Sunday, February 14, 2010

Replicating High-Quality Medical Care Organizations

Just as I posted my blog about this topic of understanding and replicating "the best places"... I read another article discussing it: "Replicating High-Quality Medical Care Organizations" by David Mechanic, PhD in the Feb 10th issue of JAMA.

Dr. Mechanic starts by proposing that there is strong interest in developing accountable care organizations (ACOs) that have the capacity to:
1. Monitor meaningfully patient needs and outcomes
2. Use performance indicators for assessment of physicians and other professionals
3. Implement new forms of reimbursement that result in improved quality while constraining increases in cost.

He notes the typical examples (Mayo, Kaiser, Cleveland Clinic, Geisinger) don't match well with the typical medical organization and thus pushes us to think about how other organizations can replicate the giants.

He proposes that even if reimbursement systems improve, there is still a need for a strong collaborative organizational culture which has 4 key elements:
1. Strong focus on mission
2. Strong Leadership
3. Good measures and feedback of results including clinical quality indicators
4. Tools for care coordination, operational system support, and an outstanding clinical information system.

More info on these key elements can be found in a 2008 Kaiser report entitled "Keys to Stronger Hospital/Physician Relationships: Culture and Incentives".

Then, Dr. Mechanic wisely points out that "Few organizations use pure payments types without modifications and additional incentives to encourage initiative, productivity, performance quality and loyalty to the organization. The distinction between how these organizations are reimbursed and how they pay their professionals is important".

He points out that "there is considerable agreement about essential tools, including development of information technology, electronic medical records, and system connectivity; better dissemination and use of evidence for making decisions; and improved clinical measures with continuing feedback to clinicians. Better organized teamwork, coordination and collaboration are also needed". Be he then adds that "Although financial and organizational coordination are important, the ultimate test is success in clinical integration, which is the most challenging of the changes needed".

He ends with the thought that "Innovative approaches to primary care are needed along with new ideas for how physicians and other primary care clinicians can be educated to work together effectively and to fill their roles in thoughtful and more satisfying ways". Amen to that.

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