Quality: Toward Unity

Janice Simmons, for HealthLeaders Magazine , August 12, 2009
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Hospital and physician strategic alignment will develop under healthcare and payment reform.

Despite some support for the idea of alignment, hospital and physician groups tend to focus on their own independent interests. But with changes afoot in Congress and in the payment landscape—such as bundling of medical services and insurers paying for quality care—that could be changing.

Hospitals and physicians for the most part could practice separately in the past because there "was an infinite amount of money in the system," said Joane Goodroe, who heads Goodroe Healthcare Solutions and is senior vice president at its parent company, Irving, TX-based VHA, a national healthcare network that focuses on supply chain management. "Hospitals could drive quality in one way and physicians could drive it in another."

And in the process, hospitals and physicians defined quality in different ways, said Goodroe, who specializes in gainsharing solutions. Physicians would look at quality based on what they or their group did—for instance, whether a patient got the right medication on time. Meanwhile, the hospitals would focus on whether their statistics "looked good"—and not on the individual patient.

"What you see now is more specificity in how quality is being measured. And you also see more recognition that physicians are the drivers of quality and the cost side . . . and for the future, that's going to require hospital-physician alignment," she said.

But some organizations have already moved ahead to this concept of alignment. At the 280-licensed bed Poudre Valley Hospital in Fort Collins, CO, and 136-licensed bed Medical Center of the Rockies in Loveland, CO, the history of the hospital-physician alignment started in 1995. But it wasn't until recently that "we've just started to include our physicians in much more of the strategic planning of the organization," said Rulon Stacey, PhD, president and CEO of the parent organization, Poudre Valley Health System, which received a Baldrige National Quality Award in 2008.

"It used to be that we would try and keep the physicians informed of what we were doing, but it became apparent that we just weren't as good as we needed to be—and truly engaging them in the decisions that we were making," Stacey said. "Now we're using them in creation of our plans going forward."

Currently, Poudre Valley is focusing on clinical integration among its hospitals and other facilities. Strategic planning meetings are being held quarterly in which all physicians are invited. "We think that's going to be crucial in the next phase of healthcare reform—that organizations that are integrated clinically will have a strategic advantage over those that are not," Stacey said.

"We're trying to ensure that we bring physicians into the mix. If they are not our employees, we pay them to be there because it's crucial for us to have that input," he added. "We can't move forward without them."

Working together on a quality agenda
Another type of relationship is a physician specialty group working in conjunction with a hospital. Minneapolis Heart Institute (MHI), with about 60 physicians, has been working with the 633-staffed-bed Abbott Northwestern Hospital (part of the Allina Health System) for 15 years.

"The way we've described ourselves is we're physician-led and professionally managed in terms of how our division works," said Christine Bent, COO of MHI, which served 70,000 patients last year.

At the beginning of each year, goals are aligned using a type of report card, Bent said. "I think it really helps advance our quality agenda when we're all on the same page."

The report card includes categories such as achieving exceptional patient care that is safe, patient-centered, effective and efficient; service reflected through patient satisfaction; people in terms of retaining employees and individuals who put people first; financial health in relation to employees helping the parent company grow; and growth in terms establishing successful relationships with providers that integrate care (and drive growth).

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