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.

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