Monthly Archives: January 2014

Communities Fix Leakage

Medical homes and neighborhoods are becoming popular models for quality and cost-effective health care.  The concept is right on track.  A connected group of health care providers discussing cases, sharing information and working together for the best interest of the patient.  But not everyone gets it.

Recently an organization in the midst of creating a new health care integrated delivery system recognized that patients were being sent out of the system for referrals to specialists or testing.  Can’t ignore that this is a problem.  Their answer was to assign administrators to physicians to carry out daily interrogations.  Seriously!  No vision.  No thoughtfulness.  If these are the leaders charged with creating the strategy for the future there could be big trouble looming.  But what else would you expect?  It is the way of corporate medicine led by non-providers.  Band-aids and goon squads.  A short-term, rather than long-term, view of the bottom-line.

It’s easy to be critical.  But if criticism is genuinely intended to make a situation better an alternative must be offered.  Enter the concept of community.  Community can be defined in many different ways based on context.  But the most applicable here is that a community represents a group of unified individuals with shared values.   A community completes the home and neighborhood theme.

If the above mentioned integrated delivery system truly had visionary leadership they would have recognized that the fix for leakage is community building among the providers.  A referral from a physician to another physician for specialty services or to a site for testing is first and foremost based on trust.  In turn, trust is based on relationships.  A patient who has a bad experience with a referral holds the referring physician accountable even if they don’t vocalize their displeasure.  If a physician has had a good experience with a specialist why would they want to change and risk a bad experience for themselves and their patients?  How do you help them transition?  It’s not with daily interrogations.  The better way is to help them build relationships within the community of providers within the system.  It’s a process of an introduction followed by assimilation.

Community building.  Like culture this concept will make some nervous.  The most nervous will be the ones that think interrogation is the answer to leakage.  Communities, like culture, evolve and emerge.  Wouldn’t it be great if all of the physicians in an organization could meet even every week to discuss issues?  Yes it would but the reality is this can’t happen.  However, for the past 20 years technology has helped to form communities.  Could this be the better answer for leakage?  Not just a static web page for physicians but rather a site that allows for community building.  One that includes robust communication channels between physicians.  A site that includes forums where voices are heard.  A site that forms the foundation of collegiality and trust among the providers so that referrals can be made voluntarily and with confidence.

So the leakage problem is one of many that new health care entities need to address.  Some will bring out the rusty tools and grind.  Not a working brain in the bunch.  Others will sit and think before they act and listen to the voice of the soldier on the front line – the physician.  It should be obvious which approach is more likely to be successful in the long run.

A Service Industry

If you change how they think then you will change how they act.

In this case, “they” refers to physicians.  Many of the posts here at HCR have been critical of the cost, inefficiency and ineffectiveness of corporate health care and the non-providers who are in charge.  However, the most important posts at HCR are those that ask physicians to look in the mirror, reassess the state of the profession and take charge of reforming the system.

What is the best pathway to change and reform the activities and behaviors of a profession?  One can apply external positive and negative reinforcement to good and bad behaviors.  Alternatively, one can change the thinking that leads to behavior.  In other words, one can change the culture!!!  As mentioned in previous posts the concept of culture is at times difficult for the bottom line grinders to appreciate.  Difficult to define, measure and manage.  However, it is the unwavering belief of HCR that establishing a new culture for physicians and other providers is easier than it may seem and is the only pathway to meaningful change in the health care system that results in an improvement in quality and a reduction in cost.

Organizational culture has been defined in various ways by many management experts and anthropologists.  One of the common themes in the definitions of culture links thoughts to actions.  The thought components have been described as values, norms, and beliefs.  HCR is constructing a framework for health care culture that will define the important values and priorities for physicians and other providers.  At the same time HCR will develop the strategies necessary to allow the values and priorities to evolve into a culture with measurable improvements in quality and cost.

One of the most important values to establish in the health care system is that of service.  Health care is above all else a service industry.  Perhaps the most important service industry.  Health care needs to prioritize and value service above all else.  For physicians there is a service obligation to many but most importantly there is a service obligation to patients to provide evidence-based, humanistic and cost-effective health care.  Physicians also have a service obligation to their colleagues and other providers to be an effective part of a multidisciplinary team.  There is a service obligation for physicians to educate and mentor those in training and there is a service obligation to the general public to be productive citizens.

Service is one of the principle values/priorities on which HCR will create the successful cultural change in health care.  While others look to change behavior through process HCR will change behavior by changing the way physicians think.