Policy reform is only the beginning in healthcare transformation, according to a perspective penned by Richard M.J. Bohmer for The New England Journal of Medicine.
Reform often spurs top-down restructuring — merged or divided services, new roles and responsibilities — but it cannot guarantee change on an individual level, according to Dr. Bohmer. Instead, true transformation requires minute changes over long periods of time, made by multidisciplinary teams. "In practice, healthcare transformation is a long series of local experiments," Dr. Bohmer wrote.
For hospitals and health systems to make these local changes in a systematic, efficient manner, Dr. Bohmer recommended the following seven organizational elements to support team-based redesign.
1. Concurrent deployment of redesign teams. These teams may be permanent for long-term oversight or created transiently to address key processes, according to Dr. Bohmer.
2. Clinical representation. Redesign teams should be led by clinicians and managers. The most successful transformers create their own leadership programs to empower clinicians to lead teams.
3. Routinized process for change. It is not important which model of transformation an organization uses, whether its Six Sigma, Lean Management or Continuous Improvement. Rather, what matters is that an organization is consistent and repetitive in the model of change it uses so local teams can lead efforts in a standardized way.
4. Internal support resources. These include resources for design, project management, data analysis, financial analysis and organizational development.
5. Well-developed measurement systems. While data collection and analytics will improve over time, successful transformers maximize the information they have now, Dr. Bohmer wrote.
6. Senior oversight. This group oversees team creation, goal-setting, progress monitoring, addressing barriers to change and team integration. It is part of a broader governance structure, according to Dr. Bohmer.
7. Set of unified values and norms. These standards can help guide and align staff when unforeseen challenges arise.
"The short-term investments that are required can be surprisingly small, because most organizations already have many of the requisite human assets," Dr. Bohmer wrote. "The most substantial hurdle, it seems, is the change in mindset."
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