Healthcare reform, coupled with reimbursement cuts and the economic recession, has put many hospitals and health systems in a bind with no clear road to future success. Many of the actions hospitals and health systems have traditionally taken to save money — such as downsizing staff, reducing the cost of supplies and freezing capital — are coming up short.
"[It] will not be enough to replace the lost margins that hospitals are experiencing," says Andrew Agwunobi, MD, director of the Hospital Performance Improvement practice at Berkeley Research Group. "The old tools we used are not going to be enough. That's where clinical redesign comes in."
According to Dr. Agwunobi, clinical redesign involves several steps, including reducing clinical variation and potentially avoidable complications through implementing physician-led best practices while improving care models.
1. Physician leadership. Though all of the key elements are important to a successful clinical redesign, Dr. Agwunobi stresses this one as the most important. "Clinical redesign is about true physician leadership of the change process," he says. That does not mean administrators should simply get input from physicians or inform them of change. Instead, the physicians should be involved in every step of the clinical redesign. "Actually have them at the table as leaders with the administration," he says.
2. Data. Clinical redesign needs to be a data-rich process to facilitate physician buy in. Asking physicians to change how they practice medicine can be a difficult conversation if the reasoning is not based in data, and according to Dr. Agwunobi, hospital administrators need to go more in depth with physicians than they have in the past. "Look at data in extreme granularity," he says. For example, data should be adjusted for severity and include patient-refined DRGs. That way, physicians have more trust in the data and are less likely to challenge suggestions made based on the presented data.
3. Focus on quality improvement. While reducing costs is often a major reason hospitals pursue clinical redesign, it is also important to root the clinical redesign effort in quality improvement. There are two main reasons a quality improvement initiative is essential to clinical redesign, according to Dr. Agwunobi. First, a focus on quality better ties into the goals of healthcare reform and the triple aim, which includes cutting costs as well as improving care quality and outcomes. Second, physicians are more likely to buy in to a redesign with a quality aspect as opposed to a purely financially driven initiative. "If it just reduces costs, physicians interpret that as boosting the hospital's bottom line. But by simultaneously improving quality, physicians are interested in that," he says.
4. Integrate traditional performance improvement. Traditional approaches hospitals have taken to improve clinical performance, such as labor productivity, staffing levels and supply costs, need to be a part of the clinical redesign process, says Dr. Agwunobi. For example, part of a clinical redesign may decrease patient length of stay in a unit, such as the intensive care unit. "Then you have to change the staffing levels in the ICU to make it more efficient," he explains.
Clinical redesign can be challenging, as it relies on a partnership between physicians and hospitals, two parties that have not traditionally had constructive relationships. However, it is a better way for hospitals and health systems to effectively approach healthcare reform, the triple aim and the numerous other changes happening in the industry.
"[It] will not be enough to replace the lost margins that hospitals are experiencing," says Andrew Agwunobi, MD, director of the Hospital Performance Improvement practice at Berkeley Research Group. "The old tools we used are not going to be enough. That's where clinical redesign comes in."
According to Dr. Agwunobi, clinical redesign involves several steps, including reducing clinical variation and potentially avoidable complications through implementing physician-led best practices while improving care models.
Clinical redesign essentials
All of the clinical redesign steps require engaged physicians working with hospital administrators to transform the organization for the future. To achieve clinical redesign, hospitals need to have the following four key essentials, according to Dr. Agwunobi.1. Physician leadership. Though all of the key elements are important to a successful clinical redesign, Dr. Agwunobi stresses this one as the most important. "Clinical redesign is about true physician leadership of the change process," he says. That does not mean administrators should simply get input from physicians or inform them of change. Instead, the physicians should be involved in every step of the clinical redesign. "Actually have them at the table as leaders with the administration," he says.
2. Data. Clinical redesign needs to be a data-rich process to facilitate physician buy in. Asking physicians to change how they practice medicine can be a difficult conversation if the reasoning is not based in data, and according to Dr. Agwunobi, hospital administrators need to go more in depth with physicians than they have in the past. "Look at data in extreme granularity," he says. For example, data should be adjusted for severity and include patient-refined DRGs. That way, physicians have more trust in the data and are less likely to challenge suggestions made based on the presented data.
3. Focus on quality improvement. While reducing costs is often a major reason hospitals pursue clinical redesign, it is also important to root the clinical redesign effort in quality improvement. There are two main reasons a quality improvement initiative is essential to clinical redesign, according to Dr. Agwunobi. First, a focus on quality better ties into the goals of healthcare reform and the triple aim, which includes cutting costs as well as improving care quality and outcomes. Second, physicians are more likely to buy in to a redesign with a quality aspect as opposed to a purely financially driven initiative. "If it just reduces costs, physicians interpret that as boosting the hospital's bottom line. But by simultaneously improving quality, physicians are interested in that," he says.
4. Integrate traditional performance improvement. Traditional approaches hospitals have taken to improve clinical performance, such as labor productivity, staffing levels and supply costs, need to be a part of the clinical redesign process, says Dr. Agwunobi. For example, part of a clinical redesign may decrease patient length of stay in a unit, such as the intensive care unit. "Then you have to change the staffing levels in the ICU to make it more efficient," he explains.
Clinical redesign can be challenging, as it relies on a partnership between physicians and hospitals, two parties that have not traditionally had constructive relationships. However, it is a better way for hospitals and health systems to effectively approach healthcare reform, the triple aim and the numerous other changes happening in the industry.