Why hospital-physician relationships must allow form to follow function.
Hospital and physician relationships often get caught up in a sea of organizational acronyms – ACO, CIN, PCMH, MSO, PSA, PHO, etc., etc. This problem stems from the fact that too much time and effort is spent on the structural, rather than the functional, nature of these relationships. Hospital-physician partnerships should consider early on their basic function and then let form follow function rather than vice-versa.
Meaningful healthcare reform will require deep transformation of the healthcare delivery system. This transformation will need to occur at the bedside and exam room level. It will literally require the multiple processes now used to manage the most common clinical conditions seen in a hospital inpatient or outpatient care setting to be retooled or value reengineered.
This retooling of the care delivery system can best be done by those closest to the care process who have significant clinical experience, a familiarity with the evidence-based literature on best practices and a willingness to consider multiple perspectives, including that of the patient. The process design teams will also need to be supported by experts in modern-day process engineering, operations management, performance improvement and cost accounting.
Transforming care delivery will require changes within nearly every area of the organization, and this change will not come easily to those who are wedded to the status quo. Therefore, it cannot be overemphasized how important it will be for these care design teams to be fully supported at the highest level of hospital leadership.
Finally, those involved in this work must understand that the goal is not to work through a single change initiative and then stop. Instead, the goal will be to implement a system for continuous process improvement that is self-sustaining and value producing, (i.e., high quality of care delivered in a cost efficient manner, ad infinitum).
The benefits of setting such a system in motion will be significant to hospitals and physicians alike. Put another way, transforming care delivery in a way that consistently delivers value and self-adjusts when needed to maintain high quality outputs and low costs will be invaluable to those who invest in this very challenging undertaking. Some of these benefits include:
- The capability to successfully participate in a value based reimbursement environment where reliable quality production and knowledge of true costs will be of vital importance.
- Improved consumer satisfaction resulting in larger market shares of profitable service lines.
- Enhanced satisfaction among caregivers who have become demoralized working in a business model that incents volume production over all other activities.
- Greater understanding of the clinical care process itself with an ability to provide answers to the myriad questions that will never warrant study through a randomized controlled clinical trial.
- Better working relationships between hospitals and physicians, driven by achieving tangible rewards that will overcome the distrust now inherent in these associations.
Creating a system like this will be tedious, "roll up your sleeves" type work. Nevertheless, the work can and is being done by some of the most competitive healthcare systems in the world. The sooner hospitals everywhere bend to this task, the sooner true, long lasting healthcare reform will occur. Let's get started!
Ellis Knight, MD, serves as senior vice president of Coker Group will lead its hospital operations and strategic services service line. Prior to joining Coker, Dr. Knight served as chief physician and clinical integration officer for Palmetto Health in Columbia, S.C. He has more than 30 years of experience in healthcare, which include multiple administrative/management responsibilities such as oversight of hospital service lines, management and oversight of Palmetto Health’s provider employed network and interface with the University of South Carolina faculty and medical school initiatives. In 2011 he led the development of and continued oversight of the Palmetto Health Quality Collaborative. He graduated from Stanford University with a BA degree in human biology and received his medical degree from the University of Oregon Health Science Center's School of Medicine. He earned an MBA from the University of Massachusetts at Amherst.