"The trend is very clear that the major payer, CMS, will report hospital outcomes, and that's a prelude to reporting individual physician outcomes on the Internet," he says. "Hospital Compare will lead to Doctor Compare."
In assigning physician leaders, says Stadnyk, Banner seeks a physician who has a knowledge and passion for a particular initiative and matches that person with a nonphysician leader.
In the bigger picture, Stadnyk says, physicians have started to understand—and believe—that working toward clinical and financial targets will lead to more efficient and less harmful ways to treat the patients they see. That's been the big hurdle to overcome, winning hearts and minds. The rest of the journey, he says, is just hard work.
"We are trying to move more to a model where we have timely data that is provided to all leaders, not just physicians," he says. "We've spent a lot of time explaining to them that the data will not be perfect unless they help us perfect it. One of the tragedies in healthcare is we've been reluctant to be measured."
Blending the clinical and financial
If measurement is key, grouping clinical services into the appropriate leadership groups is just as essential, says William Cors, MD, vice president and chief quality medical officer for 210-staffed-bed Pocono Health System in East Stroudsburg, Pa.
"We're taking major clinical services, grouping them together in a logical sense, and doing exactly the dyad model in cardio, cancer, surgery, medicine, and women's and children's," he says.
The main difficulty in changing the way hospitals and health systems do business, however, is combining the inpatient and outpatient pieces of the business when the hospital itself traditionally has focused only on inpatient care, and has an underlying traditional medical staff model that physicians are extremely leery of recasting.
"In order to make this work, you have to roll in not only the inpatient pieces, but the outpatient continuum, the medical home, and the relationship with other providers," he says. "The problem is that in most places, you have an underlying traditional medical staff model and the hospital itself is organized by departments, but it doesn't make sense anymore."
Cors says the trick is instituting clinical service lines and running them almost independently of the medical staff. That way, the old medical staff model can be complementary, and the transition will be less jarring.