Becoming the Change Agent Your Healthcare System Needs

Change Agent in Healthcare Becoming an agent of change in healthcare is not easy. Over the past decade, it has been my good fortune to encounter many clinicians and healthcare operational leaders across the U.S. In these encounters, two trends have become apparent. First, many of the discussions are increasingly dominated by a common theme — tight budgets and cost cutting. Second, it has been troubling to see many clinicians who represent some of the smartest, best-trained, highly motivated, and passionate people I have ever met becoming progressively cynical and disengaged, distancing themselves from important healthcare reform debates.

No doubt there is a need to control costs. But in this focus on cost cutting, are we forgetting the patient? Many countries are struggling with healthcare costs. Healthcare costs are a major part of the national budgets for most industrialized countries, and costs do need to be managed more effectively. Based on this need, it is not surprising that many national reforms are focused on controlling the growth of healthcare costs. The United States is no exception to this trend.

Healthcare Quality and Safety Issues

At the same time, healthcare also faces many quality and safety issues. These issues are as equally important to patients as the cost of healthcare. In healthcare, the agents of change are the clinicians who provide patient care. One thing clinicians really care about is the quality of care they deliver to the patients they serve. Like many other professionals, clinicians tend to be competitive. They want to believe they are exceeding the standards for performance, and they think they are committed to continuously improving. Yet, while clinicians really want to believe they are the best, most do not really know if this is true. Clinicians often lack the ability to actually measure the quality of care their patients receive or the outcomes they achieve. As a result, they don’t always know what is best for the patient, nor can they learn because they don’t have quality and outcomes data.

A growing number of clinicians is discovering that debating proven practices and choosing the most successful practices based on data is enhancing professional experience and patient outcomes. Continuous improvement can be rewarding and fun, and it is certainly in line with professional values. But this requires data and a willingness to discover the tested practices that work best. When clinicians work together, they can agree on what quality is and start measuring their performance. They can share and debate the data and identify what works best. In the process, everyone can learn from the experience. This is continuous improvement

Using data and analysis to drive continuous improvement is exciting, but there’s even more good news. If you look at the cost side of the equation, it turns out that those who focus on quality frequently have the lowest costs. Published studies based on Dr. Jack Wennberg’s data indicate that if all U.S. healthcare providers operated at the same level as the top 10 percent of performers, it would vastly improve care and lower Medicare costs by about 20 percent.  Furthermore, the quality of U.S. healthcare for many diseases is actually below the average of other countries based on data from the international association Organization for Economic Co-operation and Development (OECD). If the U.S. healthcare system would focus more on measuring quality and strive to raise quality just to the level of the average OECD data, it would improve care and save the American people $500 billion a year. That represents approximately 20 percent of the annual U.S. healthcare budget.

Most clinicians would agree that these numbers are logical and the potential for savings is exciting, but are they possible to achieve? In order to achieve these savings, a shift towards measuring value in healthcare — that is, not only costs but also the optimized clinical outcomes that actually matter to patients — needs to occur.

Clinician Groups for Change in Healthcare

This is not just a nice idea. It is actually happening. Groups of innovative clinicians are already forming, identifying evidence-based care practices, measuring outcomes, and continuously improving care for the patients they serve. In the process, these clinicians are asking a number of key questions: What is quality? What should we measure? How can we achieve the best outcomes? How can we continuously improve? Disease by disease, they are attacking the medical conditions that afflict humanity, and in the process they are improving the value of care being delivered to patients.

Based on personal experience, I can tell you that every time a group of clinicians embarks on this quest, there is enormous energy in the room. This is because the reform debate has suddenly shifted to what matters most to both clinicians and patients: the value of care that patients are receiving. The future will mandate that healthcare organizations are managed based on what matters to patients, the quality of care they receive. In the process, we can — and will — manage costs.

By measuring value in healthcare we will understand that clinicians are generally not the problem. Instead, they are an important part of the solution. Measuring value in healthcare will bring about a revolution. This will make Sir William Osler and the other great clinical innovators who revolutionized healthcare a century ago smile in their graves

In the future, all healthcare delivery organizations will need to transform themselves in order to meet the quality, safety and cost challenges confronting healthcare. In this process, they will need to implement value and clinician engagement strategies that allow them to optimize clinical outcomes and provide care as efficiently as possible.

What have you seen work well when effecting change in healthcare? What hasn’t?

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