The rate of change in healthcare and the rules for Medicare reimbursements seem to occur even more fast and furious from month to month – or even week to week or day to day, it seems.
It’s true that healthcare is steaming full speed ahead towards value-based care, when physicians and health systems are paid – and either rewarded or penalized – based on the quality of care, not just the amount of care they provide. Meanwhile, many of the systems that have been in place for decades to guide the business of healthcare have not changed much.
But they will.
Rather than get run down or overwhelmed by the break-neck pace of change leading to value-based care, it’s advisable to step back for a moment to review some crucial steps for not only arriving at the VBC destination but to stay ahead of the rapid changes. Here are five keys to changing and adopting a new healthcare culture.
1. Building a culture centered on quality improvement and patient-centered care is not a single event or an immediate step. It’s a process.
Changing an internal structure is a pivotal step for any efforts in improvement, whether for patient safety or cybersecurity or quality. At the risk of overusing some tired clichés, there’s a lot of truth and clarity to following this tried and true adage: Plan your work and work your plan.
A plan to transform physician practices and health systems is both possible and doable if it is clear, goal-oriented and involves a team.
2. Patient engagement is crucial for this transformation and culture change.
Physicians are going to more responsible for managing population health – not just individual patients – but that starts with the patient experience, making well care visits and preventative screenings a part of the overall plan, and becoming health literacy advocates.
Take this a step further by not only understanding but advocating for patients – and their families – to be core members of the care team. Physicians need the most and best information possible to diagnose and treat an illness. By the same token, patients and their families need the most and best information possible to make decisions about treatment or for dealing with a chronic condition.
3. Care coordination must move from theory to practice.
This step happens in conjunction with patient engagement. The healthcare journey has multiple, potential stops: behavioral and mental health; specialists; primary care; community supports and rehab facilities; hospital and pharmacy; and patient and family.
Through our work as a subcontractor for TMF Quality Innovation Network-Quality Improvement Organization (QIN-QIO), we’ve seen this illustrated multiple times through our work with community diabetes education and a diabetes self-management program. In the past, a physician might send a patient to a podiatrist for a foot exam or to an endocrinologist for more thorough analysis of blood glucose readings. But there might not be much follow up if any to be sure that, first, the exam happened and second, that the results were shared with each provider involved in the patient’s care.
But care coordination is now an integral function of quality improvement aimed at reducing avoidable readmissions and unnecessary hospitalizations. Those costly consequences will now have a direct impact on the physician and hospital reimbursement.
4. Implement change from the top down, not expecting a bottom-up culture shift.
Chris DeRienzo, M.D. chief quality officer at Mission Health, wote in an NEJM Catalyst blog post that creating a culture of quality improvement is best accomplished when there’s not just “buy in” from staff but from giving some of the responsibility for quality improvement to clinical staff and other stakeholders. When clinicians and other staff are on board, improvements are more likely to succeed.
In the same vein, seek, create and nurture strong partnerships and bonds with other leaders across the system, including physicians, human resources and information technology.
“No matter what your title is, you can’t do this alone,” DeRienzo wrote. “These tasks are impossible to accomplish without widely patent arteries of communication. It is critical to ground population health management on the principles of open communication and alignment across entity and executive lines.
5. Data is important, but collecting measurements that are accurate and actionable is the ultimate goal.
How are you using it to actually improve patient health? In simple terms, the quality data picture isn’t just about data mining, but about data using.
Having reliable data for reporting and quality improvement is becoming more essential as the healthcare industry moves deeper into value-based care. Therefore, healthcare organizations need to treat data abstraction as a necessary step in the quality improvement process and assign dedicated staff to handle abstraction. That could mean creating an internal team of individuals who are primarily responsible for working with data or, for some organizations, it might mean outsourcing that work.
Finally, quality improvement isn’t a plan to put on paper. It’s a commitment to ongoing performance and quality review. Healthcare transformation is cultural, organizational and personal transformation.