In the summer of 2010, Tri-City Medical Center in Oceanside, Calif., opened the Cardiovascular Health Institute using a co-management structure. In this model, physicians and hospital administrators had an equal stake in the institute and equal representation on the board of managers. Donald Dawkins, RN, MBA, vice president of strategic integration at Tri-City Medical Center and secretary of CVHI's board of managers, describes how the co-management structure has benefited the institute in quality of care and cost-efficiency.
Board of managers includes "big hitters"
CVHI's board of managers consists of four members of the executive team — including the CEO, COO and chief nursing executive in addition to Mr. Dawkins — and four cardiovascular physician champions, including cardiothoracic surgery, cardiology, interventional radiology and vascular surgery. This team meets regularly to discuss priorities and goals for the institute. "With these big hitters at the table, we are able to identify key initiatives requiring our attention during the upcoming year," Mr. Dawkins says.
While coordinating schedules to bring these leaders together regularly was a challenge, both sides recognized a need for a collaborative approach to quality cardiovascular care, according to Mr. Dawkins. The hospital also created medical directorships to compensate physicians for focusing on quality. Physicians are paid hourly for taking time to meet with administrators and plan quality improvement strategies.
In addition, CVHI based decisions on data, which helped build trust between the physicians and administrators. "If you can't track [data] and report out information in a way that's meaningful to physicians, they're not going to believe it," Mr. Dawkins says. "Trust is one of the big issues between physicians and hospital administrators, and we worked tirelessly to enhance that relationship."
Quality and operations workgroups
To support the initiatives identified as important by the board of managers, CVHI established workgroups on quality and operations that address specific metrics. For example, metrics on heart attack care included ensuring a follow-up appointment for discharged patients and giving patients beta-blockers. The workgroups are comprised of clinical staff, including physicians, nurse practitioners and clinical care coordinators.
Communicating with local physicians
While the co-management agreement connected the hospital's physicians with administrators, the hospital also wanted to maintain a strong relationship with community physician partners. "We wanted to make sure our physicians in the community — primary care physicians — would not view this environment as a threat to their practice. We made sure there was communication to let them know our goal is to get the patients to [them]," Mr. Dawkins says. For example, the hospital regularly distributed printed material about the program to primary care physicians in the community. In addition, business development managers regularly met with physicians in the community to share updates on CVHI.
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Board of managers includes "big hitters"
CVHI's board of managers consists of four members of the executive team — including the CEO, COO and chief nursing executive in addition to Mr. Dawkins — and four cardiovascular physician champions, including cardiothoracic surgery, cardiology, interventional radiology and vascular surgery. This team meets regularly to discuss priorities and goals for the institute. "With these big hitters at the table, we are able to identify key initiatives requiring our attention during the upcoming year," Mr. Dawkins says.
While coordinating schedules to bring these leaders together regularly was a challenge, both sides recognized a need for a collaborative approach to quality cardiovascular care, according to Mr. Dawkins. The hospital also created medical directorships to compensate physicians for focusing on quality. Physicians are paid hourly for taking time to meet with administrators and plan quality improvement strategies.
In addition, CVHI based decisions on data, which helped build trust between the physicians and administrators. "If you can't track [data] and report out information in a way that's meaningful to physicians, they're not going to believe it," Mr. Dawkins says. "Trust is one of the big issues between physicians and hospital administrators, and we worked tirelessly to enhance that relationship."
Quality and operations workgroups
To support the initiatives identified as important by the board of managers, CVHI established workgroups on quality and operations that address specific metrics. For example, metrics on heart attack care included ensuring a follow-up appointment for discharged patients and giving patients beta-blockers. The workgroups are comprised of clinical staff, including physicians, nurse practitioners and clinical care coordinators.
Communicating with local physicians
While the co-management agreement connected the hospital's physicians with administrators, the hospital also wanted to maintain a strong relationship with community physician partners. "We wanted to make sure our physicians in the community — primary care physicians — would not view this environment as a threat to their practice. We made sure there was communication to let them know our goal is to get the patients to [them]," Mr. Dawkins says. For example, the hospital regularly distributed printed material about the program to primary care physicians in the community. In addition, business development managers regularly met with physicians in the community to share updates on CVHI.
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