This article appears in the October 2012 issue of HealthLeaders magazine.
With looming budget pressures and payment penalties, one would think most executives of high-performing organizations wouldn't eagerly share their "secret sauce" for better outcomes and lower costs, lest it give competitors an edge.
But from Los Angeles to Boston and from Michigan to Texas, that's exactly what's happening with a series of "collaboratories" designed to improve care for all patients, regardless of which health system provides their care. By being transparent about procedural sequences as well as results, all providers can learn what saves lives and lowers costs.
In American medicine today, "we just don't know what works best," says James Weinstein, DO, MS, president and CEO of Dartmouth-Hitchcock health system, a Lebanon, N.H.–based $1.3 billion organization that includes an academic medical center and a network of clinics.
Rather, he says, "In this country we've been flying the Healthcare Airlines with planes that have no instruments, no gas gauge, no flight attendant, and we don't know where we're going or what we're doing. And until we have transparency of results and share best practices among organizations to make all healthcare systems better, that's what we'll continue to fly."
How physicians and hospitals treat diseases and conditions—such as heart failure, joint malfunction, or sepsis—varies widely across systems and even within physician groups, depending on customs and cultures or how a region's physicians may have been taught, he says. For example, some orthopedic groups perform knee surgeries on both knees during the same operation, while others do so sequentially in different operations during the same hospitalization.
Which is best? Which is best for which patient?
Weinstein is a founding member of the national High Value Healthcare Collaborative, a partnership of 15 health systems across the country working to improve healthcare while lowering costs. He and Dartmouth-Hitchcock colleagues invited executives from the Cleveland Clinic, Denver Health, Intermountain Healthcare, and the Mayo Clinic to share and scrutinize each other's routines in nine procedures or diseases to see whose practices produced the best results.
Expensive knee replacement surgeries were studied first, in part because they are projected to grow seven-fold by 2030 when there will be 3.48 million procedures a year.
One system among them—Intermountain, a Salt lake City–based $4.7 billion system of 22 hospitals, physicians, clinics, and health plans—employed dedicated knee replacement teams in the operating room. That seemed to result in shorter lengths of stay and fewer patient complications. Now, others are adopting this practice in their systems.
When they looked at surgeon volume, it turned out that the more knees doctors replaced, the better their patients' outcomes, too.