can electronic health records (EHRs) help improve “systemness”?
  6. Do transformation units within health care systems produce results?

The conference essentially tried to attack in a creative way the issues around the creation of systems that function optimally. Truly changing culture and providing optimal care delivery should always result in putting the patient at the center of care. The conversation was open and the conference succeeded in fostering important dialogue among the speakers and the audience.  A major focus was on creating systems, looking at technological or financial solutions, and measuring outcomes.

The session on team care (“Creating teams to improve inter- and intra-health care systems: Does evidence show a benefit?”)  highlighted the vexing issues around how to truly foster optimal teams. Lisa Schilling, RN, MPH, VP National HC Performance Improvement, Director, Center for Health Care Systems Performance, was one of the speakers. She started in her role in 2008 and by 2010 published the results of her efforts, which led to a 30-day readmission rate after hospitalization reduction of 9% (Schilling et al, 2010) and a dramatic reduction of mortality from severe sepsis, which saved 1,100 lives. The solution, she says, was to focus on culture, with leaders and teams working together from the ground up to create learning organizations with clearly measured outcomes. She emphasized that while leaders manage variation, change culture, and manage team-based improvement, change begins at the front lines and alignment in health systems is a key factor in systemness.

Patient perspective. Another speaker, Jesse Gruman, a patient and consumer advocate, asked some heartfelt questions about who teams benefit. She answered quite honestly that patients do not really understand how teams will benefit them. Patients want to have a relationship with their “doctors,” not with teams. They are not really interested in being the leader of the teams either, as some of the rhetoric suggests. When they are sick, patients need people who can help them get better and the patient cannot lead this aspect of care.

She challenged us to think about what happens when teams do not work together well. She was concerned about the large “cast of characters” patients must often face while hospitalized. One solution, which was proposed by Children’s Hospital Boston, was a patient app called “My Passport App,” which had pictures of staff who were on their team (as an alternative to the old whiteboard solution). Family as well as patients could see who was on the care team, know what to do at home, and actually see their own plan of care.

Who really benefits from teams? One speaker asked who teams really benefit. In the end, the perception of the value of teams did not always reach the consumer. If the patient does not see the value of team care, we have a long way to go if this concept is to succeed. Patients should not have to receive the mixed messages and experience the poor communication often inherent in modern health care. Read the rest of this entry ?

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‘Who Do You Trust?’ asks ANA President Patton in White House Video

December 1, 2009

As the Senate debates health care reform legislation, lobbyists across the political spectrum are busy trying to make themselves heard both by legislators and the American public. In an attempt to blunt the impact of the numerous campaigns aimed at killing or gutting the legislation, the White House has released a video called “Who Do You Trust?”, in which Rebecca Patton, president of the American Nurses Association (ANA), appears with Joe Biden and Lori Heim, president of the American Academy of Family Physicians.

But questions do remain. Despite the obvious need for many of the insurance reforms proposed in the plan, the Democrats have yet to fully address the question of how this will be paid for by real changes in the delivery of care or real limits on the influence of pharmaceutical companies or medical device manufacturers.

How, for example, can cost controls ever occur in a system dominated by a fee-for-service model in which physicians’ income is often directly related to the numbers of tests and procedures they recommend, one in which they are rarely bound or directed by evidence-based guidelines or protocols? Would physicians’ organizations like the one represented in the White House video ever support a plan in which most physicians were, like most nurses, on salary? Why is that unthinkable?

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